Kidney Failure
What is Kidney Failure?
Kidney failure happens when your kidneys can no longer filter waste and excess fluid from your blood effectively. Your kidneys are two bean-shaped organs that clean about 150 quarts of blood every day. When they stop working properly, dangerous levels of waste build up in your body.
There are two main types of kidney failure. Acute kidney failure develops suddenly over hours or days, often from injury or poisoning. Chronic kidney failure develops slowly over months or years, usually from conditions like diabetes or high blood pressure. Chronic kidney disease affects about 37 million Americans, but many don't know they have it until the damage is severe.
Kidney failure is measured in five stages based on how well your kidneys filter blood. Stage 1 shows mild damage with normal function. Stage 5 means your kidneys are working at less than 15 percent capacity. At this point, you may need dialysis or a kidney transplant to stay alive.
Symptoms
- Swelling in your legs, ankles, or feet from fluid buildup
- Fatigue and weakness that doesn't improve with rest
- Shortness of breath from fluid in the lungs
- Nausea, vomiting, or loss of appetite
- Confusion or difficulty concentrating
- Persistent itching all over your body
- Muscle cramps and twitches
- Changes in urination, including less urine or foamy urine
- Chest pain or pressure from fluid around the heart
- High blood pressure that's hard to control
Many people with early kidney disease have no symptoms at all. Your kidneys can lose up to 90 percent of their function before you notice anything wrong. This is why regular testing is so important if you have risk factors.
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Causes and risk factors
Diabetes and high blood pressure cause about two-thirds of all kidney failure cases. High blood sugar damages the tiny blood vessels in your kidneys over time. High blood pressure puts extra strain on these delicate filtering units. Other causes include autoimmune diseases, genetic disorders, repeated urinary tract infections, and kidney stones that block urine flow.
Certain toxins can also damage your kidneys. Chronic exposure to ethylene glycol, a chemical found in antifreeze, can cause kidney failure. Your body converts this substance into toxic compounds that destroy kidney tissue. Long-term use of some pain medications, especially NSAIDs, can harm your kidneys. Risk factors include being over age 60, having a family history of kidney disease, smoking, obesity, and heart disease.
How it's diagnosed
Kidney failure is diagnosed through blood tests, urine tests, and imaging studies. Blood tests measure creatinine and blood urea nitrogen to see how well your kidneys filter waste. Your doctor calculates your estimated glomerular filtration rate, which shows what percentage of kidney function remains. Urine tests check for protein or blood, which signal kidney damage.
In cases of suspected toxic exposure, specialized urine tests can detect harmful substances like ethylene glycol. These tests help identify the cause of kidney damage and guide treatment. Your doctor may also order an ultrasound or CT scan to look at kidney structure. Sometimes a kidney biopsy is needed to determine the exact type of damage. Talk to your doctor about which tests are right for your situation.
Treatment options
- Manage underlying conditions like diabetes and high blood pressure with medication and lifestyle changes
- Follow a kidney-friendly diet low in sodium, potassium, and phosphorus
- Limit protein intake to reduce waste buildup, but maintain adequate nutrition
- Stay hydrated unless your doctor advises fluid restrictions
- Take medications called ACE inhibitors or ARBs to protect remaining kidney function
- Treat anemia with iron supplements or erythropoietin injections
- Control phosphorus levels with binders taken with meals
- Start dialysis when kidney function drops below 15 percent
- Consider kidney transplant as a long-term solution
- Avoid NSAIDs, contrast dyes, and other substances that harm kidneys
Frequently asked questions
Acute kidney failure develops suddenly over hours or days, often from injury, infection, or toxin exposure. Chronic kidney failure develops gradually over months or years from conditions like diabetes or high blood pressure. Acute kidney failure may be reversible with prompt treatment, while chronic kidney failure usually causes permanent damage.
It depends on the type and severity. Acute kidney failure can sometimes be reversed if caught and treated early. Chronic kidney failure usually cannot be reversed, but progression can be slowed with proper treatment. Once kidneys reach stage 5 failure, dialysis or transplant is needed.
You're at higher risk if you have diabetes, high blood pressure, heart disease, or a family history of kidney disease. Being over 60, smoking, obesity, and taking certain medications also increase risk. Regular blood and urine tests can catch kidney problems early, especially if you have risk factors.
Dialysis is a treatment that filters your blood when your kidneys can't. Hemodialysis uses a machine to clean your blood, usually three times a week for about four hours. Peritoneal dialysis uses the lining of your abdomen to filter blood and can be done at home daily.
Limit foods high in sodium like processed meats and canned soups. Reduce potassium from bananas, oranges, and potatoes if your levels are high. Cut back on phosphorus found in dairy, nuts, and whole grains. Your specific restrictions depend on your lab results and stage of kidney disease.
Ethylene glycol is a toxic chemical found in antifreeze. When ingested or absorbed through skin over time, your body converts it into harmful compounds. These metabolites destroy kidney tissue and can cause acute or chronic kidney failure. Specialized urine tests can detect ethylene glycol exposure.
Yes, many people live healthy lives with one functioning kidney. One kidney can filter enough blood to keep you healthy. However, you need to protect your remaining kidney by staying hydrated, avoiding kidney-toxic medications, and managing blood pressure carefully.
Most people with early kidney disease should have blood and urine tests every three to six months. Your doctor may recommend more frequent testing if your function is declining or if you start new treatments. Regular monitoring helps catch changes before they become serious.
ACE inhibitors and ARBs are medications that lower blood pressure and protect kidney function. They reduce protein loss in urine and slow damage progression. SGLT2 inhibitors, originally diabetes medications, also show promise in protecting kidneys. Your doctor will choose medications based on your specific situation.
For most people, kidney transplant offers better quality of life and longer survival than long-term dialysis. Transplant recipients have more freedom and fewer dietary restrictions. However, not everyone is eligible for transplant, and the wait for a donor kidney can be years long.