Kidney failure occurs when these organs cease to remove toxic wastes from the blood and excrete it in the urine. There are many causes of kidney failure but it follows one of two courses:
Acute kidney failure comes on suddenly. There is an abrupt decrease in urination and widespread swelling, or edema. Warning signs include unexplained weight gain of two or more pounds a day, facial puffiness, nausea, and marked weakness, As the failure progresses, the breath may have a urine odor. This is a life threatening medical emergency, yet most patients eventually recover kidney function. About 60 percent of cases are associated with surgery or an injury that causes shock. Other precipitating conditions include severe kidney infection or injury, dehydration or heatstroke, poisoning, extensive burns, and failure of other organ systems. Acute kidney failure can also be a complication of pregnancy, especially if the woman has preeclampsia, or toxemia.
Chronic kidney failure develops slowly and is usually irreversible. The early stages may produce no noticeable symptoms. As the condition worsens, fatigue, lethargy, and headaches occur, possibly with muscle twitches, cramps, numbness, or pain in the arms or legs. In contrast to the weight gain of acute failure, the patient experiences loss of appetite and weight, nausea, vomiting, and a bad taste in the mouth. Glomerulonephritis, in which the kidney’s filtering units (nephrons) are gradually destroyed by chronic inflammation, is the most common cause of chronic kidney failure. Other causes include diabetes, high blood pressure, and such kidney disorders as hereditary polycystic kidney disease.
Diagnostic Studies And Procedures
Diagnosis requires a complete physical examination, as well as urine and blood tests, X-rays, kidney scans, and in some cases, a kidney biopsy.
Medical Treatments
Whatever the type and cause of kidney failure, renal dialysis must be performed to remove the buildup of waste products in the blood, a process called uremia. In acute failure, reatment of the underlying cause usually allows the kidneys to recuperate and return to normal function, thus ending the need for dialysis. In the case of chronic progressive failure, however, dialysis must continue for the rest of a patient’s life, unless a kidney transplant is under taken. There are two major types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, the blood is filtered through a membrane in an artificial kidney machine. First, an artery and vein in either an arm or a leg are joined under the skin to form a fistula. Then a small tube, or shunt, is inserted into the fistula so that the machine can be attached to the body. During the procedure, blood is drawn from the artery, through the shunt, and into tubes that take it to an artificial kidney, where it is cleansed by a fluid called dialysate and then returned to the body through the vein. Depending on the level of kidney failure and the achines being used, a hemodialysis session can take from three to eight hours and generally must be performed several times a week. It can take place in a hospital, an out patient kidney ialysis center, or the patient’s residence with a home dialysis machine.
The last usually requires the assistance of someone who is trained in the use of the machine. Even so, most people find home dialysis less expensive than going to a dialysis center and also more convenient, as it can be done at night while they sleep. An added convenience is that a portable home achine can be used when traveling. Otherwise, advance arrangements must be made to have dialysis performed at an out of town site when a patient travels for more than two or three days. Peritoneal dialysis involves using the peritoneum, the membrane that lines the abdomen, for filtering wastes. To provide access to it, a small incision is made in the wall of the abdomen and a permanent opening is established with a soft plastic tube. During dialysis, the peritoneal sac is filled with a special fluid that helps draw off waste material. This fluid is washed in and out of the abdomen in cycles. Three techniques are used for this type of dialysis. Intermittent peritoneal dialysis (IPD) lasts 10 to 14 hours and is done in a hospital or clinic three times a week.
Another method, continuous ambulatory peritoneal dialysis (CAPD), can be performed at home. This is an ongoing process in which the person always has about two quarts of dialysis fluid in the abdomen. The fluid is changed manually three or four times a day, with each fluid exchange taking 20 to 40 minutes. In automated peritoneal dialysis (APD), a more recent innovation, a cycler machine performs the dialysis while the patient sleeps. This system usually eliminates the need for fluid exchanges during the day. A doctor must monitor blood levels of phosphate, potassium, and other electrolytes at regular intervals, because these substances, essential to maintaining normal body chemistry, often become imbalanced during kidney failure. The physician will recommend supplements as needed. Because kidney failure also increases the risk of anemia, blood tests must be done frequently, and erythropoietin may be prescribed. This hormone, which is normally produced by the kidneys, helps prevent anemia by stimulating the bone marrow to make red blood cells. A kidney transplant is an alternative to long-term dialysis. This is the treatment of choice for chronic kidney failure, but donor kidneys can be difficult to find.
