Live with Kidney Disease

Kidney Failure

Kidney disease can get worse over time, and may lead to kidney failure. Kidney failure means very advanced kidney damage with less than 15% normal function. Most people with kidney failure have symptoms from the build up of waste products and extra water in their body. End-stage renal disease (ESRD) is kidney failure treated by dialysis or kidney transplant.
If the kidneys fail, treatment options such as dialysis or a kidney transplant can help people live longer and healthier lives. If your kidneys fail, talk with your health care provider about choosing a treatment that is right for you. Learn about what you can do to prepare for kidney failure and treatment.

What are the Causes of kidney failure.

In Acute Kidney Failure, kidney function is lost over a period of hours, days, or in some cases, weeks. The causes are categorized based on where the injury is set. We mainly talk about the causes of Chronic Kidney Failure.

1. Pre-renal causes
Pre-renal kidney failure occurs due to decreased blood supply to the kidneys. Pre-renal causes mainly include the follows:

• Low blood volume due to blood loss
• Dehydration from loss body fluid, examples of which include: vomiting, diarrhea, severe sweating, high fever, etc.
• Insufficient fluid intake. Such medicines as diuretics may result in severe water loss
• Abnormal blood flow to and from the kidney due to obstructions in renal arteries or veins

 

2. Renal Causes
Renal causes of kidney failure (factors that damage kidney itself) mainly include:
Sepsis: the body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually doesn't occur with urinary tract infections.
Nephrotoxic medicines: nonsteroidal anti-inflammatory analgesic medicines like idomethacin, ibuprofen, aspirin, etc. Other potentially toxic medicines also include antibiotics such as gentamicin, Nafcillin, and anesthetic medicines like diethyl ether.

 

3. Multiple myeloma
Acute glomerulonephritis or inflammation of glomeruli the filtering system of the kidneys. Diseases that could cause the inflammation mainly include Systemic Lupus Erythematosus, Goodpasture Syndrome, Wengener's granlomatosis, etc.

 

4. Post-renal causes of kidney failure
Common causes mainly include

• urinary tract stones
• bilateral pelvic effusion
• prostatic hyperplasia
• tumors in the abdomen that surround and obstruct the ureters.

 

5. Chronic Kidney Failure.
Chronic diseases, such as Diabetes and Hypertension.

 

6. Diseases and factors.

• Recurring pyelonephritis
• Polycystic kidney disease
• Autoimmune disorders such as Systemic Lupus Erythematosus and Purpura
• Hardening of the arteries, which can damage blood vessels in the kidney
• Urinary tract blockages and reflux, due to frequent infections, stones, or an anatomical abnormality that happened at birth
• Excessive use of medications that are metabolized through the kidneys

 

What are the Symptoms of Kidney Failure

• Itching (pruritus) and dry skin
• Headaches
• Weight loss without trying
• Loss of appetite
• Nausea
• Other symptoms may include:
• Abnormally dark or light skin
• Nail changes
• Bone pain
• Drowsiness and confusion
• Problems concentrating or thinking
• Numbness in the hands, feet, or other areas
• Muscle twitching or cramps
• Breath odor
• Easy bruising, nosebleeds, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia, restless leg syndrome, or obstructive sleep apnea
• Swelling of the feet and hands (edema)
• Vomiting, especially in the morning
• Metallic taste in mouth
• Abdominal pains

 

Treatment

The first step in the treatment of chronic kidney disease is to determine the underlying cause. Some causes are reversible, including use of medications that impair kidney function, blockage in the urinary tract, or decreased blood flow to the kidneys. Treatment of reversible causes may prevent CKD from worsening.
Research has shown that management of chronic kidney disease is best done with the assistance of a nephrologist, a doctor who specializes in kidney diseases. Early referral to a nephrologist decreases the chance of developing complications associated with chronic kidney disease.

