Kidney Failure

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 inflicts temporary damage. Other times, it can be a chronic condition which can worsen over time. 

Stages of Kidney Failure: 

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. Minor kidney damage might be present, 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 moderate to severe scale. 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.

Symptoms of Kidney Failure:

Many people exhibit few or no symptoms in the early stages of kidney disease. Even if you are feeling fine, CKD can still cause damage.

The symptoms of CKD and kidney failure vary by individual. If your kidneys aren't working properly, you might notice one or more of the following symptoms:
Extreme fatigue.
Nausea and vomiting.
Confusion or difficulty concentrating.
Swelling (oedema), especially in the hands, ankles, and face.
Peeing more often.
Cramps or muscle spasms.
Dry or itchy skin.
Poor appetite or food that tastes metallic.

Causes of Kidney failure:

Kidney disease develops when a disease or condition impairs kidney function, causing kidney damage to worsen over months or years.
Chronic kidney disease is caused by the following diseases and conditions:
Type 1 or Type 2 diabetes;
elevated blood pressure;
Glomerulonephritis, an inflammation in the kidney's filtering units (glomeruli);
Interstitial nephritis, an inflammation of kidney tubules and surrounding structures;
Polycystic kidney disease and other inherited kidney diseases;
Prolonged obstruction of the urinary tract due to conditions such as enlarged prostate, kidney stones, and some cancers;
Vesicoureteral reflux, a condition that causes urine to back up into the kidneys;
Recurring kidney infection, also called pyelonephritis.

Risks of Kidney Failure:

The following factors can increase your risk of developing chronic kidney disease:
Diabetes;
High Blood Pressure;
Heart (cardiovascular) disease;
Smoking and Obesity;
Family history of kidney disease;
Abnormal kidney structure in older individuals;
Frequent use of medications that can cause kidney damage.
 

Complications:

Chronic kidney disease can affect nearly every organ in your body. Possible complications include:

Fluid retention may cause swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary oedema);
A sudden increase in potassium levels in your blood (hyperkalemia), which may impair your heart's function and be life-threatening;
Anemia, heart disease;
Weak bones with an increased risk of bone fractures;
Reduced sexual drive, erectile dysfunction, or decreased fertility;
Damage to your central nervous system can cause difficulty concentrating, personality changes, or seizures;
Decreased immune response, making you more susceptible to infection;
Pericarditis is an inflammation of the sac-like membrane surrounding your heart (pericardium).

Prevention: 

Though kidney failure and CKD are irreversible, you can take steps to help maintain kidney function. Healthy habits and routines may slow the rate at which your kidneys lose function.

If you have CKD or kidney failure, it is recommended to monitor your kidney function.
If you have diabetes, keep your blood sugar levels within normal ranges.
Maintain normal blood pressure levels.
Do not use tobacco products.
Avoid eating foods high in protein and sodium.
Attend all regularly scheduled appointments with your healthcare provider.
 

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, its progress can be slowed to prevent complete kidney or renal failure.

If an individual struggles 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:

As a first step toward diagnosing kidney disease, your doctor will ask you about your personal and family history. Among other things, your doctor may inquire whether you have been diagnosed with high blood pressure if you have taken a medication that may impair kidney function if you have noticed changes in your urinary habits, and if you have family members with kidney disease. Your doctor will perform a physical exam and a neurological exam to look for signs of heart or blood vessel problems.
 

• 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.

4. 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.

5. Advanced Tests: The nephrologist may also suggest an advanced test, 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 to support the kidneys' functioning 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 kidney disease patients also face high blood pressure. There are medications to control the same, such as angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors (e.g., Benazepril, Captopril, Enalapril, Fosinopril). 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 (Eg., Furosemide) 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 into the abdominal cavity to fill the dialysis solution. This solution absorbs excess fluid and waste and is drained out of the body after some time.