Chronic Kidney Failure Health Article

Definition

Chronic kidney failure occurs when disease or dis- order damages the kidneys so that they can no longer adequately remove fluids and wastes from the body or maintain proper levels of kidney-regulated chemicals in the bloodstream.

Description

Chronic kidney failure, also known as chronic renal failure, affects over 250,000 Americans annually. It may be caused by a number of diseases and inherited disorders, but the progression (end result) of chronic kidney failure is always the same. The kidneys, which serve as the body's natural filtration system, gradually lose their ability to remove fluids and waste products (urea) from the bloodstream. They also fail to regulate certain chemicals in the bloodstream and allow protein to leak into the urine. Chronic kidney failure is irreversible and eventually leads to total kidney failure, known as end-stage renal disease (ESRD). Without treatment and intervention to remove wastes and fluids from the bloodstream, ESRD is inevitably fatal.

Causes and symptoms

Kidney failure is caused by acquired disease or hereditary disorders in the kidneys. The four most common causes of chronic kidney failure include:

• Diabetes. Diabetes mellitus (DM), both insulin dependant (IDDM) and non-insulin dependant (NIDDM), occurs when the body cannot produce and/or use insulin, the hormone necessary for the body to process glucose. Long-term diabetes may cause the glomeruli, the filtering units located in the nephrons of the kidneys, to gradually lose function.
• Hypertension. High blood pressure is both a cause and a result of kidney failure. The kidneys can become stressed and ultimately sustain permanent damage from blood pushing through them at excessive pressures over long periods of time.
• Glomerulonephritis. Glomerulonephritis is an inflammation of the glomeruli, or filtering units of the kidney. Certain types of glomerulonephritis are treatable, and may only cause a temporary disruption of kidney functioning.
• Polycystic kidney disease. Polycystic kidney disease is an inherited disorder that causes cysts to form in the kidneys. These cysts impair the regular functioning of the kidney.

Less common causes of chronic kidney failure include kidney cancer, obstructions such as kidney stones, pyelonephritis, reflux nephropathy, systemic lupus erythematosus, amyloidosis, sickle cell anemia, Alport syndrome, and oxalosis.

Initially, symptoms of chronic kidney failure develop slowly. Even individuals with mild to moderate kidney failure may have few symptoms in spite of increased urea in their blood. Among signs and symptoms that may be present at this point are frequent urination during the night and high blood pressure.

Most symptoms of chronic kidney failure are not apparent until kidney disease has progressed significant- ly. Common symptoms include:

• Anemia. The kidneys are responsible for the production of erythropoietin (EPO), a hormone that stimulates red cell production. If kidney disease causes shrinking of the kidney, this red cell production is hampered.
• Bad breath or a bad taste in mouth. Urea in the saliva may cause an ammonia-like taste in the mouth.
• Bone and joint problems. The kidneys produce vitamin D, which aids in the absorption of calcium and keeps bones strong. In patients with kidney failure, bones may become brittle, and in children, normal growth may be stunted. Joint pain may also occur as a result of unchecked phosphate levels in the blood.
• Edema. Puffiness or swelling around the eyes and legs.
• Frequent urination.
• Foamy or bloody urine. Protein in the urine may cause it to foam significantly. Blood in the urine may indicate bleeding from diseased or obstructed kidneys, bladder, or ureters.
• Headaches. High blood pressure may trigger headaches.
• Hypertension, or high blood pressure. The retention of fluids and sodium causes blood volume to increase, which, in turn, causes blood pressure to rise.
• Increased fatigue. Toxic substances in the blood and the presence of anemia may cause feelings of exhaustion.
• Itching. Phosphorus, which is typically eliminated in the urine, accumulates in the blood of patients with kidney failure. This heightened phosphorus level may cause itching of the skin.
• Low back pain. Pain where the kidneys are located, in the small of the back below the ribs.
• Nausea, loss of appetite, and vomiting. Urea in the gastric juices may cause upset stomach. This can lead to malnutrition and weight loss.