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23 / 03 / 2018
Kidney failure
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Kidney failure


Healthy kidneys clean the blood by filtering out extra water and wastes. They also make hormones that keep your bones strong and blood healthy. When both of your kidneys fail, your body holds fluid. Your blood pressure rises. Harmful wastes build up in your body. Your body doesn't make enough red blood cells. You develop fatigue, nausea, and loss of appetite. When this happens, you need treatment to replace the work of your failed kidneys.

Your kidneys are two bean-shaped organs, each about the size of your fist. They're located at the back of your upper abdomen, one on either side of your spine. The kidneys' main function is to eliminate excess fluid and waste material from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body - a condition known as kidney (renal) failure.

Sometimes kidney failure happens suddenly (acute kidney failure). This is most likely to occur after complicated surgery or a severe injury, or when blood vessels leading to your kidneys become blocked.

Chronic kidney failure, on the other hand, usually develops slowly, with few signs or symptoms in the early stages. Many people with chronic kidney failure don't realize they have a problem until their kidney function has decreased to less than 25 percent of normal. High blood pressure and diabetes - a disorder that causes high blood sugar levels - are the most common causes.

In end-stage renal disease, the kidneys function at less than 10 percent of normal capacity. At this point they simply can't sustain life. People with end-stage renal disease need either dialysis or a kidney transplant to stay alive. When a transplant isn't possible - often because of poor general health - dialysis becomes the only option.

Signs and symptoms 

The signs and symptoms of kidney failure vary, depending on whether the failure is acute or chronic.

Acute kidney failure
Acute kidney failure occurs when your kidneys suddenly stop filtering waste products from your blood. The signs and symptoms may include:

  • Fluid retention

  • Bleeding, often in your stomach or intestines

  • Confusion

  • Seizures

  • Coma

Chronic kidney failure
Over time, chronic kidney failure can lead to congestive heart failure, weak bones, stomach ulcers and damage to the central nervous system. Unfortunately, signs and symptoms often don't appear until irreversible damage has occurred. They include:

  • High blood pressure
  • Unexplained weight loss
  • Anemia
  • Nausea or vomiting
  • Malaise or fatigue
  • Headaches that seem unrelated to any other cause
  • Decreased urine output
  • Decreased mental sharpness
  • Muscle twitches and cramps
  • Bleeding in the intestinal tract
  • Yellowish-brown cast to the skin
  • Persistent itching
  • Sleep disorders

End-stage renal disease
For some people, end-stage renal disease is the final result of chronic kidney failure. A number of complications may develop in conjunction with end-stage renal disease, depending on how rapidly it develops, including:

  • Anemia
  • High blood pressure
  • Congestive heart failure
  • Bone disease
  • Digestive tract problems
  • Loss of mental functioning (dementia)


Your kidneys are part of a system that removes excess fluid and waste material from your blood. Initially, blood enters your kidneys through the renal arteries, which are branches of the aorta — the main artery carrying oxygenated blood from your heart to the rest of your body. From there, blood moves through structures in your kidneys known as nephrons.

A single kidney contains approximately 1 million nephrons, each consisting of a tuft of capillary blood vessels (glomerulus) and tiny tubules that lead into larger collecting tubes. Each tuft of capillaries filters fluid from your bloodstream.

The filtered material — which contains both waste products and substances vital for your health — passes into the tubules. From there, waste byproducts such as urea, uric acid and creatinine are excreted in your urine while substances your body needs such as sugar, amino acids, calcium and salts are absorbed back into your bloodstream. Although this filtration system is usually able to clear all the waste products your body produces, problems can occur if the tubules or glomeruli are damaged or diseased.

Many factors can damage your kidneys, including kidney diseases, injury, high blood pressure, exposure to toxins and certain medications, kidney stones, tumors and even infections in other parts of your body. Many of these may cause no signs or symptoms until irreparable damage has occurred.

Acute kidney failure
Factors that can cause your kidneys to shut down suddenly include:

  • Complicated surgery, severe burns or trauma. Many cases of acute kidney failure are related to surgery or to trauma that involves shock or severe bleeding. In these cases, the cause is often a drastic drop in blood pressure that prevents an adequate amount of blood from reaching your kidneys. In addition, when muscles are crushed in severe injuries, they release a molecule called myoglobin that lodges in the kidney's tubules and blocks the flow of urine.

  • Renal ischemia. This occurs when an obstructed or constricted blood vessel prevents your kidneys from getting enough blood, and it may be the result of shock or dehydration.

  • Drugs. A number of substances can be toxic to your kidneys. These include contrast dyes used in tests such as arteriography, which help diagnose coronary artery disease, stroke and aneurysms. Contrast dyes are a common cause of acute renal failure in people with diabetic kidney disease or multiple myeloma. Certain antibiotics — especially streptomycin or gentamicin — and common pain medications, such as aspirin and ibuprofen (Advil, Motrin, others), can also damage your kidneys. Pain medications have the potential to cause acute kidney failure even in healthy people who use them regularly. Antibiotics pose a greater risk of acute renal failure if you already have liver or kidney disease, are older, or use diuretics or other drugs that affect your kidneys.

