This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

KIDNEY FAILURE

The kidneys clean wastes from the blood and eliminate them through the urine. They also regulate body fluids, help to make red blood cells, and keep calcium and phosphorous levels in balance.

Kidney failure occurs when the kidneys are unable to filter waste materials from the blood. Acute kidney failure comes on suddenly. Symptoms can be severe but it usually lasts for only short time, and recovery is possible. Chronic kidney failure develops over a longer period of time. When the kidneys cannot properly clean wastes from the blood, the matter builds up and causes a toxic condition known as uremia.

WHAT CAUSES KIDNEY FAILURE?

Each kidney is made up of groups of tiny blood vessels (nephrons) that filter wastes from the blood in the form of urine. The urine then passes through a small tube into the bladder and out of the body through the urethra. Kidney failure occurs when the nephrons become inflamed, a condition known as nephritis.

Most cases of acute kidney failure are due to the blood and fluid loss that follow trauma (a physical injury) or surgery. Acute kidney failure can also result from exposure to toxins, serious infections, kidney diseases, an overdose of drugs, the use of certain medications, or obstructions in the flow of urine.

Chronic kidney failure comes on slowly so that symptoms may not appear until normal kidney function is greatly reduced. This type of failure can result from chronic nephritis, urinary infections, complications of diabetes, hardening of the blood vessels in and around the kidneys, polycystic kidney disease, systemic lupus erythematosus, or an overdose of drugs or chemicals.

WHO GETS KIDNEY FAILURE?

Kidney failure affects people of both sexes and all ages. Over half the people with diabetes mellitus experience kidney failure. Since the condition can be caused by a variety of illnesses and traumas, anyone can develop it.

WHAT ARE THE SYMPTOMS?

An early sign of acute kidney failure is trouble urinating, an indication that the body is retaining fluids and wastes. Other symptoms include intense itching, easy bruising and bleeding, nausea, diarrhea, loss of appetite, seizures, intestinal bleeding, and coma.

By the time symptoms of chronic kidney failure appear, the kidneys may have lost up to three-quarters of their normal function. Symptoms include confusion, high blood pressure, muscle cramps, difficult breathing, itching, burning and tingling in the feet and legs, anemia, bleeding, brittle bones, lowered sex drive, and failure to menstruate in women.

DIAGNOSING KIDNEY FAILURE

The doctor will take several tests to determine the cause of your condition. Urine and blood tests will be taken, as will a test called the GFR, which measures how much water is filtering through the kidneys. You may be injected with a dye, after which x-rays are taken every few hours to see how long it takes the kidneys to filter the dye out. These x-rays will also show any blockages that may exist.

CT scans can be taken of the kidneys – highly detailed computerized pictures that are examined on a television screen. In an ultrasound test, sound waves are bounced off the kidneys to give a picture of their size and shape and to see where there are kidney stones present.

If the doctor thinks you might have kidney disease, a biopsy may be performed. In this procedure, a tiny piece of tissue is taken from the kidney to be examined under a microscope.

TREATMENT

Once you are admitted to the hospital, a medical team will try to find out why your kidneys failed. Meanwhile, they will control your intake of fluids so that you are not taking in more than your kidneys can handle. You will be fed a low-protein, high carbohydrate diet. The doctor may decide to feed you intravenously (liquid nourishment is dripped directly into a vein). You will be watched closely for complications such as infection, heart problems, anemia, or high blood pressure. The doctor may use dialysis in the early stages of acute kidney failure to avoid complications. Dialysis is a process of removing wastes from the blood while the kidneys are not functioning normally. If you need this procedure, you will be connected to a dialysis machine by a tube that is inserted into a blood vessel in your arm or leg. Your blood will flow into the machine, which acts as an artificial kidney, filtering wastes from the blood and removing excess fluid from the body.

Your clean blood is then returned. The use of dialysis for acute kidney failure enables your kidneys to rest and heal themselves.

Acute kidney failure is often reversible, and it is possible to recover within 4 to 8 weeks.

For chronic kidney failure, you will be given treatment to control the symptoms and lessen the chance of complications. The illness that caused the condition will be treated. You will be given a low-protein, high-carbohydrate diet, and your fluid levels will be closely watched. If your blood pressure is high, you will need to restrict your salt intake. Chronic kidney failure patients may have to undergo regular dialysis.

After many years, chronic kidney failure may lead to end-stage renal disease, when the kidneys stop working entirely or function at only 5% to 10% of normal capacity. At this stage, treatment choices are dialysis or kidney transplant. About 100,000 people in the U.S. are on dialysis regularly, and over 20,000 have had successful kidney transplants.

WHAT YOU CAN DO

To prevent kidney failure, the average person should drink between 1 and 2 quarts of water everyday. Medications of any kind should be taken only when necessary. Ask your physician about chemicals and drugs that should be avoided.

If you have been diagnosed with acute or chronic kidney failure, it can help to educate yourself about the condition. Knowing what to expect can help you feel less anxious and fearful.

You might want to learn and try relaxation techniques while you are undergoing dialysis. Continue to get regular exercise and follow the diet recommended by your doctor.

COPING

When you learn you have acute or chronic kidney failure, you are likely to experience a wide variety of feelings. It can cause stress, and you may have to make adjustments in the way you live and work. The State Department of Vocational Rehabilitation can help you with changes that may be necessary in your working life (such as a change in your type of work or going to a part-time schedule). It is normal to feel sad or resentful, and it can be helpful to talk about your feelings with your family and friends. Support groups also exist for people who have had kidney failure. The common bond you share with these people will help you feel less alone, and members often share methods for coping with the emotional as well as physical aspects of the illness.

The National Kidney Foundation and the National Association of Patients on Hemodialysis and Transportation can supply you with information and help you find or form a support group in your area.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

Planetree Health Fact Sheets are developed by Planetree, Inc., a non-profit consumer health organization, founded in 1978. The Planetree Alliance includes hospitals and libraries which, among many other patient-centered concepts, promote the importance of access to health information for patients, families, and community. For more information regarding affiliation with the international Planetree Alliance, call (203) 732-1365 or visit Planetree, Inc. at www.planetree.org.