KIDNEY  FAILURE  (Acute or chronic  renal  failure)



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Kidney failure occurs when these organs cease to remove toxic wastes from the blood and excrete the same in the urine. Though there are mainy causes of kidney failure, it invariably follows one of these two courses > Acute kidney failure comes on suddenly. There is an abrupt decrease in urination and widespread swelling all over the body (edema). Warning signs include unexplained weight gain of about 2 or more pounds a day, facial puffiness, nausea, and marked weakness. As the failure progresses, even the person's breath may develop a urine-like odor. This definitely is a life-threatening medical emergency, yet most of the patients eventually recover almost full kidney function. About 60% of such cases are associated with surgery or an injury that causes sudden shock. Other precipitating conditions may include severe kidney infection or injury, dehydration or heatstroke, poisoning, severe burns, and even failure of some other organ systems. Acute kidney failure may also be a complication of pregnancy, especially if the mother has pre-eclampsia, or uremic 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 may occur, possibly with muscle twitches, cramps, numbness, or pain in the arms or legs. In contrast of the weight gain of acute renal failure, the patient experiences loss of appetite & 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 poorly controlled diabetes, high blood pressure, prolonged use of NSAIDs, and such kidney disorders as hereditary polycystic kidney disease.

The diagnostic procedures for renal failure (acute or chronic) require a complete physical examination, as well as urine & blood tests, X-rays, kidney scans, and in some cases, even a kidney biopsy.

In most cases, kidney failure is caused by other health problems that have done permanent damage (harm) to your kidneys little by little, over time. When your kidneys are damaged, they may not work as well as they should. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease, or ESRD for short. Diabetes is the most common cause of ESRD. High blood pressure is the second most common cause of ESRD. Other problems that can cause kidney failure include : autoimmune diseases, such as lupus and IgA nephropathy, genetic diseases, such as polycystic kidney disease, nephrotic syndrome, urinary tract problems

Sometimes the kidneys can stop working very suddenly (within two days). This type of kidney failure is called acute kidney injury or acute renal failure. Common causes of acute renal failure include: heart attack, drug abuse, not enough blood flowing to the kidneys, urinary tract problems. This type of kidney failure is not always permanent and kidneys may attain normal to almost normal functioning with treatment, especially if you do not have other serious health problems. Having one of the health problems that can lead to kidney failure does not mean that you will definitely have kidney failure. Living a healthy lifestyle and working with your doctor to control these health problems can help your kidneys work for as long as possible.

Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body. You may notice one or more of the following symptoms if your kidneys are beginning to fail : itching, muscle cramps, unexplained nausea and/or vomiting, loss of apetite, swelling in your feet and ankles (angiodema), too much (polyuria) or too little urine (oligouria), respiratory distress at rest, or even insomnia. If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms : abdominal (belly) pain, back pain, diarrhea, persistent fever, nosebleeds (linked to hypertension), body rashes, nausea and/or vomiting. Having one or more of any of these symptoms may well be a sign of serious kidney problems.

Treatment of kidney failure ; ESRD requires ambulatory dialysis or a kidney transplant to survive. There is no cure for ESRD, but many people live long lives while having dialysis (several types) or after having a renal transplant. Dialysis helps to do some of the work that your kidneys did when they were healthy, but it cannot do everything that healthy kidneys do. Therefore, even when you are on dialysis, you will need to limit what and how much you eat and drink. Your diet needs may depend on the type of dialysis you are on (hemodialysis or peritoneal dialysis) and your treatment schedule. Kidneys perform many jobs to keep you healthy - cleaning your blood of all waste (mostly nitrogenous) is only one of their jobs. They also control chemicals and fluids in your body, as also the vital function of maintaining plasma & tissue fluids' electrolyte balance, help control blood pressure and also help making of red blood cells through the process of erythropoiesis. Dialysis can meet only some, not all, of the requirements expected of our healthy kidneys. So even the basic & essential clinical treatment for kidney failure may leave some problems unresolved. You nephrologist will look into these issues and keep advising you periodically.