Chronic kidney failure
Filed under: Boomer's Health
Chronic kidney failure describes the gradual loss of kidney function.
Your kidneys filter wastes and excess fluids from your blood which are
then excreted in your urine. When chronic kidney failure damages your
kidneys, dangerous levels of fluid and waste can accumulate in your
In the early stages of chronic kidney failure, you may have few signs or
symptoms. Chronic kidney failure may not become apparent until your
kidney function is significantly impaired.
Treatment for chronic kidney failure, also called chronic kidney
disease, focuses on slowing the progression of the kidney damage,
usually by controlling the underlying cause. Chronic kidney failure can
progress to end-stage kidney disease, which is fatal without artificial
filtering (dialysis) or a kidney transplant.
Signs and symptoms of kidney failure develop slowly over time if kidney
damage progresses slowly. Signs and symptoms of kidney failure may
* Decreased urine output or no urine output
* Loss of appetite
* Fatigue and weakness
* Sleep problems
* Decreased mental sharpness
* Muscle twitches and cramps
* Swelling of the feet and ankles
* Persistent itching
Signs and symptoms of kidney failure are often nonspecific, meaning they
can also be attributed to other illnesses. In addition, because your
kidneys are highly adaptable and able to compensate for lost function,
signs and symptoms of kidney failure may not appear until irreversible
damage has occurred.
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
If you have a chronic medical condition that increases your risk of
chronic kidney failure, your doctor is likely to monitor your blood
pressure and kidney function with urine and blood tests during regularly
scheduled office visits. Ask your doctor whether these types of tests
are right for you.
Chronic kidney failure occurs when a disease or condition impairs kidney
function. Over several months or years, this can cause worsening kidney
Diseases and conditions that commonly cause chronic kidney failure include:
* Type I diabetes
* Type II diabetes
* High blood pressure
* Enlarged prostate
* Kidney stones
* Bladder cancer
* Kidney cancer
* A condition that causes urine to back up into your kidneys (vesicoureteral reflux)
* Polycystic kidney disease
* Kidney infection (pyelonephritis)
* Damage to the artery that carries blood to your kidneys (renal artery stenosis)
Factors that may increase your risk of chronic kidney failure include:
* High blood pressure (hypertension)
* Heart disease
* High cholesterol
* African-American, American Indian or Asian-American race
* A family history of kidney disease
* Age 65 or older
Chronic kidney failure can affect almost every part of your body. Potential complications may include:
* Fluid retention, which could lead to swelling in your arms and
legs, high blood pressure or fluid in your lungs (pulmonary edema)
* A sudden rise in potassium levels in your blood (hyperkalemia),
which could impair your heart's ability to function and may be
* Cardiovascular disease
* Weak bones and an increased risk of bone fractures
* Decreased sex drive or impotence
* Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
* Decreased immune response, which makes you more vulnerable to infection
* Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium)
* Pregnancy complications that carry risks for the mother and the developing fetus
* Irreversible damage to your kidneys (end-stage kidney disease),
eventually requiring either dialysis or a kidney transplant for survival
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have
any signs or symptoms that worry you. If tests reveal you have kidney
damage, you may be referred to a doctor who specializes in kidney
Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared for your
appointment. Here's some information to help you get ready, and what to
expect from your doctor.
What you can do
* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along. Sometimes it can be
difficult to absorb all the information provided during an appointment.
Someone who accompanies you may remember something that you missed or
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
chronic kidney failure, some basic questions to ask include:
* Do I have chronic kidney failure?
* What is the level of damage to my kidneys?
* Is my kidney function worsening?
* Do I need additional tests?
* What's causing my chronic kidney failure?
* Can the damage to my kidneys be reversed?
* What are my treatment options?
* Do I need treatment right away?
* What are the potential side effects of each treatment?
* I have these other health conditions. How can I best manage them together?
* Do I need to eat a special diet?
* Can you refer me to a dietitian who can help me plan my meals?
* Should I see a nephrologist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take with me? What websites do you recommend?