• Hypertension — Hypertension, or high blood pressure, is present in 80 to 85 percent of people with chronic kidney disease. Maintaining good blood pressure control is the most important goal for trying to slow progression of CKD. Taking a medication called an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) reduces blood pressure and levels of protein in the urine, and is thought to slow the progression of chronic kidney disease to a greater extent than some of the other medicines used to treat high blood pressure. Sometimes, a diuretic (water pill) or other medication is also added. You may be asked to monitor your blood pressure at home to be sure that your blood pressure is well controlled.
• Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
• Anemia — People with chronic kidney disease are at risk for anemia. This occurs because improperly functioning kidneys produce reduced amounts of a substance called erythropoietin. Anemia can lead to fatigue and other complications.
• Selected patients can be treated with drugs that stimulate production of red blood cells. You or a family member can inject these drugs at home. In some cases, iron supplements are also prescribed
• Dietary changes — Changes in your diet may be recommended to control or prevent some of the complications of chronic kidney disease; most important is salt restriction to help control the blood pressure.
• Protein restriction — Restricting protein in the diet may slow the progression of chronic kidney disease, although it is not clear if the benefits of protein restriction are worth the difficulty of sticking to a low protein diet. Although a reduced protein diet may delay dialysis for several years, the unappetizing nature of the diet is difficult for most people to tolerate. Speak to your healthcare provider about the advantages and disadvantages of a low protein diet.
• Salt restriction: Limit to 2 to 4grams a day to avoid fluid retention and help control high blood pressure
• High potassium — Some people with chronic kidney disease develop a high blood potassium level, which can interfere with normal cell function. This is frequently treated with a diuretic. Measures to prevent high potassium might also be recommended, including a low potassium diet and avoiding medicines that raise potassium levels.
• High phosphate — Phosphate is a mineral that helps to keep the bones healthy. Early in the course of chronic kidney disease, the body begins to retain phosphate. As the disease progresses, high blood phosphate levels can develop. This is usually treated with medicines that prevent phosphate (found in foods) from being absorbed in the digestive tract. Dietary phosphate restrictions are also recommended
• High cholesterol and triglycerides — High cholesterol and triglyceride levels are common in people with kidney disease. High triglycerides have been associated with an increased risk of coronary artery disease, which can lead to heart attack.Treatments to reduce the risk of coronary artery disease are usually recommended, including dietary changes, medications for high triglyceride and cholesterol levels, stopping smoking, and tight blood sugar control in people with diabetes.
• Sexual function — Men and women with advanced chronic kidney disease often have difficulties with sexual function and infertility. Over 50 percent of men with end-stage kidney disease have difficulties with erection and decreased sex drive. Women often have disturbances in the menstrual cycle and fertility, usually leading to a stop in menstrual periods. Decreased sex drive may also occur in women. You should discuss any changes in your sexual function with your healthcare provider because medications or other treatments may be effective
• Pregnancy — The risk that pregnancy will worsen kidney function, or that decreased kidney function will interfere with pregnancy depends upon a number of factors. A woman with mild to moderate chronic kidney disease who is considering becoming pregnant should discuss the possible risks with her nephrologist and obstetrical provider before trying to conceive. Women with end-stage kidney disease who are on dialysis and who become pregnant are at very high risk for miscarriage, premature delivery, severe hypertension, and preeclampsia. A woman who undergoes successful renal transplantation has a lower risk of these complications. It may be advantageous for a woman to delay becoming pregnant while on hemodialysis if renal transplantation in the near future is likely.

 

Other important measures that a patient can take include:

Carefully follow prescribed regimens to control blood pressure and/or diabetes;
stop smoking; and  lose excess weight.
In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:

• Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
• Fleets or Phospho-Soda enemas because of their high content of phosphorus
• Laxatives and antacids containing magnesium and aluminum such as magnesium hydroxide (Milk of Magnesia) and magnesium and aluminum hydroxide (Mylanta)
• Ulcer medication H2-receptor antagonists: cimetidine (Tagamet) and ranitidine (Zantac) (decreased dosage with kidney disease)
• Decongestants such as pseudoephedrine (Sudafed) and phenylpropanolamine (Rhindecon) especially if the patient has high blood pressure
• Alka Seltzer, since this contains large amounts of sodium
• Herbal medications

If a patient has a condition such as diabetes, high blood pressure, or high cholesterol underlying chronic kidney disease, they should take all medications as directed and see their health care practitioner as recommended for follow-up and monitoring.