What happens in chronic renal failure?

What Your Kidneys Do

Healthy kidneys:

• Keep a balance of water and minerals (such as sodium, potassium, and phosphorus) in your blood
• Remove waste from your blood after digestion, muscle activity, and exposure to chemicals or medications
• Make renin, which your body uses to help manage your blood pressure
• Make a chemical called erythropoietin, which prompts your body to make red blood cells
• Make an active form of vitamin D, needed for bone health and other things

Kidney Disease Causes

Acute kidney disease causes: If your kidneys suddenly stop working, doctors call it acute kidney injury or acute renal failure. The main causes are:

• Not enough blood flow to the kidneys
• Direct damage to the kidneys
• Urine backed up in the kidneys

Those things can happen when you:

• Have a traumatic injury with blood loss, such as in a car wreck
• Are dehydrated or your muscle tissue breaks down, sending too much kidney-toxic protein into your bloodstream
• Go into shock because you have a severe infection called sepsis
• Have an enlarged prostate or kidney stones that blocks your urine flow
• Take certain drugs or are around certain toxins that directly damage the kidney
• Have complications during a pregnancy, such as eclampsia and preeclampsia

Autoimmune diseases -- when your immune system attacks your body -- can also cause an acute kidney injury.

People with severe heart or liver failure commonly go into acute kidney injury as well.

Chronic kidney disease causes: When your kidneys don't work well for longer than 3 months, doctors call it chronic kidney disease. You may not have any symptoms in the early stages, but that's when it’s simpler to treat.

Diabetes (types 1 and 2) and high blood pressure are the most common culprits. High blood sugar levels over time can harm your kidneys. And high blood pressure creates wear and tear on your blood vessels, including those that go to your kidneys.

Other conditions include:

• Immune system diseases (If you have kidney disease due to lupus, your doctor will call it lupus nephritis.)
• Long-lasting viral illnesses, such as HIV and AIDS, hepatitis B, and hepatitis C
• Pyelonephritis, a urinary tract infection within the kidneys, which can result in scarring as the infection heals. It can lead to kidney damage if it happens several times.
• Inflammation in the tiny filters (glomeruli) in your kidneys. This can happen after a strep infection, for example.
• Polycystic kidney disease, a genetic condition where fluid-filled sacs form in your kidneys

Defects present at birth can block the urinary tract or affect the kidneys. One of the most common ones, , for example” involves a kind of valve between the bladder and urethra. A urologist can often do surgery to repair these problems, which may be found while the baby is still in the womb.

Drugs and toxins -- such as lead poisoning, long-term use of some medications including NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen, and IV street drugs -- can permanently damage your kidneys. So can being around some types of chemicals over time.

Kidney Disease Symptoms

Your kidneys are very adaptable. They can compensate for some of the problems that can happen when you have kidney disease. So if your kidney damage gets worse slowly, your symptoms will reveal themselves slowly over time. In fact, you may not feel symptoms until your disease is advanced.

You might have:

• High blood pressure
• Nausea and vomiting
• Loss of appetite
• A metallic taste in your mouth
• Fatigue
• Weakness
• Trouble thinking
• Sleep issues
• Muscle twitches and cramps
• Swelling in your feet and ankles
• Itching that won't go away
• Chest pain, if fluid builds up around the lining of the heart
• Shortness of breath, if fluid builds up in the lungs

Kidney Disease Diagnosis

Your doctor will start by asking questions about your family medical history, which medications you're taking, and if you notice that you're peeing more or less than normal. After that, they'll do a physical exam.

You also may have:

• Blood tests, to see how much waste product is in your blood
• Urine tests, to check for kidney failure
• Imaging tests, like an ultrasound, to let the doctor see your kidneys
• A kidney biopsy, where tissue from your kidney is sent to a lab for testing to try and figure out the cause of your kidney issues.

Kidney Disease Treatment

Some forms of kidney disease are treatable. The goals of these treatments are to ease symptoms, help keep the disease from getting worse, and lessen complications. In some cases, your treatment may help restore some of your kidney function. There is no cure for chronic kidney disease.

The plan you and your doctor will decide on will depend on what’s causing your kidney disease. In some cases, even when the cause of your condition is controlled, your kidney disease will worsen.

Once your kidneys can't keep up with waste on their own, you'll have treatment for end-stage kidney disease. This can include:

Dialysis. Waste and extra fluid are taken out of your body when your kidneys can't do it anymore. There are two types:

• Hemodialysis, where a machine removes the waste and extra fluids from your blood
• Peritoneal dialysis, which involves inserting a thin tube called a catheter into your abdomen. Then, a solution goes into your abdomen that absorbs the waste and fluids. After a while, the solution drains from your body.

Kidney transplant. A surgeon replaces your kidney with a healthy one from a donor. This donor can be living or deceased. After the procedure, you take medicine for the rest of your life to make sure that your body doesn't reject your new kidney.

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