The best chance for achieving a successful transplant rests with receiving a kidney from a living donor, preferably a relative whose body tissues are genetically compatible so that the chances of rejection are reduced. Healthy people require only one kidney to function, but only 20 percent of those needing a kidney transplant have a relative who is an acceptable donor. Most transplant candidates go on a waiting list to receive a healthy cadaver kidney taken from someone within minutes of dying, usually as the result of an accident. A shortage of cadaver kidneys forces many transplant candidates to wait years for one. The transplanting of a kidney is major surgery, requiring general anes thesia and lasting two to three hours.
After removal from a donor, a kidney must be transplanted within 18 hours. In most cases, the failed kidneys are left in place, with the transplanted kidney positioned much lower in the abdomen than normal. The donor kidney also must be attached to blood vessels the internal iliac artery, which supplies blood to the pelvic organs, and the external iliac artery and vein, which serve the legs. The majority of kidney transplants are successful, allowing the recipient to lead a relatively normal life. But about one third of transplanted kidneys temporarily cease to function for a time ranging from a few days to two weeks. In a few cases, the kidneys will never resume functioning, necessitating con tinued dialysis or a second transplant. Most transplant recipients leave the hospital in two to three weeks to continue recuperation at home. In the first few weeks after surgery, patients have blood tests several times a week to monitor for signs of organ rejection. They must also take powerful immuno suppressive drugs for the rest of their lives to prevent rejection. Because these drugs increase the risk of infection and cancer, regular checkups are necessary.
Alternative Therapies
Kidney failure always requires careful medical treatment directed by a nephrologist, a specialist in kidney disease. Thus, any alternative practitioners should be a part of the treatment team.
Herbal Medicine
Uvaursi, or bearberry, is an old remedy for irritation and inflammation of the urinary tract. Practitioners recommend one or two capsules of uvaursi extract three or four times a day to treat nephritis, which can cause kidney failure.
Nutrition Therapy
A nutritionist or clinical dietitian trained in treating kidney failure should be enlisted to plan a diet. In particular, protein intake must be carefully regulated because too much places a heavy burden on the kidneys. Fluids may be restricted. Also, the diet should be low in salt and phosphorus, and potassium levels must be carefully monitored. Vitamin and mineral supplements may be advised. Some dietary restrictions might be adjusted for patients who undergo a kidney transplant. For example, protein intake should actually be increased after surgery to prevent a breakdown of muscle tissue caused by steroid medications, which are often given to help prevent rejection.
Tai Chi
This or some other gentle exercise program can help counter the loss of muscle mass and weakness that often accompanies kidney failure. Exercise is also important to prevent bone loss caused by steroids and other drugs given to kidney transplant patients.
Self Treatment
- In addition to adhering consistently to any dietary restrictions, self care centers on maintaining overall good health and controlling any underlying condition that contributes to kidney failure.
- If you have high blood pressure or diabetes, two common causes of chronic kidney failure, be especially diligent about keeping them in check.
- If you require long term dialysis, learn how to do home dialysis.
- If you have flaky skin, a common problem for people with chronic kidney failure, apply a moisturizer after bathing and bathe in lukewarm, rather than hot, water.
- If you are a woman suffering from chronic kidney failure, practice scrupu lous birth control because pregnancy presents an increased risk of complications for both you and the fetus.
Other Causes of Kidney Failure
A number of conditions can cause urinary symptoms, including an enlarged prostate, bladder or kidney stones, urinary tract infection or tumors, and an obstruction of the ureters, the tubes that carry urine from the kidneys to the bladder. If untreated, these disorders can damage the kidneys.