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Renal Failure

An estimated 400,000 Americans are now being treated with dialysis for chronic kidney failure, and many more develop chronic kidney disease each year.  Many people don't realize that they have chronic kidney failure until their kidney function has decreased to less than 25 percent of normal, says Robert S. Brown, M.D., a Beth Israel Deaconess Medical Center nephrologist who oversees the hemodialysis program at Hebrew Rehabilitation Center's Medical Acute Care Unit. 

Definition

Long-term (over three months) dysfunction of the kidneys in which waste products build up in the blood and extra fluid may be retained in the body. 

Causes

  • Chronic illnesses that may affect the kidneys, such as diabetes and hypertension
  • Inflammation of the kidneys, such as chronic glomerulonephritis
  • Hereditary or congenital diseases (polycystic kidneys, hereditary nephritis, obstructive or reflux kidney disease)
  • Unrecovered acute kidney failure (from infection, vascular shock, or toxins)
  • Renal artery stenosis

Symptoms

  • High blood pressure
  • Unexplained weight loss or weight gain from swelling
  • Unexplained anemia
  • Nausea or vomiting
  • General sense of fatigue or discomfort (malaise)
  • Headaches
  • Excessive bleeding, such as bloody or tarry stools
  • Yellowish tint to skin
  • Persistent, generalized itching

Risk Factors

  • Diabetes
  • Hypertension
  • Obesity
  • Atherosclerosis
  • Lupus
  • Overexposure to toxins or some medications or herbal remedies
  • Sickle cell anemia

Diagnosis

  • Microalbuminuria test for early kidney disease
  • Urinalysis
  • Blood tests for increased waste products (creatinine, BUN)
  • Radiologic tests--ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI)
  • Kidney biopsy

Prevention and Treatment

  • Treatment of underlying conditions, such as diabetes and hypertension
  • Proper diet (limited protein and salt intake)
  • Medications to decrease protein in the urine, which may slow progression
  • Avoidance of nonsteroidal anti-inflammatory drugs and contrast dyes used in certain X-rays
  • Specific medical treatment for certain inflammatory conditions of the kidneys
  • Hemodialysis
  • Peritoneal dialysis
  • Kidney transplant

Glossary

Anemia -  the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood.

Atherosclerosis - a condition in which fatty material is deposited on the walls of arteries that thickens and eventually blocks the arteries.

BUN - for blood urea nitrogen, a breakdown product of protein metabolism; high levels of urea, which is secreted by the liver and removed from the blood by the kidneys, are a result of decreased excretion when the kidneys fail to function properly.

Computerized tomography scan - a noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body, showing detailed images of bone, muscle, fat and organs.

Chronic glomerulonephritis - a chronic inflammation of membrane tissue in the filtering structures of the kidneys that separate wastes and extra fluid from blood.

Creatinine - a breakdown of creatine, which is an important part of muscle; if kidney filtering is deficient, blood levels of creatinine rise, which is used as a marker of decreased kidney function.

Diabetes - a disease characterized by high blood sugar levels, which result from defects in insulin secretion or action, or both.

Hemodialysis - a medical procedure that uses a special machine to filter waste products from blood.

Hereditary nephritis - a familial disease characterized slow scarring of the kidneys and which is usually accompanied by the presence of protein and either microscopic or visible blood in the urine.

Hypertension - a medical condition in which blood pressure (the force applied to the walls of arteries as the heart pumps blood through the body) is consistently higher than 135-140 over 90.

Kidney biopsy - removal of a small sample of kidney by needle for microscopic testing.

Lupus - a chronic inflammatory condition caused by an autoimmune disease that can affect the skin, heart, lungs, kidneys, joints, and the nervous system.

Magnetic resonance imaging - a diagnostic procedure that uses a combination of large magnets, radiofrequencies and computers to produce detailed images of organs and structures in the body.

Microalbuminuria test - a test to determine a subtle increase in the urinary excretion of the protein albumin.

Nonsteroidal anti-inflammatory drugs - commonly prescribed drugs to treat arthritis and inflammation of tissues.

Obstructive or reflux kidney disease - a condition in which urine in the bladder passes up to the ureter to the kidneys instead of out through the urethra during the process of urination.

Peritoneal dialysis- a technique that uses a patient's own body tissues in the abdomen to act as a filter to remove waste from blood.

Polycystic kidneys - a genetic disorder in which clusters of cysts (noncancerous sacs of water-like fluid) develop primarily within the kidneys, causing slow loss of kidney function with aging.

Renal artery stenosis - narrowing of the major artery that supplies blood to the kidneys.

Sickle cell anemia - a genetic blood disorder due to the presence of an abnormal form of hemoglobin.

Unrecovered acute kidney failure - when the kidneys fail and shut down suddenly from conditions that cause circulatory failure, such as severe bleeding, very low blood pressure (vascular shock), serious heart problems, generalized infections (sepsis), or toxins; such episodes of acute kidney failure often recover, but may not, leading to chronic kidney failure.

Links

National Kidney Foundation: www.kidney.org
National Institute of Diabetes & Digestive & Kidney Diseases: www2.niddk.nih.gov
American Association of Kidney Patients: www.aakp.org

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