kidney failure

{{See also|Hepatorenal syndrome}}

Kidney failure can be divided into two categories: acute kidney failure or chronic kidney failure. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney failure from chronic kidney failure include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.niddk.nih.gov, [Anemia in Chronic Kidney Disease](https://www.niddk.nih.gov/health-information/kidney-disease/anemia)

{{Main|Acute kidney injury}}

Acute kidney injury (AKI), previously called acute renal failure (ARF),{{cite journal | vauthors = Moore EM, Bellomo R, Nichol AD | title = The meaning of acute kidney injury and its relevance to intensive care and anaesthesia | journal = Anaesthesia and Intensive Care | volume = 40 | issue = 6 | pages = 929–48 | date = November 2012 | pmid = 23194202 | doi = 10.1177/0310057X1204000604 | doi-access = free }}{{cite journal | vauthors = Ricci Z, Ronco C | title = New insights in acute kidney failure in the critically ill | journal = Swiss Medical Weekly | volume = 142 | pages = w13662 | year = 2012 | pmid = 22923149 | doi = 10.4414/smw.2012.13662 | doi-access = free }} is a rapidly progressive loss of renal function,{{cite encyclopedia |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/ | archive-url = https://web.archive.org/web/20140117220151/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/ | archive-date = 17 January 2014 |title=Acute kidney failure | encyclopedia = A.D.A.M. Medical Encyclopedia |year=2012 |publisher=U.S. National Library of Medicine |access-date=1 January 2013}} generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,{{cite journal | vauthors = Klahr S, Miller SB | title = Acute oliguria | journal = The New England Journal of Medicine | volume = 338 | issue = 10 | pages = 671–5 | date = March 1998 | pmid = 9486997 | doi = 10.1056/NEJM199803053381007 }} less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. Many people diagnosed with paraquat intoxication experience AKI, sometimes requiring hemodialysis.Predictors of acute kidney injury after paraquat intoxication, [National Library of Medicine - National Institutes of Health](https://pmc.ncbi.nlm.nih.gov/articles/PMC5584253/) The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.{{citation needed|date=April 2023}}

{{Main|Chronic kidney disease}}

File:CKD - Chronic kidney disease.jpg

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms.{{cite encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/000471.htm |title=Chronic kidney disease |year=2011 |encyclopedia=A.D.A.M. Medical Encyclopedia |publisher= Medline Plus, National Institutes of Health |access-date=1 January 2013}} CKD can be the long term consequence of irreversible acute disease or part of a disease progression.{{citation needed|date=August 2022}} CKD is divided into 5 different stages (1–5) according to the estimated glomerular filtration rate (eGFR). In CKD1 eGFR is normal and in CKD5 eGFR has decreased to less than 15 ml/min.{{Cite web |date=2021-11-22 |title=Stages of kidney disease |url=https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease |access-date=2023-03-09 |website=www.kidneyfund.org |language=en}}

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the person to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the person has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.{{citation needed|date=August 2022}}

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When the kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.{{cite web | vauthors = Grinsted P | title = Kidney failure (renal failure with uremia, or azotaemia) | work = Netdoctor | date = 2005-03-02 | url = http://www.netdoctor.co.uk/diseases/facts/kidneyfailure.htm | access-date = 2009-05-26 | archive-date = 2015-10-15 | archive-url = https://web.archive.org/web/20151015111748/http://www.netdoctor.co.uk/diseases/facts/kidneyfailure.htm | url-status = dead }}

