urination; passing only small amounts of urine.
feeling of poor health.
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
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?
and hypertension are the most common causes of chronic renal
disorders, such as acute and chronic glomerulonephritis, polycystic
kidney disease, and kidney infection, may lead to chronic renal
pressure can both cause and be caused by progressive damage to
stones, or an enlarged prostate gland may obstruct the urinary
tract, impair the flow of urine, and thus damage the kidneys.
of large doses of nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen or naproxen, may lead to chronic renal failure.
heavy metals like cadmium, lead, mercury, or gold may lead to
(like streptomycin), antifungal drugs, and immunosuppressants
may damage the kidney and lead to kidney failure.
substances used in some x-ray procedures may induce kidney failure
in those with weakened kidneys.
by any disorder are more prone to chronic infection.
(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.
potential underlying causes (especially drug therapy for high
blood pressure and scrupulous control of diabetes) may prevent
or delay development of chronic renal failure.
and physical examination.
Blood and urine
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
low-protein, high-carbohydrate diet, restricted fluid intake,
and vitamin supplements may be recommended.
be necessary to remove an obstruction in the urinary tract.
may be prescribed to treat associated bacterial infections.
drugs are prescribed to control associated high blood pressure.
may be needed to treat congestive heart failure.
be treated with erythropoietin, which stimulates blood cell formation.
or calcium carbonate is administered to treat the excessive accumulation
of body acids (renal acidosis).
agents, calcium supplements, and vitamin D are given to prevent
secondary hyperparathyroidism, which may produce further kidney
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).
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.
local chapter of the National
Kidney Foundation for information about support groups.
Hopkins Symptoms and Remedies, the complete home medical
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