Kidney or renal failure is a state where the kidneys lose their regular functionality, which perhaps due to diverse factors including infections, auto immune diseases, diabetes and other endocrine disorders, cancer, and toxic chemicals. It is characterized by the decline in the excretory and regulatory functions of the kidney. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease); several other diseases or health problems may cause either form of renal failure to take place.
The kidneys are located in the abdomen toward the back, normally one on each side of the spine. They get their blood supply through the renal arteries straight from the aorta and send blood back to the heart via the renal veins to the vena cava. (The term \”renal\” is originated from the Latin name for kidney.)
The main purpose of the kidneys is to eliminate waste products and surplus water from the blood. The kidneys process about 200 liters of blood per day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic side-effects will increase to dangerous levels. The kidney also plays a most important role in regulating levels of a variety of minerals such as calcium, sodium, and potassium in the blood.
Causes
There are a lot of potential causes of kidney damage. They consist of:
Acute tubular necrosis (ATN)
Autoimmune kidney disease, including:
Acute nephritic syndrome
Interstitial nephritis
Decreased blood flow due to very low blood pressure, which can result from:
Burns
Dehydration
Hemorrhage
Injury
Septic shock
Serious illness
Surgery
Disorders that cause clotting within the kidney\’s blood vessels:
Hemolytic-uremic syndrome
Idiopathic thrombocytopenic thrombotic purpura (ITTP) (Idiopathic thrombocytopenic purpura is a bleeding disorder in which the immune system demolishes platelets, which are essential for normal blood clotting. Persons with the disease have excessively few platelets in the blood.)
Malignant hypertension
Transfusion reaction (A hemolytic transfusion reaction is a severe problem that occurs after a patient obtains a transfusion of blood. The red blood cells that were given to the patient are destroyed by the patient\’s own immune system)
Scleroderma (Scleroderma is a wide-ranging connective tissue disease that leads to changes in the skin, blood vessels, muscles, and internal organs).
Infections that directly damage the kidney are including:
Acute pyelonephritis
Septicemia
Pregnancy complications, including:
Placenta abruptio (Placenta abruptio is separation of the placenta (the organ that nurtures the fetus) from the site of uterine implantation previous to delivery of the fetus.)
Placenta previa (Placenta previa is a complication of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix).
Urinary tract obstruction (Acute bilateral obstructive uropathy is an abrupt obstruction of the flow of urine from both kidneys. The kidneys carry on producing urine in the normal manner, but because urine does not drain properly, the kidneys initiate to swell)
Symptoms
Bloody stools
Breath odor
Bruising easily
Changes in mental status or mood
Decreased appetite
Decreased sensation, especially in the hands or feet
Fatigue
Flank pain (between the ribs and hips)
Hand tremor
High blood pressure
Metallic taste in mouth
Nausea or vomiting, may last for days
Nosebleeds
Persistent hiccups
Prolonged bleeding
Seizures
Slow, sluggish movements
Swelling – generalized (fluid retention)
Swelling of the ankle, feet, and leg swelling
Urination changes:
Decline in amount of urine
Too much urination at night
Urination stops absolutely
The subsequent signs and symptoms signify the probability of a serious complication of chronic kidney disease and warn you for a quick visit to the nearest hospital emergency department.
Change in level of awareness – extreme sleepiness or difficult to awaken
Fainting
Chest pain
Difficulty breathing
Severe nausea and vomiting
Severe bleeding (from any source)
Exams and Tests
Many patients suffer from generalized swelling caused by fluid retention. The doctor can hear a heart beating, crackles in the lungs, or indications of inflammation of the lining of the heart when listening to the heart and lungs with a stethoscope.
The results of laboratory tests may alter abruptly (within a few days to 2 weeks). Such tests may include:
BUN- It is the short form of Blood Urea Nitrogen. Urea nitrogen is formed when protein breaks down. An investigation can be performed to assess the amount of urea nitrogen in the blood.)/p>
Creatinine clearance (the creatinine clearance test evaluates the level of creatinine in urine with the creatinine level in the blood)/p>
Serum creatinine (this laboratory test is performed to determine the amount of creatinine in the blood)./p>
Serum potassium (this test measures the amount of potassium in the blood. Potassium (K+) aids nerves and muscles to communicate. It also helps move nutrients into cells and waste products out of cells.)/p>
Urinalysis (Urinalysis is the physical, chemical, and microscopic examination of urine. It consists of a number of tests to discover and measure a variety of compounds that move across the urine)/p>
A kidney or abdominal ultrasound is an important test for diagnosing kidney failure. And abdominal x-ray, abdominal CT scan, or abdominal MRI can explain if there is an obstruction in the urinary tract./p>
Blood tests can disclose the fundamental cause of kidney failure. Arterial blood gas and blood chemistries may demonstrate metabolic acidosis./p>
What is the treatment for kidney failure?