Symptoms of kidney failure include the following:{{cite book | vauthors = Stein A | title = Understanding Treatment Options For Renal Therapy | publisher = Baxter International Inc. | date = 2007-07-01 | location = Deerfield, Illinois | page = 6 | url = http://www.renalinfo.com/ | isbn = 978-1-85959-070-6 | access-date = 2010-07-12 | archive-date = 2019-01-30 | archive-url = https://web.archive.org/web/20190130063734/http://www.renalinfo.com/ | url-status = dead }}{{cite book | title = The PD Companion | publisher = Baxter International Inc. | date = 2008-05-01 | location = Deerfield, Illinois | pages = 14–15 | url = http://www.renalinfo.com/uk | id = 08/1046R | access-date = 2010-07-12 | archive-url = https://web.archive.org/web/20100625040151/http://www.renalinfo.com/uk/ | archive-date = 2010-06-25 | url-status = dead }}{{cite web | last = Amgen Inc. | author-link = Amgen | title = 10 Symptoms of Kidney Disease | year = 2009 | url = https://www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4 | access-date = 2009-05-26}}

• High levels of urea in the blood, which can result in:
• Vomiting or diarrhea (or both) that may lead to dehydration
• Nausea
• Weight loss
• Nocturnal urination (nocturia)
• More frequent urination, or in greater amounts than usual, with pale urine
• Less frequent urination, or in smaller amounts than usual, with dark coloured urine
• Blood in the urine
• Pressure, or difficulty urinating
• Unusual amounts of urination, usually in large quantities
• A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
• Itching
• Bone damage
• Nonunion in broken bones
• Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)
• A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
• Abnormal heart rhythms
• Muscle paralysis{{cite web | work = MedicineNet, Inc. | title = Hyperkalemia | date = 2008-07-03 | url = https://www.medicinenet.com/hyperkalemia/page4.htm | access-date = 2009-05-26}}
• Failure of kidneys to remove excess fluid may cause:
• Swelling of the hands, legs, ankles, feet, or face
• Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
• Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
• Pain in the back or side
• Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
• Feeling tired or weak
• Memory problems
• Difficulty concentrating
• Dizziness
• Low blood pressure
• Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,{{cite web | vauthors = Hebert LA, Charleston J, Miller E | title = Proteinuria | year = 2009 | url = http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ | access-date = 2011-03-24 | archive-url = https://web.archive.org/web/20110505073832/http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ | archive-date = 2011-05-05 | url-status = dead }} after which symptoms include:
• Foamy or bubbly urine
• Swelling in the hands, feet, abdomen, and face
• Other symptoms include:
• Appetite loss, which may include a bad taste in the mouth
• Difficulty sleeping
• Darkening of the skin
• Excess protein in the blood
• With high doses of penicillin, people with kidney failure may experience seizures{{cite book| vauthors = Katzung BG |title=Basic and Clinical Pharmacology |edition=10th |year=2007|publisher=McGraw Hill Medical|location=New York, NY|isbn=978-0-07-145153-6|page=733}}

{{Main|Acute kidney injury}}

Acute kidney injury (previously known as acute renal failure) – or AKI – usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.{{citation needed|date=April 2022}}

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, along with bee stings{{cite journal | vauthors = Silva GB, Vasconcelos AG, Rocha AM, Vasconcelos VR, Barros J, Fujishima JS, Ferreira NB, Barros EJ, Daher EF | display-authors = 6 | title = Acute kidney injury complicating bee stings - a review | journal = Revista do Instituto de Medicina Tropical de Sao Paulo | volume = 59 | pages = e25 | date = June 2017 | pmid = 28591253 | pmc = 5459532 | doi = 10.1590/S1678-9946201759025 }} may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the person with AKI to resume a normal life. People with acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.{{cite web |url=http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#7 |title=The Kidneys and How They Work |author=National Kidney and Urologic Diseases Information Clearinghouse |year=2012 |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |access-date=1 January 2013 |archive-url=https://web.archive.org/web/20150502081848/http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#7 |archive-date=2 May 2015 |url-status=dead }}

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.{{citation needed|date=April 2023}}

