Complications of Renal Failure
Renal failure (kidney disease) is a disease condition referring to impaired kidney function. The kidneys, a pair of bean-shaped organs, are located in the mid-back region, one on each side of the vertebral column. They lie in back of the abdominal cavity. The kidneys are principally responsible for cleansing the blood of waste products and excreting it in the form of urine. Because their function is very complex, kidney damage and disease affects nearly every organ system in the body.
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Types
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There are 2 types of renal failure: acute and chronic.
Acute renal failure (ATF) is an express development of decreasing kidney function, usually occurring over a period of days or several weeks. Symptoms include edema of the extremities, weight gain progressing to nausea, vomiting, seizures and coma. Other possible symptoms include fluid accumulation in the lungs (pulmonary edema) and brown cola-colored urine.
Chronic renal failure, also known as chronic kidney disease (CKD) is characterized by a gradual worsening, or loss of normal kidney function. Developing over a period of many years, it occurs in stages ranging from very mild and moderate to severe and complete failure. It is during the later stages that CKD may progress to end-stage renal disease (ESRD) as the kidneys can no longer function as required for survival, which is below 10% of normal.
In the mild to moderate stages, those with CKD report no symptoms other than needing to frequently urinate during the night. However, as the disease progresses symptoms of uremia may develop: anorexia, mental confusion, weakness, nausea, vomiting and seizures. Uremia is due to the build up of waste products, namely urea within the blood.
Causes
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Acute renal failure may be caused by infections such as septicemia and acute pyelonephritis, disorders causing blood clotting within the kidney's blood vessels, low blood pressure resulting from burns or other trauma, hemorrhaging or dehydration. It may also manifest from obstruction of the urinary tract due to kidney stones, cancer of the bladder or prostate enlargement.
Chronic renal failure occurs because of disease causing kidney function to slowly deteriorate. Heart disease, diabetes and hypertension are the most common conditions responsible for chronic kidney disease. According to the National Kidney Foundation, heart disease is the leading cause of death among those with CKD.
Some common risk factors of developing chronic renal failure include: having a history of chronic kidney disease within the family, being diagnosed with diabetes, cardiovascular disease, or high blood pressure, being over 60 years of age, African American, Asian, Native American, Mexican American or of Pacific Islander ethnicity.
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Diagnosis
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Diagnosis of kidney damage usually begins with urinalysis and blood lab testing. Increased serum creatinine and BUN levels are indicative of decreased kidney function. Creatinine is a waste product of muscular function which the kidneys normally secrete. BUN refers to the level of urea nitrogen found within the blood. It is produced from protein metabolism. Other tests used to diagnose and evaluate possible kidney failure include ultrasonography, and renal biopsy. Next, it is necessary to determine whether disease is acute or chronic, and the cause. Based upon information gained from lab testing, physicians calculate the glomerular filtration rate, or GFR.
The GFR is used to evaluate the overall functioning of the kidneys and to determine the stage and extent of kidney failure. Doctors also utilize the GFR to decide when dialysis and transplantation are necessary.
Treatment
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Typical treatment modalities for renal failure begins with controlling any contributing disease conditions, such as diabetes and hypertension. Dietary restrictions and modifications involve monitoring sodium, protein, potassium, phosphate and water intake. Anemia, is treated with supplemental iron given intravenously and in severe cases transfusions are necessary. Because those with renal failure have a decreased ability to excrete medication, physicians prescribe drugs and adjust dosages very cautiously.
Dialysis and Transplantation
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When the function of the kidneys are no longer adequate for daily survival needs, physicians will deem hemodialysis as a necessary treatment. Hemodialysis is the process by which the blood is cleansed by way of an artificial kidney. Those receiving hemodialysis will undergo minor surgery to construct a fistula in order to obtain access. Fistulas are placed either in the arm or leg of those preparing to begin receiving hemodialysis treatment. It is through these fistulas that the blood can be gradually removed, cleansed and then returned to the body. Hemodialysis may be done in the home, in the hospital or at a hemodialysis center.
A procedure done within the body, peritoneal dialysis involves the placement of a catheter via minor surgery within the peritoneal cavity of the abdomen. The catheter is filled with dialysate as it draws the products of waste out of the blood. The dialysate is then discarded. Peritoneal dialysis can be done at home while sleeping during the night. It may also be done while at work or school.
Dialysis treatment is not a cure for those with kidney failure; it is a replacement therapy that must be done for the entirety of life, or until a kidney transplant can be performed.
Kidney transplantation is surgery that is done to replace failed kidneys with those that are healthy. Transplanted kidneys are donated by people who are living or from those who have died. The outcome is better in the long term if transplantation takes place as early as possible, before dialysis treatment is started. Immunosuppressant drugs are given as a safeguard against transplant rejection, a possible complication.
Complications
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There are many complications associated with renal failure, especially over the long-term. Some of the more common problems are heart failure, anemia, high blood pressure, electrolyte imbalances, hemorrhage, bone fractures and lowered immune response.
In addition, those receiving dialysis treatments are at risk for malnourishment, infections at the site of vascular access as well as systemically. Other associated complications of dialysis include hypotension (low blood pressure) air embolism, pericarditis and pneumonia.
Prevention
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Because diabetes and hypertension are the most common causes of renal failure, it is essential that these conditions be adequately controlled and monitored. Those who are at increased risk must have their blood pressure monitored, as well as urine screening for the presence of the protein albumin, which is typically the earliest indicator of kidney disease. A creatinine test should also be performed.
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