Kidney Failure

• Symptoms: Breathlessness, reduction in urine output, change in urine colour; persistent nausea, pressure, and pain in the chest; swelling in feet, legs, and ankles due to fluid retention caused by lack of kidney function; extreme fatigue and drowsiness, confusion, seizures and coma
• Causes: Diabetes, high blood pressure, polycystic kidney disease (PKD), glomerular disease, lupus, autoimmune kidney ailment, severe dehydration, untreated systemic disorders such as liver disease and heart disease; urinary tract obstruction, certain medications
• Risk factors: People who are over 60 and are Hispanic, black, Alaska native, native American or first nation and have diabetes, hypertension, heart disease, prior family history of kidney failure, abnormal structure of the kidney, history of consuming pain relievers such as NSAIDs or non-steroidal anti-inflammatory drugs
• Severity: Mild to serious
• Which doctor to consult: Nephrologist

Overview

The kidneys are bean-shaped organs, usually fist-sized, and sit just below the ribcage in the back. Usually, most healthy individuals have two properly functioning kidneys, but one can survive with just one kidney if the other one is not functioning properly.

The prime function of this organ is to flush out all the toxins from the human body. Kidneys filter the blood and eliminate waste through urine. If this organ begins to malfunction, it will lead to a buildup of toxins in the body. It is referred to as kidney or renal failure, wherein either one or both kidneys stop functioning.

Sometimes, this failure becomes acute and inflict temporary damage. Other times, it can be a chronic condition which can worsen over time. It can be differentiated into five stages, ranging from stage 1 (mild) to stage 5 (complete organ failure).

Stage 1 is usually very mild and has no visible symptoms or complications. There might be minor kidney damage, but one can still manage it with a healthy lifestyle.

Stage 2 presents obvious issues like physical kidney damage and protein in urine output. Lifestyle changes are still considered the best way to slow down the progression of the illness.

In stage 3, the kidneys will begin to function inadequately, and the emergence of symptoms like swollen feet and hands, back pain, and frequent urge to pee, will be observed. Correct medication is essential to fix the underlying conditions.

Stage 4 lies on the scale of moderate to severe. In this stage, the kidneys are functioning poorly, and it can lead to complications like bone disease, hypertension, and anaemia.

Stage 5 is the last in which the kidneys are nearing complete failure. Patients will start experiencing breathlessness, nausea, vomiting and itchy skin. A kidney transplant or dialysis is the only treatment possible at this stage.

Lack of medical attention may shorten a patient's life expectancy. So, getting the proper treatment to manage the disease is of utmost importance.

When to Consult a Doctor?

If there are apparent symptoms and warning signs of kidney disease, it's time to reach out to an experienced medical practitioner or nephrologist. If the kidney disease is detected early on, it’s progress can be slowed down to prevent complete kidney failure or renal failure.

In case an individual is struggling with an underlying health condition that might amplify the risk of developing kidney disease,, the healthcare provider may closely monitor the patient's kidney function and blood pressure. Regular blood and urine tests might also be conducted.

Diagnosis

If any symptoms of kidney disease or failure arise, it is best to get an appointment with a healthcare practitioner or nephrologist. They are likely to run some of the following standard tests to confirm the medical condition:

• Lab Tests: The doctor will start with basic lab tests to diagnose the condition. This will include the following:

1. Urinalysis: A simple urine test to check for anything suspicious or abnormal such as sugar traces or atypical protein. Additionally, the diagnostic centre may run a urinary sedimentation exam as well. This will help detect white and red blood cells and the number of cellular casts (tube-shaped particles) and bacteria.

2. Urine Volume Measure: This is one of the primary ways to determine if one is suffering from kidney failure. If the urine output is low, it may indicate kidney disease, possibly due to urinary blockage, injuries, or underlying illnesses.

3. Blood Sample: A blood test is another essential lab examination that looks for creatinine and urea nitrogen levels. The kidneys ordinarily filter these substances during normal functioning. If the levels of these wastes are high, it may signify kidney failure.

