Renal Failure

Renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease); a number of other diseases or health problems may cause either form of renal failure to occur.

Renal failure is described as a decrease in the glomerular filtration rate. Biochemically, renal failure is typically detected by an elevated serum creatinine level. Problems frequently encountered in kidney malfunction include abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium, phosphate, and (in the longer term) anemia. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may occur. Long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease.

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Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Renal failure accompanied by noticeable symptoms is termed uraemia.

Symptoms of kidney failure include: 

High levels of urea in the blood, which can result in:

Vomiting and/or diarrhea, which may lead to dehydration/ Nausea/ Weight loss, Nocturnal urination, Foamy or bubbly urine/ More frequent urination, or in greater amounts than usual, with pale urine, Less frequent urination, or in smaller amounts than usual, with dark coloured urine, Blood in the urine/Pressure, or difficulty urinating, Unusual amounts of urination, usually in large quantities.

A build-up of phosphates in the blood that diseased kidneys cannot filter out, and may cause:

Itching, Bone damage, Muscle cramps (caused by low levels of calcium which can cause hypocalcaemia).

A build-up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia), and may cause:

Abnormal heart rhythms, muscle paralysis.

Failure of kidneys to remove excess fluid, and may cause:

Swelling of the legs, ankles, feet, face and/or hands, Shortness of breath due to extra fluid on the lungs (may also be caused by anemia).

Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:

Pain in the back or side.

Healthy kidneys produce the hormone erythropoietin which stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:

Feeling tired and/or weak, Memory problems, Difficulty concentrating, Dizziness, Low blood pressure.

Other symptoms include: Appetite loss, a bad taste in the mouth, Difficulty sleeping, Darkening of the skin.

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Acute Renal Failure

Acute kidney failure usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute failure include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Chemotherapeutics, may also cause the onset of acute kidney failure. Unlike in chronic kidney disease, however, the kidneys can often recover from acute failure, allowing the patient to resume a normal life. People suffering from acute failure require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.

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Babu, Sateesh C., MD
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Arun Goyal, MD
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Igor Laskowski, MD
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