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.
Treatment for kidney failure varies, depending on whether the problem is acute, chronic or end-stage.
In all cases, the first goal is to treat the illness or injury that originally damaged your kidneys. Once that's under control, the focus will be on preventing the accumulation of excess fluids and wastes in your blood while your kidneys heal. This is best accomplished by limiting your fluid intake and following a high-carbohydrate, low-protein, low-potassium diet.
Your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate) to prevent the accumulation of high levels of potassium in your blood. You may also need to undergo dialysis to help remove toxins and excess fluids from your body while your kidneys are healing.
Chronic kidney failure
The first priority is controlling the condition responsible for your kidney failure and its complications. If you have diabetes or high blood pressure (hypertension), for instance, that means carefully following your doctor's recommendations for diet and exercise and taking any medications as directed.
In addition, following a proper diet is extremely important in treating kidney failure itself. Restricting the amount of protein you eat may help slow the progress of the disease. It can also help ease such symptoms as nausea, vomiting and lack of appetite. You'll likely need to limit the amount of salt in your diet to help control high blood pressure. Over time, you may also need to restrict the amount of potassium and phosphorous you consume.
If you have high blood pressure, your doctor will prescribe medications that both lower your blood pressure and help preserve kidney function. These include the blood pressure-lowering medications known as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (A-II) receptor blockers.
Your doctor may also prescribe medications to help deal with complications.
End-stage renal disease
The exact point at which this is needed varies from person to person. In most cases, doctors try to manage chronic kidney failure as long as possible because both dialysis and transplantation are serious undertakings that can be life threatening. Eventually, however, a time may come when their benefits outweigh their risks.
Dialysis is an artificial means of removing waste products and extra fluid from your blood when your kidneys aren't able to do this on their own. It's not a miracle cure, and it presents significant risks, including infection. Still, it can help prolong life for people with end-stage renal disease.
There are several different types of kidney dialysis. They include:
If you have no other serious medical conditions, a kidney transplant is usually a better option than dialysis because it provides a better quality of life. But you may need dialysis until a suitable kidney donor is found. Finding the right donor may be difficult, however.
The more closely the donor matches your blood type, cell surface proteins and antibodies, the less likely your body is to reject the new kidney. A sibling is likely to be the best donor. But you may not have siblings, or they may not qualify for various reasons. In that case, another blood relative, such as a parent, aunt, uncle or cousin, or even a non-blood-related adult may be considered. When a living donor isn't available, tissue-typing centers throughout the country may search for a kidney from an accident victim or other person who has offered to donate organs after his or her death.