Prevention is always the best cure for kidney failure. Chronic diseases such as hypertension and diabetes are devastating because of the damage that they can do to kidneys and other organs. Enduring diligence is significant in keeping blood sugar and blood pressure within regular limits. Exact treatments are dependent upon the underlying diseases.
Once kidney failure is there, then primary goal is to avert more deterioration of renal function. If ignored, the kidneys will progress to absolute failure, but if underlying illnesses are addressed and treated violently, kidney function can be preserved, though not always improved.
Diet
Diet is an important part for those with damaged kidney function. Because the impaired kidneys cannot easily remove excess water, salt, or potassium; these may require to be consumed in restricted volumes. Foods that contain a large volume of potassium include bananas, apricots, and salt can be the substitutes.
Phosphorus is an elapsed chemical that is related with calcium metabolism and perhaps this chemical accelerates kidney failure. In excess of phosphorus can leech calcium from the bones and cause osteoporosis and fractures. Foods with high phosphorus content include milk, cheese, nuts, and cola drinks.
Medications
Medications possibly applied to help control some of the issues related with kidney failure.
Phosphorus-lowering medications (calcium carbonate [Caltrate], calcitriol [Rocaltrol], sevelamer [Renagel])
Red blood cell production stimulation (erythropoietin, darbepoetin [Aranesp])
Red blood cell production (iron supplements)
Blood pressure medications
Vitamins
Dialysis
Dialysis cleanses the body of waste products in the body by use of filter systems. There are four types of dialysis;
Hemodialysis, (HD, hard to do particularly in the hypotensive post operative or septic patient, requiring vasopressor support).
Peritoneal dialysis, (PD, not typically considered in the post effective common surgical patient with abdominal pathology or respiratory compromise).
Continuous Arterio Venous Hemofiltration (CAVH, depends on an enough pressure head, has no externalapparatus to handle flow or provide warning and neds the insertion of a wide bore catheter into anartery which may cause bleeding, an aneurysm, thrombosis and clot formation).
It has been mostly replaced by Continuous VenoVenous Hemofiltration CVVH, is a slow process of solute and fluid removal, results in a largely haemodynamically steady milieu and can eliminate a large volume of cytokines which may decrease the frequency or progression of multi-organ failure.
Both types of dialysis have benefits and complications. Not every patient can decide which type he or she would prefer. The treatment decision depends on the patient\’s illness and their past medical history along with other issues. Generally, the nephrologists (kidney specialist) will go for a long discussion with the patient and family to fix on what will be the best option available.
Dialysis may be needed, and can make you feel better. It is not always necessary, but it can protect your life if your potassium levels are severely high. Dialysis will also be performed if your psychological status revolts, you stop urinating, develop pericarditis, retain too much fluid, or you fail to remove nitrogen waste products from your body.
Once the kidneys fail entirely, the treatment options are limited to dialysis or kidney replacement by transplantation
Transplantation
Kidney transplantation recommends the best consequences and the best quality of life. Transplanted kidneys may come from living related donors, living unrelated donors, or people who have died of other causes (cadaveric donors). In people with type I diabetes, a combined kidney-pancreas transplant is often a better option.
Though, not everyone is a candidate for a kidney transplant. People need to undergo wide-ranging testing to give assurance their suitability for transplantation. Also, there is a dearth of organs for transplantation, requiring waiting times of months to years prior to receiving a transplant.
A person who needs a kidney transplant undergoes several tests to categorize characteristics of his or her immune system. The recipient can allow only a kidney that comes from a donor who matches definite of his or her immunologic characteristics. The more similar the donor is in these characteristics, the greater the chance of long-term success of the transplant. Transplants from a living related donor generally have the best results.
Transplant surgery is a major procedure and normally necessitates four to seven days in the hospital. All transplant recipients require lifetime immunosuppressant medications to prevent their bodies from rejecting the new kidney. Immunosuppressant medications need careful scrutinizing of blood levels and amplify the risk of infection along with some types of cancer. After a year, 95% of transplanted kidneys are still functioning and after five years the number is 80%.
If the transplanted kidney not succeeds, the alternative path is another kidney transplant or a return to dialysis.