  • Toxins. Exposure to toxic substances — including heavy metals, solvents and excessive amounts of alcohol — can lead to acute kidney failure.

  • Heatstroke. This condition, which occurs when your body isn't able to deal with heat stress, may lead to acute kidney failure.

  • Multiple organ failure. In some people, acute kidney failure occurs as part of multiple organ failure in which the heart, lungs, liver, brain and kidneys totally or partially shut down. This is most often the result of major trauma or serious systemic infection (sepsis).

  • Obstructed urine flow. This may be due to a narrowing of the urinary tract, a tumor or urinary stones.

  • A sudden release of cholesterol-containing material. This material can come from a buildup of fatty deposits in the wall of an artery.

  • Hemolytic uremic syndrome (HUS). This complex condition, which results from certain strains of Escherichia coli (E. coli) bacteria, is a leading cause of acute kidney failure in infants and young children. HUS occurs less often in older children and rarely strikes adults.

  • Kidney disease (nephritis). Diseases such as glomerulonephritis and interstitial nephritis — an inflammation of the spaces between the glomeruli and tubules — can sometimes lead to acute kidney failure.

Chronic kidney failure
Unlike acute kidney failure, chronic kidney failure slowly destroys the nephrons in your kidneys over a period of years. Many factors may lead to chronic kidney failure, including:

  • Diabetes. Type 1 diabetes is a leading cause of chronic kidney failure. A small percentage of people who have had type 2 diabetes for several years also develop kidney disease. Because so many people have type 2 diabetes, it, too, accounts for a large number of cases of chronic renal failure.

  • High blood pressure (hypertension). Untreated or inadequately treated high blood pressure is another common cause of chronic kidney failure.

  • Obstructive nephropathy. This occurs when urine outflow is blocked over time by an enlarged prostate, kidney stones or tumors, or by vesicoureteral reflux, a condition that results from urine backing up into your kidneys from your bladder. The backflow pressure in your kidneys reduces their function.

  • Kidney diseases. These include clusters of cysts in the kidneys (polycystic kidney disease), kidney infection (pyelonephritis) and a condition that causes your kidneys to leak protein into your urine (glomerulonephritis).

  • Renal artery stenosis. This is a narrowing or blockage of the renal artery before it enters your kidney. In older adults, blockages often result when fatty deposits accumulate under the lining of the artery walls (atherosclerosis). Renal artery stenosis can also affect young women who have a condition known as fibromuscular dysplasia, which causes the walls of the arteries to become thicker. Both conditions are often associated with high blood pressure.

  • Lead poisoning. Ongoing exposure to lead — in lead-based paint, lead pipes, soldering materials, jewelry and even alcohol distilled in old car radiators — can lead to chronic renal failure.

  • End-stage renal disease
    Diabetes is the most common cause of end-stage renal disease. Other causes of end-stage renal disease include:

  • Vesicoureteral reflux. This is among several causes of end-stage renal disease in children and young adults.

  • Kidney disease. Polycystic kidney disease, an inherited disorder, may cause only mild symptoms in some adults, but it can lead to end-stage renal disease in others. Other kidney diseases that may lead to end-stage renal disease include Bright's disease (glomerulonephritis) and congenital nephrotic syndrome — an inherited disorder that may cause death in the first year of life.

Risk factors 

Diabetes is the single greatest risk factor for chronic renal failure. Other medical conditions that increase your risk of kidney failure include high blood pressure (hypertension), sickle cell disease, lupus erythematosis, atherosclerosis, chronic glomerulonephritis, congenital nephrotic syndrome and polycystic kidney disease.

In addition, drug overdose, excessive use of alcohol, long-term use of pain medications such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others), and treatment with the antibiotics streptomycin or gentamicin can increase your vulnerability to kidney failure. Severe injuries or burns to your body and complicated surgery also increase your risk.

When to seek medical advice 

If you have a chronic medical condition that puts you at increased 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. Call your doctor right away if you experience any of the signs and symptoms of chronic kidney failure between visits. These may include decreased urination, unexplained weight loss, nausea or vomiting, fatigue, headaches or a yellowish-brown cast to your skin. Even if you have no risk factors for kidney failure, see your doctor immediately if you notice that you're urinating much more or much less than usual or if you see any blood in your urine.

Kidney failure > 1 > 2 > 3 > 4

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

In no event will the be liable for any decision made or action taken in reliance upon the information provided through this web site.
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Dr. Eddy Bettermann M.D.

Mob: +60.17 545 1784         +66.89 8550 5066





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