* How often should I come back to have my kidney function tested?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment anytime you
don't understand something.
Tests and diagnosis
To determine whether you have chronic kidney failure, you may undergo tests and procedures including:
* Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
* Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure.
* Imaging tests. Your doctor may use ultrasound to assess your kidneys. Other imaging tests may be used in some cases.
* Removing a sample of kidney tissue for testing. Your doctor may
recommend a kidney biopsy to remove a sample of kidney tissue. The
biopsy sample is sent to a laboratory for testing to help determine
what's causing your kidney problems. Kidney biopsy is often done using a
long, thin needle that's inserted through your skin and into your
Treatments and drugs
Chronic kidney failure has no cure, but treatment can help control signs
and symptoms, reduce complications, and slow the progress of the
disease. If your kidneys become severely damaged, you may need
treatments for end-stage kidney disease.
Treating the cause of kidney failure
Your doctor will work to slow or reverse the disease or condition that's
causing your kidney failure. Treatment options vary depending on the
cause of your kidney failure.
Stopping the underlying condition may slow kidney damage, but sometimes
kidney failure worsens despite treatment. Damage to the kidneys can
cause stress on the kidneys that continues to worsen even when an
underlying condition, such as high blood pressure, has been controlled.
Treating complications of kidney failure
Kidney failure complications can be controlled to make you more comfortable. Treatments may include:
* Treatment to control high blood pressure. People with chronic
kidney failure may experience worsening high blood pressure. Your doctor
may recommend medications to lower your blood pressure — commonly
angiotensin-converting enzyme (ACE) inhibitors or angiotensin II
receptor blockers — and to preserve kidney function. High blood pressure
medications can initially decrease kidney function, so you may have
frequent blood tests to monitor your condition. Your doctor will likely
also recommend a low-salt diet.
* Medications to lower cholesterol levels. Your doctor may recommend
medications, called statins, to lower your cholesterol. People with
chronic kidney failure often experience high levels of bad cholesterol,
which can increase the risk of heart disease.
* Medications to relieve anemia. In certain situations, your doctor
may recommend supplements of the hormone erythropoietin to induce
production of more red blood cells. This may help relieve the fatigue
and weakness that's associated with anemia.
* Medications to relieve swelling. People with chronic kidney
failure may retain fluids. This can lead to swelling in your arms and
legs, as well as high blood pressure. Medications called diuretics can
help maintain the balance of fluids in your body.
* Medications to protect your bones. Your doctor may prescribe
calcium and vitamin D supplements to prevent weak bones. You may also
take a phosphate-binding medication to lower the amount of phosphate in
your blood. Lowering phosphate will increase the amount of calcium
available for your bones so that they don't become weak and vulnerable
* A low-protein diet to minimize waste products in your blood. As
your body processes the proteins in the foods you eat, it creates waste
products that your kidneys must filter from your blood. To reduce the
amount of work your kidneys must do, your doctor may recommend a
low-protein diet. Your doctor may ask you to meet with a dietitian who
can help you assess how much protein you eat each day and suggest ways
to lower your protein intake while still eating a healthy diet.
Treatment for end-stage kidney disease
If kidney damage continues to progress to the point where your kidneys
are functioning at less than 15 percent of capacity, you have end-stage
kidney disease. Your kidneys are no longer able to keep up with waste
and fluid clearance on their own. Soon, dialysis or a kidney transplant
becomes the only option to support life.
* Dialysis. Dialysis is an artificial means of removing waste
products and extra fluid from your blood when your kidneys aren't able
to perform these functions. There are two types of dialysis. In
hemodialysis, blood is pumped out of your body to a machine that works
like an artificial kidney, filtering waste out of your blood. The blood
is then pumped back into your body. Another type of dialysis, called
peritoneal dialysis, involves pumping a dialysis solution into your
abdominal cavity. Peritoneal dialysis relies on your body's network of
tiny blood vessels to carry waste products and excess fluids to your
abdominal cavity where the dialysis solution absorbs them. The dialysis
solution is then pumped out of your body, carrying the waste and excess
fluids with it.
