Kidneys are pair of vital organs in your body that is responsible for purifying the blood by filtering the waste products from it. It also helps in regulating Blood Pressure and in maintaining electrolyte balance in the body. They are small bean shaped organs found below the abdomen at the back of your body, just below the spine. If the kidneys do not function properly, it leads to accumulation of waste products in the blood causing various complications.
There are sensors present in the kidney that controls the output of urine from the body. Kidney would efficiently retain water when the person is in dehydrated condition. On normal conditions, the urine will be very dilute and clear. Kidneys are in charge of stimulating the production of red blood cells in the body and it also controls the volume of oxygen to be present in blood. There are many causes for kidney failure and some can be fully treated. But in some cases kidney failure cannot be reversed. Keeping the blood sugar level and blood pressure in control can help in preventing kidney failure.
Symptoms :
If there is an excess amount of waste products in the blood due to improper functioning of kidney or kidney failure, it can produce symptoms like shortness of breath, reduced urine output, building up of body fluids resulting in swelling of legs, extreme tiredness, confusion, and nausea and chest pain. In rare cases it can cause seizures and even coma due to kidney failure. However in some cases kidney failure may not show any symptoms and will be detected during tests done for other illness.
Causes and Types :
Kidney failure can be acute (fast and sudden) or chronic (slow occurring as a process). Kidney failure can occur due to other complications in the body or due to damage to the kidneys. Acute kidney failure can develop due to reduced blood flow to the kidney. This can occur due to Hypovolemia (reduction in total blood volume), loss of bodily fluids leading to sudden dehydration (can be caused by Diarrhea and vomiting), insufficient intake of fluids, and taking diuretic drugs for long term (which causes loss of water).
Acute kidney failure can occur due to sudden Heart Attack, Stroke, heart disease and liver failure. This can directly reduce the blood flow to the kidneys. Sometimes damage done to the kidney can cause kidney failure. Examples of such case include Sepsis (when the immunity of the body gets hampered due to severe infection), intake of certain drugs like NSAIDS (Brufen or naproxen) antibiotics (garamycin) and lithium can cause toxicity in kidney leading to kidney failure. Kidney can get affected directly due to Multiple Myeloma (cancer affecting plasma cells), certain types of blood disorders, heavy toxic substances like cocaine and heavy metals, and inflammation of blood vessels.
If there is considerable muscle loss in the body due to trauma or injury like burns it can lead to clogging of muscle fiber in the kidney affecting the filtering ability of the kidney. Certain diseases like systemic lupus and granulomatosis and alter the normal filtering capacity of kidneys. Post renal causes of kidney failure can affect the body’s output of urine. When normal output of urine gets affected due to certain conditions it can cause acute kidney failure.
Reasons include block in the bladder/ureter (a tube that carries urine), prostatic hypertrophy (Prostate Cancer), any tumor in the ureter region, formation of Kidney Stones. This can affect the normal outflow of urine leading to accumulation of toxic materials in the kidney. Chronic kidney failure is one that develops slowly as a process. It might take months or sometimes years for the failure to progress. Some of the underlying causes include prolonged diabetes and blood pressure that is not managed properly, reflux nephropathy, prostate disease and development of cyst in kidneys.
Who Are At Risk?
People with prolonged diabetes, prolonged blood pressure, elderly people, people with heart disease, people with Peripheral Artery Disease, people living with kidney or liver disease and those who are in intensive care for long time are prone to develop kidney failure. As long as you manage BP and diabetes effectively through medications, you have less chance of developing kidney failure. Kidney failure can lead to complications like excess of fluid retention in the body, muscle weakness, chest pain, permanent kidney damage and even death.
Tests :
Your doctor may order for few tests based on your symptoms and health condition. He would recommend urine and blood analysis, urine output test, imaging tests like CT scan and in rare cases biopsy of kidney sample. Increased level of sodium or creatinine in blood indicates improper kidney function.
Treatment :
Your doctor will identify the root cause of kidney failure before starting any treatment. Acute kidney failure may require inpatient treatment in hospital for few days. If there is any complication in the body due to kidney failure, your doctor will have to treat it first to prevent further damage. In case of acute dehydration or loss of body fluids in blood, your doctor will put you on IV fluids until your kidneys fully recover.
In case of excess accumulation of body fluids in blood leading to swelling, your doctor will immediately start diuretics to get rid of extra fluids from the body. Medications are prescribed to manage blood potassium levels. High levels of potassium in blood can cause irregular heartbeat. If the medications fail to manage the function of kidneys, dialysis will be done.
Dialysis :
Temporary dialysis or hemodialysis will be done to expel toxic substances from your blood until your kidneys can function normally. In this process a dialyzer machine is used to expel excess of water and salt from the body. This process helps in removing excess of waste products from the body and helps in maintaining the electrolyte balance. Blood from the body is sent through a special tube fitted to a machine which then filters the blood by means of chemical solution.
This would remove the impurities and toxic substances from the blood. For this procedure, the surgeon would open a large artery and vein from particular spot in your body to expel volumes of blood from the body. Not all the patients are fit for hemodialysis. For some people, in the place of fistula, catheters are inserted into the blood vessel of leg or arm and the catheters are kept intact for 2-3 weeks or even more. Depending on the severity of toxicity and impurities in the blood, dialysis will be done 2-3 times in a week.
Peritoneal Dialysis :
In this procedure, catheter is kept in the abdominal cavity via a small hole in the abdominal wall. The specialized chemical solution used in dialysis will be then sent into the catheter by dripping method which would then be drained out after few hours. Peritoneum is the soft lining of the abdomen through which the entire process takes place. Your doctor will decide about the type of dialysis after considering the kidney’s function and health condition.
Surgery :
In case the damage done to the kidneys become irreversible, transplantation of kidney will be done. For undergoing kidney transplant, firstly you should find out suitable donor. Kidney transplantation surgery is the only option available for patients who are not suitable for dialysis. Success rate depends on many factors like age, health, and immune system of your body. Sometimes the body may not accept the transplanted (new) kidney and it may not work properly.
Lifestyle Changes :
Once you know that your kidneys are not working well, you need to follow the instructions of your doctor with respect to diet. You need to know what are the foods to be avoided and about the foods that you can take liberally. Foods that contain salt or potassium should be restricted or totally avoided. Similarly one has to limit calcium intake to prevent Osteoporosis.
You can take foods like cabbage, apples, green beans and grapes liberally since they contain low levels of potassium. Restrict the amount of salt intake as per the suggestions of your dietician. Taking phosphorus rich foods like milk, cheese and nuts can weaken your bones leading to fractures. So, make suitable changes in your daily diet.
Outlook :
Often kidney failure caused by obstruction in the pathways like ureter or bladder can be treated fully and the kidney would get back to normal function after treatment. In case the underlying medical issues like diabetes or Hypertension is the cause for kidney failure, you need to take prescribed drugs to manage the blood glucose level and blood pressure.
Prevention :
You can prevent acute kidney failure by maintaining your blood sugar level and blood pressure level at optimum. Follow the instructions of your doctor in taking medications. Stick on to healthy diet pattern and do regular exercises.