{{Main|Chronic kidney disease}}

Chronic kidney failure has numerous causes. The most common causes of chronic failure are diabetes mellitus and long-term, uncontrolled hypertension.{{cite journal | vauthors = Kes P, Basić-Jukić N, Ljutić D, Brunetta-Gavranić B | title = [The role of arterial hypertension in development of chronic renal failure] | language = hr | journal = Acta Medica Croatica | volume = 65 | issue = Suppl 3 | pages = 78–84 | date = October 2011 | pmid = 23120821 | url = http://www.amzh.hr/amc/pdf/amc_2011%20vol%2065%20supplement%203.pdf | url-status = dead | trans-title = The role of arterial hypertension in the development of chronic renal failure | archive-url = https://web.archive.org/web/20130719135947/http://www.amzh.hr/amc/pdf/amc_2011%20vol%2065%20supplement%203.pdf | archive-date = 2013-07-19 }} Polycystic kidney disease is another well-known cause of chronic failure. The majority of people affected with polycystic kidney disease have a family history of the disease. Systemic lupus erythematosus (SLE) is also a known cause of chronic kidney failure. Other genetic illnesses cause kidney failure, as well.{{citation needed|date=August 2022}}

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney failure.{{cite journal | vauthors = Perneger TV, Whelton PK, Klag MJ | title = Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs | journal = The New England Journal of Medicine | volume = 331 | issue = 25 | pages = 1675–9 | date = December 1994 | pmid = 7969358 | doi = 10.1056/NEJM199412223312502 | doi-access = free }}

Some infectious disease agents, such as hantavirus, can attack the kidneys, causing kidney failure.{{cite web |url=https://www.uptodate.com/contents/renal-involvement-with-hantavirus-infection-hemorrhagic-fever-with-renal-syndrome |title=Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome) | vauthors = Appel GB, Mustonen J |year=2012 |publisher=UpToDate |access-date=1 January 2013}}

The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies.{{cite journal | vauthors = Bostrom MA, Freedman BI | title = The spectrum of MYH9-associated nephropathy | journal = Clinical Journal of the American Society of Nephrology | volume = 5 | issue = 6 | pages = 1107–13 | date = June 2010 | pmid = 20299374 | pmc = 4890964 | doi = 10.2215/CJN.08721209 }} Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.{{cite journal | vauthors = Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, Bowden DW, Langefeld CD, Oleksyk TK, Uscinski Knob AL, Bernhardy AJ, Hicks PJ, Nelson GW, Vanhollebeke B, Winkler CA, Kopp JB, Pays E, Pollak MR | display-authors = 6 | title = Association of trypanolytic ApoL1 variants with kidney disease in African Americans | journal = Science | volume = 329 | issue = 5993 | pages = 841–5 | date = August 2010 | pmid = 20647424 | pmc = 2980843 | doi = 10.1126/science.1193032 | bibcode = 2010Sci...329..841G }}{{cite journal | vauthors = Tzur S, Rosset S, Shemer R, Yudkovsky G, Selig S, Tarekegn A, Bekele E, Bradman N, Wasser WG, Behar DM, Skorecki K | display-authors = 6 | title = Missense mutations in the APOL1 gene are highly associated with end stage kidney disease risk previously attributed to the MYH9 gene | journal = Human Genetics | volume = 128 | issue = 3 | pages = 345–50 | date = September 2010 | pmid = 20635188 | pmc = 2921485 | doi = 10.1007/s00439-010-0861-0 }}

;Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using the person's GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. People with stage 4 and 5 kidney failure usually require preparation towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.Kidney Transplantation as Primary Therapy for End-Stage Renal Disease: A National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) Conference](https://pmc.ncbi.nlm.nih.gov/articles/PMC2390948/)

;

;Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function.Fadem, Stephen Z., M.D., [http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm FACP, FASN. Calculators for HealthCare Professionals. National Kidney Foundation. 13 Oct 2008] {{Webarchive|url=https://web.archive.org/web/20140727183526/http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |date=27 July 2014 }} The National Kidney Foundation offers an easy to use on-line GFR calculator{{cite web |url=http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |title=GFR calculator |publisher=Kidney.org |access-date=2011-09-25 |archive-date=2014-07-27 |archive-url=https://web.archive.org/web/20140727183526/http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |url-status=dead }} for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator.)

