Chronic Kidney Failure

Written by Teresa Bergen | Published on May 2, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What Is Chronic Kidney Failure?

Your kidneys are responsible for filtering excess fluids and waste products from your blood. This waste is then eliminated in your urine.

Chronic kidney failure refers to the loss of kidney function over months or years. In the severe stage, dangerous levels of wastes and fluids back up in your body. Another name for this condition is chronic kidney disease.

Causes of Chronic Kidney Failure

Diabetes and high blood pressure are the most common conditions that can lead to chronic kidney failure.

Other causes include:

  • congenital kidney disease (structural or functional problems present at birth)
  • obstruction of the urinary tract (structural or due to kidney stones or cancer)
  • kidney injury
  • exposure to certain drugs or chemicals, including some cancer drugs
  • autoimmune disorders
  • recurring kidney infections
  • inflammation within the kidneys’ filtration system (due to autoimmune diseases, infection or toxins)

You are at a statistically higher risk of chronic kidney failure if you are:

  • obese
  • a smoker
  • have heart disease
  • have high cholesterol
  • are Native American, African American, or Asian American
  • from a family with a history of kidney disease
  • over the age of 65

Recognizing the Symptoms of Chronic Kidney Failure

People in the early stages of chronic kidney failure may or may not have symptoms. In addition, many of the early signs of kidney failure can be easily confused with other illnesses and conditions. This makes diagnosis difficult.

Early symptoms include:

  • nausea and vomiting
  • loss of appetite
  • itching
  • chest pain
  • uncontrollable high blood pressure
  • unexpected weight loss

If the damage to your kidneys worsens, you will eventually notice symptoms. However, this may not happen until a lot of damage is already done.

Later-stage symptoms include:

  • difficulty staying alert
  • cramps and twitches
  • numbness in the limbs
  • weakness
  • fatigue
  • bad breath
  • skin that’s darker or lighter than usual
  • bone pain
  • excessive thirst
  • bleeding and bruising easily
  • insomnia
  • urinating significantly more or less
  • hiccups
  • swollen feet and ankles
  • absent menstrual periods
  • shortness of breath

Chronic kidney disease interferes with excretion of toxins from the body, and the resulting retention of waste products and fluids can lead to serious complications. This condition can decrease red blood cell production and cause high blood pressure. It can cause fluid buildup in the lungs as well as in other areas. Chronic kidney failure may also prevent your body from getting the right amount of vitamin D and, therefore, affect your bone health. It can also cause nerve damage and lead to seizures.

Diagnosis of Chronic Kidney Failure

If you have high blood pressure, diabetes, or another condition that puts you at higher risk, your doctor will probably monitor your kidney function. Be sure to have regular checkups, and report any unusual symptoms.

Physical Exam

At your appointment, your doctor will examine you thoroughly. If kidney failure is causing fluids to back up in your lungs or heart, examination of these organs by listening with a stethoscope will provide important clinical information.

Blood and Urine Tests

If your doctor thinks you might have chronic kidney failure, he or she will order tests. Blood tests for kidney function measure the levels of waste in your blood. This testing will measure waste products such as creatinine levels (breakdown product of muscle) and blood urea (breakdown product of protein).

 

Urine tests will be performed to check for abnormalities. For example, protein is normally present only in insignificant trace amounts in your urine. An elevated protein level might show up in your urine months or even years before other symptoms are apparent. The urine sediment and cells found in the urine will also be examined in the laboratory.

Imaging Tests

Imaging tests, such as an ultrasound, MRI and CT scan can provide structural details of the kidneys.

Biopsy

If your doctor is still unsure about the cause of your symptoms, he or she might do a biopsy. This can be performed as a closed biopsy (needle biopsy) or an open biopsy.

Needle biopsy: The area of entry into the kidney is cleansed thoroughly and a strict sterile technique is used throughout the procedure to limit the risk of infection. A local anesthetic is given to numb the area and prevent discomfort and pain. The doctor or technician will insert a special biopsy needle into the kidney. CT scan or ultrasound using high frequency sound waves can be used to help guide the needle insertion. This is considered a minimally invasive procedure and is the technique used for most kidney biopsies.

Open biopsy: This procedure requires strict sterile techniques, general anesthesia, and a surgical incision to expose the kidney. The kidney is biopsied and a small sample is sent to the lab for microscopic examination.

Testing Results and Follow-Up

The results of the examination will help confirm the diagnosis and possibly the cause of the kidney failure.

If you are diagnosed with chronic kidney failure, you will need regular blood tests to measure various substances (such as calcium, potassium, cholesterol, sodium, and magnesium. You will also need to undergo ongoing kidney function tests for creatinine and urea levels.

Treatment of Chronic Kidney Failure

There is no cure for chronic kidney failure. But there are measures you can take to slow its progression.

Medication

Because kidney failure is linked to high blood pressure, your doctor might put you on blood pressure medication. You will need to follow a low-salt diet, as salt can raise blood pressure.

You might need medications called statins to lower your cholesterol level.

