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Kidney failure - Chronic Kidney Disease
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Kidney failure

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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 

Treatment for kidney failure varies, depending on whether the problem is acute, chronic or end-stage.

Acute kidney failure
Although not every person with acute kidney failure can regain normal kidney function, in many cases acute kidney failure is reversible.

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
Chronic kidney failure has no cure, but treatment can help control symptoms, reduce complications and slow the progress of the disease.

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
By the time end-stage renal disease develops, the conservative measures used to treat chronic kidney failure — diet, medications and controlling the underlying cause and complications — are no longer enough. The kidneys aren't able to support life on their own, and dialysis or a kidney transplant becomes the only option.

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:

  • Hemodialysis. The most common form of dialysis is known as hemodialysis. It removes extra fluids, chemicals and wastes from your bloodstream by filtering your blood though an artificial kidney (dialyzer). Blood is pumped out of your body to the artificial kidney through a vascular access that's created surgically, usually in your arm or leg. Inside the artificial kidney, your blood moves across membranes that filter out wastes. Less than 1 cup of blood is outside your body at any one time. Most people require approximately 12 hours of dialysis each week, usually divided into three sessions.

  • Peritoneal dialysis. Instead of filtering your blood through a machine, this type of dialysis uses the vast network of tiny blood vessels in your own abdomen (peritoneal cavity) to filter your blood. First, a small, flexible tube (catheter) is implanted into your abdomen. Then, a dialysis solution is infused into and drained out of your abdomen for as long as is necessary to remove waste and excess fluid.

  • Continuous ambulatory peritoneal dialysis (CAPD). You perform this type of dialysis yourself at home, exchanging the dialysis solution in your abdomen four times a day, seven days a week. These exchanges are spaced throughout the day.

  • Continuous cycling peritoneal dialysis (CCPD). In this type of dialysis, a machine (cycler machine) automatically infuses dialysis solution into and out of your peritoneal cavity over a period of 10 to 12 hours while you sleep.

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.

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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.
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