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Kidney failure

From Wikipedia, the free encyclopedia

Kidney failure
Other namesRenal failure, end-stage renal disease (ESRD), stage 5 chronic kidney disease[1]
A hemodialysis machine which is used to replace the function of the kidneys
SymptomsLeg swelling, feeling tired, loss of appetite, confusion[2]
ComplicationsAcute: Uremia, high blood potassium, volume overload[3]
Chronic: Heart disease, high blood pressure, anemia[4][5]
TypesAcute kidney failure, chronic kidney failure[6]
CausesAcute: Low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome.[6]
Chronic: Diabetes, high blood pressure, nephrotic syndrome, polycystic kidney disease[6]
Diagnostic methodAcute: Decreased urine production, increased serum creatinine[3]
Chronic:Glomerular filtration rate (GFR) < 15[1]
TreatmentAcute: Depends on the cause[7]
Chronic: Hemodialysis, peritoneal dialysis, kidney transplant[2]
FrequencyAcute: 3 per 1,000 per year[8]
Chronic: 1 per 1,000 (US)[1]

Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal.[2] Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly.[6] Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion.[2] Complications of acute and chronic failure include uremia, high blood potassium, and volume overload.[3] Complications of chronic failure also include heart disease, high blood pressure, and anemia.[4][5]

Causes of acute kidney failure include low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome.[6] Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease.[6] Diagnosis of acute failure is often based on a combination of factors such as decrease urine production or increased serum creatinine.[3] Diagnosis of chronic failure is based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy.[1] It is also equivalent to stage 5 chronic kidney disease.[1]

Treatment of acute failure depends on the underlying cause.[7] Treatment of chronic failure may include hemodialysis, peritoneal dialysis, or a kidney transplant.[2] Hemodialysis uses a machine to filter the blood outside the body.[2] In peritoneal dialysis specific fluid is placed into the abdominal cavity and then drained, with this process being repeated multiple times per day.[2] Kidney transplantation involves surgically placing a kidney from someone else and then taking immunosuppressant medication to prevent rejection.[2] Other recommended measures from chronic disease include staying active and specific dietary changes.[2]

In the United States acute failure affects about 3 per 1,000 people a year.[8] Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly develop the condition each year.[1][9] Acute failure is often reversible while chronic failure often is not.[6] With appropriate treatment many with chronic disease can continue working.[2]

YouTube Encyclopedic

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  • ✪ Symptoms of Kidney Disease
  • ✪ Stages of Kidney Disease
  • ✪ Understanding the basics of Chronic Kidney Failure | Dr. Asit Mehta (Hindi)
  • ✪ Acute Renal Failure
  • ✪ Chronic Kidney Disease (CKD) Pathophysiology


hello welcome to the chronic kidney disease program at University of California San Diego my name is Danuta Trzebinska and I'm a nephrologist in our clinic in this module we'll talk about symptoms of chronic kidney disease or CKD the symptoms associated with chronic kidney disease worsen as you progress from the least severe stage stage one to most severe stage Stage five patients will have chronic kidney disease stage one usually have no symptoms the only exception is patients who are spilling a massive amount of protein in the urine because they can subsequently develop swelling in the legs or other parts of the body now chronic kidney disease stage two is usually associated with no symptoms either just like stage one you don't know the vast majority of patients with CKD stage one and two are not aware of having kidney disease unless they undergo specific blood and urine testing so most of the time it's incidental finding you are not even looking for it now chronic kidney disease stage three this is the most common stage of kidney disease this is middle road your GFR is between 30 and 59 since this stage is associated with moderate reduction in level of kidney function a proportion of patients might develop some symptoms and what kind of symptoms some of those symptoms like fatigue or more frequent urination at night are nonspecific and overlooked by patients or attributed to some other things going on in their lives think about it there is a very long list of causes for fatigue and kidney diseases certainly not number one some patients who are in chronic kidney disease stage three can experience swelling in the legs now we are moving on to stage 4 stage 4 is associated with farther reduction in the level of kidney function is considered severe GFR is between 15 and 29 thus as you can expect there will be more patients having symptoms in this stage symptoms can be similar to those with stage 3 but they're just more obvious there might be some additional symptoms like decreasing appetite or some patients will experience shortness of breath now we are moving to stage 5 chronic kidney disease and this is the most severe stage if you recall in stage 5 GFR is less than 15 as with other stages various patients will experience different amounts of symptoms there are certainly many people in this stage who continue to work full-time and live a pretty much normal life you look at them and you would never guess that they have chronic kidney disease stage 5 they ask me doc are you sure I feel just fine I cannot tell in general however in this stage there are more symptoms than in any other previous stages on top of previously mentioned symptoms like fatigue swelling in the legs patients might suffer from some other symptoms like skin itching metallic or bitter taste in the mouth sometimes I ask patients do you feel like you swallowed a coin now that I know what it tastes like but it's just your taste is off sometimes patients experience nausea or even vomiting and this naughty and vomiting vomiting might be most more pronounced in the morning when you are in stage 5 you can expect further worsening in energy level and some sleep disturbances some patients will require we require more sleep at night for example instead of your previous six seven hours which was enough to feel refreshed now you will need nine hours to feel rested or semi rested or maybe you're going to have a reverse sleeping pattern that means that you will stay up at night you're just not sleepy you cannot sleep and then you will want to sleep all day long or some patients they sleep at night just fine but they also required a nap during the day that will tell me doc I go to work I can get through work but then when I got come home I really need this nap and they didn't need it a year ago many patients when they are in Stage five chronic kidney disease they are in denial all those changes are very slow it's not like one day you have hundred percent of kidney function and the next day you wake up and your level of kidney functions down to ten percent so you really have to pay attention to your body how you feel we tend to adapt if I have less energy all right I'm not going to run I'm going to do less I might sleep more oh I don't have an appetite so I will eat less but sometimes people don't notice so when you come to see us in clinic especially when you're in chronic kidney disease stage five we'll ask you very pointed questions how much do you sleep how many hours well how many hours did you sleep a year ago how much do you eat well is it up or is it down all those questions are helpful some patients in chronic kidney disease stage five suffer from muscle cramps even when measured electrolytes in the blood are normal sodium is normal potassium magnesium so please do not self medicate yourself don't just start taking magnesium supplements when you get cramps because you might overdo it you might notice worse concentration or actually you might not notice but somebody else around you will notice that you're not as sharp as you used to be some patients might feel more cold than usual than previously your urine volume eyedrop you'll be peeing less than you did previously and may be swelling in your legs will get worse sometimes when you are in stage five chronic kidney disease blood pressure control becomes more difficult we have to add another agent and blood pressure keeps creeping up patients who have diabetes might have more episodes with low instead of high sugar that's one of the findings of advanced kidney disease to summarize please remember that chronic kidney disease is a silent disease and some patients will have just nonspecific symptoms only which are often north or overlooked till kidney disease is quite advanced let us go through a couple of questions to check your understanding of this module question number one which stage of chronic kidney disease is associated with most symptoms the correct answer is chronic kidney disease stage 5 is associated with most symptoms this is the most advanced stage of kidney disease if symptoms are severe enough and or some of your labs are dangerously abnormal you might need to start either dialysis or undergo kidney transplantation in stage 5 let's do one more question which symptom would you not expect to occur in chronic kidney disease is it a fatigue or B leg swelling or C increase in appetite or D muscle cramps let's think about this and which symptoms would you not it's a tricky question and the correct answer is C increase in appetite if anything there is decrease in appetite in advanced kidney disease some people lose weight all other symptoms often occur in patients with chronic kidney disease so you will experience fatigue leg swelling and muscle cramps alright congratulations to you guys you have completed the module on symptoms of kidney disease please check our website for additional educational modules on kidney health thank you