* Kidney transplant. If you have no life-threatening medical
conditions other than kidney failure, a kidney transplant may be an
option for you. Kidney transplant involves surgically placing a healthy
kidney from a donor inside your body. Transplanted kidneys can come from
deceased donors or from living donors.
nLifestyle and home remedies
As part of your treatment for chronic kidney disease, your doctor may
recommend a special diet to help support your kidneys and limit the work
they must do. Ask your doctor for a referral to a dietitian who can
analyze your current diet and suggest ways to make your diet easier on
Depending on your situation, your kidney function and your overall health, your dietitian may recommend that you:
* Limit the amount of protein you eat. Your dietitian will determine
the appropriate number of grams of protein you should eat each day. To
lower the amount of protein you eat, limit high-protein foods such as
meats, eggs, milk, cheese and beans. Instead, choose more low-protein
foods, such as vegetables, fruits, breads and cereals.
* Choose lower potassium foods. Your dietitian may recommend that
you choose lower potassium foods at each meal. High-potassium foods
include bananas, oranges, potatoes, spinach and tomatoes. Low-potassium
foods include apples, cabbage, carrots, green beans, grapes and
* Avoid products with added salt. Lower the amount of sodium you eat
each day by avoiding products with added salt, including many
convenience foods, such as frozen dinners, canned soups and fast foods.
Other foods with added salt include salty snack foods, canned
vegetables, and processed meats and cheeses.
Coping and support
Receiving a diagnosis of chronic kidney failure can be worrisome. You
may be concerned about what your diagnosis means for your future health.
With time, you'll discover ways to help you cope with your feelings.
Until you find what works for you, consider trying to:
* Connect with other people who have kidney disease. Other people
with chronic kidney failure understand what you're feeling and can offer
unique support. Ask your doctor about support groups in your area. Or
contact organizations, such as the American Association of Kidney
Patients, the National Kidney Foundation or the American Kidney Fund for
groups in your area. The National Kidney Foundation also offers online
* Maintain your normal routine, when possible. Try to maintain a
normal routine, doing the activities you enjoy and continuing to work,
if your condition allows. This may help you cope with feelings of
sadness or loss that you may experience after your diagnosis.
* Exercise most days of the week. With your doctor's permission, aim
to exercise for at least 30 minutes most days of the week. This can
help you cope with fatigue and stress.
* Find someone to talk with. Living with chronic kidney failure can
be stressful, and it may help to talk about your feelings with someone
you trust. You may have a friend or family member who is a good
listener. Or you may find it helpful to talk with a clergy member. Ask
your doctor for a referral to a social worker or counselor.
To reduce your risk of chronic kidney failure, try to:
* Drink alcohol in moderation, if at all. If you choose to drink
alcohol, do so in moderation. Drink no more than one alcoholic drink a
day if you're a woman. If you're a man, limit yourself to two alcoholic
drinks a day.
* Follow instructions on over-the-counter medications. When using
nonprescription pain relievers, such as aspirin, ibuprofen (Advil,
Motrin, others) and acetaminophen (Tylenol, others), follow the
instructions on the packaging. Taking too many pain relievers could lead
to kidney damage. If you have a history of kidney problems, ask your
doctor whether these drugs are safe for you.
* Maintain a healthy weight. If your current weight is healthy, work
to maintain it by exercising most days of the week. If you need to lose
weight, talk to your doctor about strategies for healthy weight loss.
Often this involves increasing the amount of exercise you get each day
and decreasing the number of calories you eat.
* Don't smoke. If you don't smoke, don't start. If you're a smoker,
talk to your doctor about quitting. Support groups, counseling and
medications can all help you to stop.
* Manage your medical conditions with your doctor's help. If you
have diseases or conditions that increase your risk of kidney failure,
work with your doctor to control these. Ask your doctor about tests to
look for signs of kidney damage.