Often people with chronic kidney failure suffer from anemia. Anemia occurs when the body does not produce enough red blood cells. In the case of chronic kidney disease, the hormone erythropoietin (which is essential to red blood cell production) is not produced normally and you may need a supplement of this hormone to help increase red blood cell production. Because your body needs iron to manufacture blood cells, your doctor might also prescribe iron pills or shots of iron. In some cases, you may need a blood transfusion to improve red blood cell health.

If your kidney problem is causing fluid retention, diuretics can be prescribed to relieve your swelling. This medicine makes you urinate frequently. 

Calcium and vitamin D supplements help to protect your bones. If you have chronic kidney disease, you will have lower-than-normal levels of Vitamin D, which is essential for calcium absorption. Taking Vitamin D will reduce your risk of bone fractures. Phosphate is elevated in kidney failure and this can diminish your body’s ability to absorb calcium. Your doctor may prescribe phosphate binders, a type of medicine to control your phosphate level.

Antihistamines can relieve the symptom of itchy skin. Antiemetics can help with nausea.

Diet

Dietary changes might also be necessary. People with chronic kidney failure usually need to reduce their protein intake. As the body processes protein, it creates waste products. The kidneys are responsible for filtering this waste. A lower-protein diet makes their job easier.

You might also need to monitor your levels of salt, potassium, and phosphate. Work with a dietitian to find out how much of these substances you should eat.

Get in the habit of reading labels. Even if you don’t add table salt to your food, many prepared foods, such as canned soup or fast food, are already high in sodium.

Learn which foods are high in potassium, and which are low. The kidneys are responsible for filtering excess potassium out of your body. But when they are not functioning well, they won’t be able to filter potassium properly. In those with chronic kidney failure, high levels of potassium (hyperkalemia) could be life threatening, leading to abnormal heart functioning or paralysis. Good choices for a low-potassium diet include cabbage, green beans, strawberries, apples, and grapes.

Your kidneys may not be able to process phosphate, either. Phosphate can also diminish your body’s ability to absorb calcium. High-phosphate foods include fish, dairy products, eggs, and meat. You might need to eat less of these.

You might also need to limit your fluids, so the kidneys don’t have to work too hard.

People with chronic kidney failure often lose weight. Make sure you are consuming enough calories from foods that your dietitian has approved and recommended.

Lifestyle

Other lifestyle considerations include not smoking and keeping current on vaccinations, including flu shots. Discuss supplements and over-the-counter medications with your doctor before taking them. If you see other doctors for different conditions, always inform them of your kidney situation.

End-Stage Treatment

If attempts to control your condition through diet and medication fail, you might face end-stage kidney disease. This is when your kidneys are operating at only 10 to 15 percent of their full capacity. At this stage, the kidneys can no longer keep up with waste product elimination as fast as you’re producing waste. The two treatment possibilities here are dialysis and kidney transplant. Doctors try to postpone these options as long as possible because both carry serious risks.

Dialysis is a system for filtering waste products and excess fluids out of your blood. There are several ways to do this. The two main types of dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, your blood is filtered outside of your body, in a machine. In peritoneal dialysis, you fill your abdominal cavity with a special solution via a catheter. The solution absorbs excess fluid and waste before being drained from your body.

Because dialysis usually needs to be done several times a week, this is a big lifestyle change. Dialysis also carries a risk of infection.

Kidney transplant is more convenient than dialysis, if you can find an appropriate donor kidney. The donor needs to have the same blood type as the recipient. The kidney from a living sibling or other close relative is usually best. You could also get your kidney from a deceased donor.

Long-Term Outlook for Those With Chronic Kidney Failure

Some people with chronic kidney failure manage to live for many years. This can only be accomplished if you manage to halt the further deterioration of your kidneys through diet and medication. This will require you to maintain a kidney health regimen for the rest of your life.

But if you reach end-stage kidney disease, you will need dialysis or a kidney transplant. Without such interventions, the disease is fatal.

The health of your kidneys affects your other organs and systems, too. Possible complications of kidney failure include heart and liver failure, damage to the nerves, stroke, fluid buildup in the lungs, infertility, erectile dysfunction, dementia, and bone fractures.

Children with kidney failure may not grow properly due to the kidneys’ inability to activate vitamin D. Vitamin D is essential for bone growth.

Kidney failure poses serious risks to pregnant women and their unborn babies. Pregnant women with kidney failure face a higher incidence of preeclampsia. Preeclampsia is a spike in blood pressure that can lead to brain or liver hemorrhage in the woman, which could kill her and her unborn child.

Prevention of Chronic Kidney Failure

Many of the ways to prevent kidney failure are general tips for healthy living. Here are some general guidelines:

  • Women and men over 65 should limit themselves to no more than one alcoholic drink per day. Men who are younger than 65 should stop at two drinks.
  • Maintain good control of your blood pressure.
  • If you have diabetes, control your blood sugar.
  • If you’re overweight, try to bring yourself down to a healthy weight. This usually means consuming fewer calories and being more active.
  • Over-the-counter pain relievers can cause kidney damage. Follow the directions on the packages, and only take as needed. Discuss the use of pain relievers with your doctor if you have any kidney concerns.
  • If you smoke cigarettes, quit today.
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