Kidney failure can be divided into two categories: acute kidney failure or chronic kidney failure. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney failure from chronic kidney failure include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.

Acute kidney failure

Acute kidney injury (AKI), previously called acute renal failure (ARF),[10][11] is a rapidly progressive loss of renal function,[12] generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,[13] less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. Many people diagnosed with paraquat intoxication experience AKI, sometimes requiring hemodialysis.[14] The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney failure

Illustration of a kidney from a person with chronic renal failure.
Illustration of a kidney from a person with chronic renal failure.

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms.[15] CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic kidney failure

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the person to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the person has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Signs and symptoms

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When the kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.[16]

Symptoms of kidney failure include the following:[16][17][18][19]

  • High levels of urea in the blood, which can result in:
    • Vomiting or diarrhea (or both) may lead to dehydration
    • Nausea
    • Weight loss
    • Nocturnal urination (nocturia)
    • More frequent urination, or in greater amounts than usual, with pale urine
    • Less frequent urination, or in smaller amounts than usual, with dark coloured urine
    • Blood in the urine
    • Pressure, or difficulty urinating
    • Unusual amounts of urination, usually in large quantities
  • A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
  • A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
    • Abnormal heart rhythms
    • Muscle paralysis[20]
  • Failure of kidneys to remove excess fluid may cause:
    • Swelling of the hands, legs, ankles, feet, or face
    • Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
  • Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
    • Pain in the back or side
  • Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
    • Feeling tired or weak
    • Memory problems
    • Difficulty concentrating
    • Dizziness
    • Low blood pressure
  • Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,[21] after which symptoms include:
    • Foamy or bubbly urine
    • Swelling in the hands, feet, abdomen, and face
  • Other symptoms include:
    • Appetite loss, which may include a bad taste in the mouth
    • Difficulty sleeping
    • Darkening of the skin
    • Excess protein in the blood
    • With high doses of penicillin, people with kidney failure may experience seizures[22]


Acute kidney injury

Acute kidney injury (previously known as acute renal failure) – or AKI – usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the person with AKI to resume a normal life. People suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.[23]

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

Chronic kidney failure

Chronic kidney failure has numerous causes. The most common causes of chronic failure are diabetes mellitus and long-term, uncontrolled hypertension.[24] Polycystic kidney disease is another well-known cause of chronic failure. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses cause kidney failure, as well.

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney failure.[25]

Some infectious disease agents, such as hantavirus, can attack the kidneys, causing kidney failure.[26]

Genetic predisposition

The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies.[27] Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.[28][29]

Diagnostic approach

Measurement for CKD

Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using the person’s GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. People with stage 4 and 5 kidney failure usually require preparation towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.

Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function.[30] The National Kidney Foundation offers an easy to use on-line GFR calculator[31] for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator.)

Use of the term uremia

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urea. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra.[citation needed] The term uremia is now used for the illness accompanying kidney failure.[32]


The treatment of acute kidney injury depends on the cause.[7] The treatment of chronic kidney failure may include renal replacement therapy: hemodialysis, peritoneal dialysis, or kidney transplant[2]


In non-diabetics and people with type 1 diabetes, a low protein diet is found to have a preventative effect on progression of chronic kidney disease. However, this effect does not apply to people with type 2 diabetes.[33] A whole food, plant-based diet may help some people with kidney disease.[34] A high protein diet from either animal or plant sources appears to have negative effects on kidney function at least in the short term.[35]

Slowing progression

People who received earlier referrals to a nephrology specialist, meaning a longer time before they had to start dialysis, had a shorter initial hospitalization and reduced risk of death after the start of dialysis.[36] Other methods of reducing disease progression include minimizing exposure to nephrotoxins such as NSAIDs and intravenous contrast.[37]


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