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Diabetes

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Chronic Renal Failure

Symptoms

Frequent urination; passing only small amounts of urine.

General feeling of poor health.

Symptoms of end-stage renal failure due to the accumulation of waste products in the blood (uremia): swelling of the ankles or the tissues around the eyes due to fluid retention (edema); shortness of breath due to fluid accumulation in the lungs; nausea and vomiting; loss of appetite and weight loss; frequent hiccups; bad breath; furred tongue; pain in the chest and bones; overall itching; yellowish or brownish tinge to pale skin; tiny white crystals upon the skin (uremic frost); unexplained bruising or bleeding, including bleeding gums; cessation of menstrual periods in women (amenorrhea); fatigue and drowsiness; mental confusion; muscle spasms or seizures; loss of consciousness.

When To Call Your Doctor

Call a doctor if you experience frequent urination, nausea and vomiting, swelling around the ankles, shortness of breath, a yellowish tinge to the skin, or any other symptoms of chronic renal failure.


What Is It?

Chronic renal, or kidney, failure occurs when both kidneys gradually cease to function. Within the kidneys are numerous tiny structures (glomeruli) that filter waste products from the blood and retain larger substances, such as proteins. Waste products and excess water then accumulate in the bladder until excreted as urine. In chronic kidney failure, the kidneys suffer progressive damage over a number of months or years. As kidney tissue is destroyed by injury or inflammation, the remaining healthy tissue compensates for the loss of function. The extra work overloads the previously undamaged portions of the kidneys, causing more damage, until eventually the entire kidney may cease to function (a condition known as end-stage renal failure).

The kidneys are resilient organs; more than 80 percent of the kidneys may be damaged before symptoms appear (although symptoms may develop earlier if the weakened kidney is subjected to a sudden stress, such as an infection, dehydration, or use of a kidney-damaging drug). As excessive amounts of water, minerals like potassium, and waste products accumulate in the body, chronic renal failure becomes a life-threatening condition. However, if the underlying disease is treated and further damage can be controlled, the onset of end-stage renal failure may be delayed for up to 10 to 20 years. End-stage renal failure may be treated with dialysis or kidney transplantation; either can prolong life and allow participation in many normal activities.

What Causes It?

Diabetes mellitus and hypertension are the most common causes of chronic renal failure.

Primary kidney disorders, such as acute and chronic glomerulonephritis, polycystic kidney disease, and kidney infection, may lead to chronic renal failure.

High blood pressure can both cause and be caused by progressive damage to the kidneys.

Tumors, kidney stones, or an enlarged prostate gland may obstruct the urinary tract, impair the flow of urine, and thus damage the kidneys.

Long-term use of large doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may lead to chronic renal failure.

Poisoning with heavy metals like cadmium, lead, mercury, or gold may lead to kidney failure.

Certain antibiotics (like streptomycin), antifungal drugs, and immunosuppressants may damage the kidney and lead to kidney failure.

The contrast substances used in some x-ray procedures may induce kidney failure in those with weakened kidneys.

Kidneys damaged by any disorder are more prone to chronic infection.

Hypercalcemia (excess blood levels of calcium, from hyperthyroidism, for example) and elevated levels of uric acid may lead to chronic renal failure.

Those who have had one kidney removed are more vulnerable to severe complications from kidney damage.

Prevention

Treatment of potential underlying causes (especially drug therapy for high blood pressure and scrupulous control of diabetes) may prevent or delay development of chronic renal failure.

Diagnosis

Patient history and physical examination.

Blood and urine tests.

Ultrasound or computed tomography (CT) scans, or magnetic resonance imaging (MRI) of the abdominal area.

A kidney biopsy may be done. After local anesthesia is administered to the patient, the doctor inserts a needle into the kidney through the back to extract a small sample of tissue for microscopic examination.

How To Treat It

A low-salt, low-protein, high-carbohydrate diet, restricted fluid intake, and vitamin supplements may be recommended.

Surgery may be necessary to remove an obstruction in the urinary tract.

Antibiotics may be prescribed to treat associated bacterial infections.

Antihypertensive drugs are prescribed to control associated high blood pressure.

Medications may be needed to treat congestive heart failure.

Anemia can be treated with erythropoietin, which stimulates blood cell formation.

Sodium bicarbonate or calcium carbonate is administered to treat the excessive accumulation of body acids (renal acidosis).

Phosphate-binding agents, calcium supplements, and vitamin D are given to prevent secondary hyperparathyroidism, which may produce further kidney damage.

Dialysis, an artificial blood-filtering process, is necessary once a significant portion of kidney function has been lost. There are several types of dialysis. In hemodialysis, blood is pumped from the body into an artificial kidney machine, or dialyzer, where it is filtered before being returned to the body. Hemodialysis must be performed for about 9 to 12 hours weekly (usually in three sessions).

Peritoneal dialysis is another option. There are two types of peritoneal dialysis. Continuous ambulatory peritoneal dialysis (CAPD) requires the patient or caregiver to instill two to three liters of a sterile solution through a catheter into the peritoneum three to five times a day. Automated peritoneal dialysis (APD) utilizes a small machine the size of a personal computer to automatically instill the sterile fluid through the catheter into the peritoneum while the patient sleeps. This process generally takes about 12 hours a day.

A kidney transplant offers the best alternative to dialysis in cases of end-stage renal failure. Successful transplantation may cure kidney failure, but potential donors must be matched carefully for compatibility; family members of the patient are most likely to be compatible, but spouses and friends who wish to donate should also be screened. Recipients of a kidney transplant must remain on immunosuppressive drugs to prevent rejection of the transplant.

Contact your local chapter of the National Kidney Foundation for information about support groups.


From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.


 


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2005
WHITE PAPERS
Diabetes

The Diabetes White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.


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