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About 4.5 million American adults, or 2% of the American adult population, have been diagnosed with kidney disease. About 46,000 Americans die annually of kidney disease, the ninth-leading cause of death.
 

Acute Kidney Failure

Acute kidney failure is the kidneys' loss of ability to filter the blood within a few days. This quickly results in the accumulation of dangerous amounts of water, salts, and wastes in the body.


Acute kidney failure is most common in people who are already critically ill. It may be fatal, and requires immediate treatment. However, many otherwise healthy people have regained normal kidney function after acute kidney failure.


Symptoms

Symptoms of acute kidney failure may include:


  • Decreased urine output
  • Swelling in feet, ankles, or legs
  • Drowsiness and fatigue
  • Shortness of breath
  • Nausea
  • Confusion
  • Chest pressure or pain

Sometimes, acute kidney failure has no symptoms, but is detected through tests done in response to unrelated symptoms.


Risk factors

Acute kidney failure may be caused by a condition that directly damages the kidneys, like dehydration; a slowing of blood flow to the kidneys; or blockage of urine's path from the kidneys.  Risk factors include:


  • Hospitalization, especially in intensive care
  • Advanced age
  • Blockages in peripheral arteries
  • Blockages in urinary excretion
  • Infections
  • Cancer
  • Autoimmune diseases, such as lupus
  • Diabetes
  • High blood pressure
  • Heart attack
  • Liver disease
  • Kidney disease
  • Certain drugs or chemicals (such as contrast dye used in certain radiographic studies)

Diagnosis

Tests your WellStar physician may use to diagnose kidney failure include:


  • Measuring urine output
  • Urine tests
  • Blood tests for high levels of urea and creatinine
  • Imaging, such as computerized tomography (CT) or ultrasound
  • Biopsy of a sample of kidney tissue extracted with a thin needle

Treatment

Treatment for acute kidney failure depends on the underlying condition that originally damaged your kidneys, and may include mitigation of the chemical imbalances resulting from the failure. It may require hospitalization.


If the kidney failure was caused by dehydration, you may be given intravenous fluids. If it was caused by too much fluid, you may be given a diuretic.


Kidney failure sometimes results in accumulation of potassium in the blood. Treatments, such as calcium, prevent this accumulation. Kidney failure also may result in calcium deficiency, in which case calcium may also be prescribed. Dialysis may be required to remove toxins from the blood.


Chronic Kidney Failure

Chronic kidney failure is the gradual loss of kidney function, resulting in the accumulation of water and wastes in your body. Since kidneys are very adaptable, early stages may have no symptoms. The disease may not be noticed until it has progressed significantly and possibly irreversibly.


Symptoms

Symptoms of acute kidney failure may include:


  • Decreased or no urine output
  • Swelling in feet, ankles, or legs
  • Drowsiness and fatigue
  • Difficulty sleeping
  • Nausea
  • Vomiting
  • Confusion
  • Persistent itching

Risk factors

Conditions that may lead to chronic kidney failure include:


  • Diabetes
  • High blood pressure
  • Certain drugs (often due to non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen) and chemicals
  • Enlarged prostate
  • Kidney and bladder cancer
  • Urinary blockage
  • Blockage in the artery that carries blood to the kidneys
  • Lupus
  • Scleroderma
  • Kidney stones

Besides these direct causes, other risk factors include:


  • Being of African, Asian, or American Indian descent
  • Family history of kidney disease
  • Age over 65
  • Heart disease
  • High cholesterol
  • Smoking
  • Obesity

Diagnosis

Tests your WellStar physician may use to diagnose kidney failure include:


  • Urine tests
  • Blood tests for high levels of urea and creatinine
  • Imaging, such as computerized tomography (CT) or ultrasound
  • Biopsy of a sample of kidney tissue extracted with a thin needle

Treatment

There is no cure for chronic kidney failure, but treatment can alleviate symptoms, reduce complications, and slow progression. If the underlying condition that caused your kidneys to begin to fail is treatable, such as high blood pressure, your WellStar physician will help you control that condition. However, any kidney damage that has occurred before treatment can cause the kidneys'condition to continue to worsen.

Complications of kidney failure can often be controlled to improve quality of life, and to slow further progression of the disease. In particular, some complications, like high blood pressure and high cholesterol can worsen the condition of the kidneys. Treatment will attempt to break this vicious cycle.


Treatments of complications of kidney failure include:


  • Controlling high blood pressure. Chronic kidney failure is often accompanied by increasing blood pressure, which can be controlled with medications to inhibit angiotensin-converting enzyme (ACE) or block angiotensin II reception. These medications can themselves impact kidney function, so you may be given blood tests to monitor your kidneys'condition.
  • Lowering cholesterol through statins and a low-cholesterol diet.
  • Increasing production of red blood cells. If your kidney failure has caused anemia (low red blood cell count), resulting in fatigue, you may be prescribed erythropoietin, a hormone that induces production of red blood cells.
  • Reducing swelling caused by fluid retention. If you are retaining fluids, you may be given diuretics.
  • Medications to protect bone health. Kidney failure often affects the balance of calcium and potassium in the blood, causing bone loss. Calcium and vitamin D supplements as well as potassium binders help ensure that there is enough calcium to keep your bones strong.
  • Reducing the volume of waste products in the blood with a low-protein diet. You will likely meet with a WellStar dietitian to help you plan a diet to reduce kidney stress.
  • Avoiding medications that worsen kidney function.

End-stage kidney failure is when kidneys have less than 15 percent of normal function. At this point, replacing their function, either through dialysis or transplant, becomes necessary:


  • Dialysis is the artificial removal of waste and excess water from your blood.
  • Hemodialysis is pumping blood from your body, through a machine that performs these functions, and back into your body.
  • Peritoneal dialysis is the pumping of a solution that absorbs waste products and excess water into your abdomen, removing it when it has bound the waste and fluids.
  • Kidney transplant. If, besides your kidney failure, you are generally healthy, one of your failed kidneys may be replaced with a normal kidney from a living or dead donor.
 

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