Kidney Failure

Causes of acute kidney failure

• Rhabdomyolysis, kidney damage that can happen from muscle breakdown due to severe dehydration, infection, or other causes

• Decreased blood flow to the kidneys from blood loss or shock

• A blockage along the urinary tract

• Hemolytic uremic syndrome, blockage of the small vessels in the kidney, often caused by an E. coli infection

• Infection or certain medicines that may be toxic to the kidneys

• Glomerulonephritis, inflammation of the tiny units within the kidney where blood is cleaned—it impairs the kidney’s ability to filter urine

• Any condition that impairs the flow of oxygen and blood to the kidneys, such as a heart attack

Causes of chronic kidney failure

• Diabetic nephropathy, kidney damage due to high blood sugar

• High blood pressure

• Lupus, an immune system disease

• Urinary track blockage

• Alport syndrome, a genetic disorder

• Nephrotic syndrome, a condition that leads to too much protein in the urine

• Polycystic kidney disease, a genetic disorder that causes fluid-filled cysts in the kidneys

• Cystinosis, a genetic problem in which the amino acid builds up within the cells in the kidneys

• Interstitial nephritis or pyelonephritis, inflammation of the small structures in the kidney

Symptoms of acute kidney failure (symptoms depend on the underlying cause)

• Fever

• Weakness

• Fatigue

• Rash

• Diarrhea

• Poor appetite

• Severe vomiting

• Abdominal pain

• Back pain

• Muscle cramps

• No urine output or high urine output

• Pale skin

• Nosebleeds

• Inflammation of the eye

Symptoms of chronic kidney failure

• Poor appetite

• Vomiting

• Bone pain

• Headache

• Insomnia

• Itching

• Dry skin

• Fatigue with light activity

• Muscle cramps

• High urine output or no urine output

• Urinary incontinence

• Pale skin

• Bad breath

• Hearing problems

• Irritability

• Poor muscle tone

• Change in mental alertness

• Metallic taste in mouth

The symptoms of acute and chronic kidney failure may look like other health problems. Always talk with your healthcare provider for a diagnosis. You may be referred to a kidney specialist called a nephrologist.

Dialysis

Dialysis is used to treat both acute and chronic kidney failure. It involves removing waste substances and fluid from the blood that are normally removed by the kidneys. Dialysis may also be used for people who have been exposed to or ingested toxic substances. In this case, dialysis is used to prevent kidney failure. There are 2 types of dialysis: peritoneal and hemodialysis.

Peritoneal dialysis

Peritoneal dialysis is done by surgically placing a soft, hollow tube, called a catheter, into the lower abdomen near the navel. A solution called dialysate is passed through the tube into the peritoneal cavity. This is the space in the abdomen that houses the organs. It's lined by 2 membrane layers called the peritoneum. The solution is left in the abdomen for a certain amount of time. There, it soaks up the waste products and toxins through the peritoneum. The fluid is drained from the abdomen, measured, and discarded. There are 3 different types of peritoneal dialysis:

• Continuous ambulatory peritoneal dialysis (CAPD). This type does not need a machine. Exchanges, often called passes, can be done 3 to 5 times a day during waking hours.

• Continuous cyclic peritoneal dialysis (CCPD). This type needs a dialysis machine that can be used in the home. This type of dialysis is done automatically, even while you are asleep.

• Intermittent peritoneal dialysis (IPD). IPD uses the same type of machine as CCPD, but treatments take longer. IPD can be done at home, but it is usually done in the hospital.

Possible complications of peritoneal dialysis include an infection or inflammation of the peritoneum. This is called peritonitis. It causes fever and stomach pain.

A dietitian will help you plan your meals based on your healthcare provider's orders. Generally:

• You may have special protein, salt, and fluid needs.

• You may have special potassium restrictions.

• You may need to cut calories. The sugar in the dialysate may cause weight gain.

Hemodialysis

Hemodialysis can be done at home or in a dialysis center or hospital. An access site is surgically made, usually in your arm. This involves joining an artery and a vein together. After access has been made, you will be connected to a large hemodialysis machine. It drains the blood. The blood is bathed in a dialysate solution that removes waste substances and fluid. Then the clean blood is returned to your bloodstream.

Hemodialysis is usually done several times a week and lasts for 4 to 5 hours. During treatment, you can read, write, sleep, talk, or watch TV. At home, hemodialysis is done with the help of a partner, often a family member or friend. If you choose to do home hemodialysis, you and your partner will get training. Possible complications of hemodialysis include muscle cramps and a sudden drop in blood pressure. This may cause you to feel dizzy, weak, or sick to your stomach.

By following your diet and taking medicines as prescribed by your healthcare provider, you may be able to prevent complications. A dietitian will work with you to plan your meals, according to your healthcare provider's orders. Generally:

• You may eat foods high in protein such as meat and chicken (animal proteins).

• You may need to limit foods containing potassium.

• You may need to limit the amount you drink.

• You may need to stay away from salt.

• You may need to limit foods that have mineral phosphorus (such as milk, cheese, nuts, dried beans, and soft drinks).

Other treatment choices may include:

• Medicines (to help with growth, prevent bone density loss, and treat anemia)

• Diuretic therapy (medicines to increase urine output)

• Specific diet changes

• Kidney transplant