Kidney Failure

When the kidneys stop functioning normally leading to an excess build-up of waste products in the body, which upsets the chemical balance of the blood, it is called kidney failure. It can be acute, chronic or end-stage failure. Acute failure happens suddenly and can lead to death if not treated immediately, while chronic failure happens gradually over years and in the initial stages people may not even recognise the condition. End-stage failure is when the organs stop functioning completely. Kidney failure can be treated by either drugs, dialysis or a transplant.

1. Acute kidney failure
When both kidneys suddenly stop functioning, or there is a marked reduction in their functioning, the condition is known as acute kidney failure. Since the organs can no longer filter waste products and excess water from the blood to help them drain out in the urine, these wastes build up in the kidneys. This disrupts the chemical balance of the blood. It can lead to death if it is not treated immediately.

What causes acute kidney failure?
Acute kidney failure occurs when there is a dramatic reduction of blood supply to the organs, which may happen with a sudden drop in blood pressure caused by shock, severe bleeding or a heart attack. Other reasons for acute kidney failure may include drugs, harmful chemicals or obstruction of the flow of urine.

Symptoms
The symptoms of acute kidney failure show up all of a sudden, mostly within a few hours, and these may include, nausea, vomiting, headache, back pain, drowsiness and a substantial reduction in the volume of urine. On the appearance of these signs, the person needs to check with a doctor immediately, otherwise the condition can lead to death within a matter of a few days.

Diagnosis of the condition
The doctor will have the patient immediately admitted to hospital if he/she suspects the condition. If there is profuse bleeding, the cause may be obvious, but otherwise tests like ultrasound scanning or CT scanning may have to be performed to check the urinary tract for blockages. A kidney biopsy may also be required.

Treatment of the condition
If there has been an acute kidney failure, the patient will require quick treatment for the condition as well as other related complications. The patient may have to be admitted to an ICU for temporary dialysis to remove excessive waste products and water from the blood while investigations are on. If the patient has lost too much blood, a blood transfusion may be required to make up for it. If some disorder is detected during investigations, drug treatment may be required, and if some obstruction in the urinary tract has been detected, the patient may have to undergo a surgery to remove the obstruction.

The prognosis
If the kidneys have not been damaged permanently, complete recovery may still be possible, which could take a month and a half. But when the damage is not reversible, the condition may develop into a chronic failure or even end-stage condition in which kidneys stop functioning altogether. If such is the case, the treatment will involve long-term dialysis or a transplantation of the organ.

2. Chronic kidney failure
The danger in this condition lies in it being undetected for months or years, during which the condition progresses gradually and causes irreparable damage to the kidneys. The resultant build-up of waste products in the organ is so excessive that the kidney is damaged to the extent of more than 60 percent. In such a situation, dialysis or a transplant of the organ becomes necessary.

Causes of the condition
Disorders that steadily damage the kidney tissues like polycystic kidney disease or glomerulonephritis can be responsible for this condition. General disorders like diabetes mellitus or high blood pressure can also lead to it. People suffering from sickle-cell disease are also at risk. Prolonged blockage of the urinary tract caused by an enlarged prostrate gland can also cause chronic kidney failure.

Symptoms
When the symptoms of this condition do show up, usually after months or years, the person suffering from it initially feels weakness or a loss of appetite, but other symptoms show up as the condition progresses. They may include cramps in the legs, shortness of breath, persistent hiccups, nausea and vomiting, muscular twitching, pale, itchy, and easily bruised skin, and frequent passing of urine especially at nights.

Treatment
Dialysis is the method adopted to remove the excess build-up of waste products in the organ. The two types of dialysis are peritoneal dialysis and haemodialysis. In the first method, the peritoneum, which is the membrane that envelopes the abdominal organs, is used to filter the blood. It is called an exchange and is done four times a day. During the procedure, dialysis fluid which was infused into the abdomen earlier is drained out of the peritoneum through a catheter in the abdominal wall. The fluid is replaced with fresh solution, after which the equipment is disconnected and a person can carry on with normal activities. In the other method, haemodialysis, a machine is used to pump blood through a filter attached to the side of the machine. Blood flows from one side of a membrane inside the filter, and dialysis fluid flows on the other side. Waste products and water pass from the blood across the membrane and into the dialysis fluid, and the filtered blood returns to the body. This process takes 3-4 hours and has to be repeated three times a week.

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