Those with end stage renal failure who undergo haemodialysis have higher risk of spontaneous intra-abdominal bleeding than the general population (21.2%) and non-occlusive mesenteric ischemia (18.1%). Meanwhile, those undergoing peritoneal dialysis have a higher chance of developing peritonitis and gastrointestinal perforation. However, the rate of acute pancreatitis does not differ from the general population.{{cite journal | vauthors = Tonolini M, Ierardi AM, Carrafiello G | title = Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease | journal = Insights into Imaging | volume = 6 | issue = 6 | pages = 693–695 | date = December 2015 | pmid = 26472545 | pmc = 4656237 | doi = 10.1007/s13244-015-0439-4 }}

The treatment of acute kidney injury depends on the cause. The treatment of chronic kidney failure may include renal replacement therapy: hemodialysis, peritoneal dialysis, or kidney transplant.

In non-diabetics and people with type 1 diabetes, a low protein diet is found to have a preventive effect on progression of chronic kidney disease. However, this effect does not apply to people with type 2 diabetes.{{cite journal | vauthors = Rughooputh MS, Zeng R, Yao Y | title = Protein Diet Restriction Slows Chronic Kidney Disease Progression in Non-Diabetic and in Type 1 Diabetic Patients, but Not in Type 2 Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials Using Glomerular Filtration Rate as a Surrogate | journal = PLOS ONE | volume = 10 | issue = 12 | pages = e0145505 | date = 28 December 2015 | pmid = 26710078 | pmc = 4692386 | doi = 10.1371/journal.pone.0145505 | bibcode = 2015PLoSO..1045505R | doi-access = free }} A whole food, plant-based diet may help some people with kidney disease.{{cite journal | vauthors = Chauveau P, Combe C, Fouque D, Aparicio M | title = Vegetarianism: advantages and drawbacks in patients with chronic kidney diseases | journal = Journal of Renal Nutrition | volume = 23 | issue = 6 | pages = 399–405 | date = November 2013 | pmid = 24070587 | doi = 10.1053/j.jrn.2013.08.004 }} A high protein diet from either animal or plant sources appears to have negative effects on kidney function at least in the short term.{{cite journal | vauthors = Bernstein AM, Treyzon L, Li Z | title = Are high-protein, vegetable-based diets safe for kidney function? A review of the literature | journal = Journal of the American Dietetic Association | volume = 107 | issue = 4 | pages = 644–50 | date = April 2007 | pmid = 17383270 | doi = 10.1016/j.jada.2007.01.002 | s2cid = 39551628 }}

People who receive earlier referrals to a nephrology specialist, meaning a longer time before they must start dialysis, have a shorter initial hospitalization and reduced risk of death after the start of dialysis.{{cite journal | vauthors = Smart NA, Dieberg G, Ladhani M, Titus T | title = Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD007333 | date = June 2014 | pmid = 24938824 | doi = 10.1002/14651858.CD007333.pub2 }} Other methods of reducing disease progression include minimizing exposure to nephrotoxins such as NSAIDs and intravenous contrast.{{Cite book|url=http://accessmedicine.mhmedical.com/content.aspx?aid=1145435499|title=Current Medical Diagnosis & Treatment 2018| vauthors = Dirkx TC, Woodell T, Watnick S |date=2017|publisher=McGraw-Hill Education| veditors = Papadakis MA, McPhee SJ, Rabow MW |location=New York, NY}}

{{Reflist}}

{{Medical condition classification and resources|DiseasesDB = 26060

|ICD10 = {{ICD10|N|17||n|17}}–{{ICD10|N|19||n|17}}

|ICD9 = {{ICD9|584}}–{{ICD9|585}}

|MedlinePlus =

|eMedicineSubj =

|eMedicineTopic =

|MeshName = Renal+Failure

|MeshNumber = C12.777.419.780.500

|}}

{{Nephrology}}

{{Organ failure}}

{{Authority control}}

Category:Kidney diseases

Category:Organ failure

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