• Imaging Tests: After the initial lab tests, the doctor may also run some imaging tests like CT scans, MRIs, and ultrasounds to get a clear visual of the urinary tract, kidneys, and other surrounding areas. It will help them understand the root problem, which could be any blockage or other identifiable abnormalities.
• Advanced Tests: Lastly, the nephrologist may also suggest an advanced test which will be a kidney biopsy. Tissues from kidneys are extracted and scanned for infectious organisms, scarring and unusual deposits.

Treatment

Once the condition is diagnosed, the next step is to figure out an effective treatment plan. It could be a combination of different measures such as follows:

• Home Care: If the kidney disorder is at the initial stage, the patient will be asked to make specific dietary changes to manage the symptoms and complications. It may also slow down the progression of the disease. This includes following a special diet which will support the present functioning of the kidneys and reduce their workload. Avoiding sodium-heavy foods, fast foods, salty snacks, canned soups and vegetables, processed cheeses and meats, and ready-to-eat meals is helpful. It is also essential to monitor protein intake and potassium consumption and eat foods with lower potassium, like apples, carrots, grapes, cabbage, green beans, and strawberries. 
• Medication: Kidney disorders may pave the way for many other medical conditions and complications requiring proper medications. This includes:

1. Medicines for hypertension: Many people suffering from kidney diseases also face high blood pressure. There are medications to control the same, such as angiotensin II receptor blockers and angiotensin-converting enzymes. This will help preserve kidney function.

2. Medicines for limb swelling: Kidney diseases often lead to the retention of fluids which can cause one's hands and legs to swell up. Diuretics are given to patients to maintain the right amount of bodily fluids.

3. Medicines for anaemia: Someone struggling with kidney disease may also develop anaemia due to low EPO count (which is produced by kidneys.) So, hormone erythropoietin supplements with additional iron may help make red blood cells. It might also relieve weakness and fatigue linked to anaemia.

4. Medicines for high cholesterol: People with kidney disease are likely to also suffer from bad cholesterol, which can put them at risk of cardiac ailments. The doctor may suggest statin to maintain the cholesterol levels.

5. Medicine for bones: Bad kidney function can impact bone strength. Vitamin D, calcium supplements, and phosphate binders are required to protect blood vessels from calcification.

• Surgical Treatment: In severe cases where the kidneys fail to clear the waste from the body and near total organ failure, the doctor may resort to surgical treatment such as a kidney transplant. After the transplant, a patient would need to be on life-long medication to ensure that the body does not reject the new kidney.
• Alternative Management: Dialysis is a process wherein the extra fluid and waste products are artificially removed from the blood since the kidneys are no longer functioning correctly. There are two kinds of dialysis – hemodialysis and peritoneal dialysis. A machine filters the fluid and waste from the blood in the former. In the latter process, a slim tube is inserted in the abdominal to fill the dialysis solution in the abdominal cavity. This solution absorbs excess fluid and waste and is drained out of the body after some time.

Risks and Complications if Left Untreated

People who struggle with kidney disease or failure require immediate medical attention. If the condition prolongs or is left untreated, it can lead to several complications like:

• Anaemia
• Bone weakness
• Fluid retention
• Metabolic acidosis or extreme acid in bodily fluids
• Hyperkalemia or high potassium levels
• Heart disease or failure
• Kidney stones
• Skin infections
• Liver failure
• Gout
• Fluid in lungs
• Nerve damage
• Depression

Additional information

Prevention:

While there is no sure-shot cure for chronic kidney ailments, preventive measures can lower the risk of developing such an illness. These include:

• Taking non-prescribed pain medications like ibuprofen and aspirin according to the written instructions given on the package
• Avoiding the consumption of too many pain medications as it might cause further kidney damage
• Maintaining a healthy weight by staying physically active and adopting medically approved weight loss strategies
• Quitting smoking tobacco