What is Kidney Failure?
Our kidneys mainly function as the body’s filtration system: it filters the blood to rid it of toxins and waste products and eliminates unwanted substances through urination. Sometimes, though, the kidneys can no longer filter the blood as effectively as they should. We call this condition kidney or renal failure. Left untreated, kidney failure may lead to numerous complications and death.
Acute vs. Chronic Kidney Failure
There are two types of kidney failure: acute kidney failure and chronic kidney failure. Learn more about their differences below:
Acute Kidney Failure
Acute kidney failure (AKI) means the filtration system within the kidney stopped suddenly, usually within hours to days. AKI is commonly reversible, meaning, with intervention, the kidneys recover and regain their function.
Since acute renal failure is often temporary, many healthcare professionals now prefer to use acute kidney injury instead of acute kidney failure. In this article, we’ll use the terms acute kidney injury and acute kidney failure interchangeably.
Chronic Kidney Failure
Unlike acute kidney injury, chronic kidney failure means a progressive and persistent deterioration in renal function. This means the problem starts lightly, develops slowly, and may even reach the point where you require renal replacement therapy (transplantation or dialysis).
Signs and Symptoms of Kidney Failure
To better shed light on kidney failure symptoms, we dedicate one section each for acute kidney injury and chronic renal failure.
Signs and Symptoms of Acute Kidney Failure
- Reduced urine output, although there are instances when urine output is normal.
- Swollen legs, ankles, and feet due to fluid retention
- Weakness and fatigue
- High blood pressure
- Irregular heartbeat
- Internal bleeding
- Pressure or pain in the chest
- Seizures or coma in severe cases
Please note that acute kidney injury does not present with any symptoms in some cases, and you might only find out from lab tests conducted for another concern.
Signs and Symptoms of Chronic Kidney Failure
Reports say the signs and symptoms of chronic kidney failure do not show until after renal function dropped to 20%. By that time, the following kidney failure symptoms may appear:
- Abnormal blood tests, including a diagnosis of anaemia
- Abnormal urine tests
- Swelling in the face, hands, and feet
- High blood pressure
- Loss of appetite
- Nausea and vomiting
- Metallic taste in the mouth
- Unexplained weight loss
- Shortness of breath
- Chest pains
- Easy bruising
- Yellow to brown skin colour
- Muscle cramps or twitches
- Numbness and tingling sensation
- Weak bones that increase the risk of fracture
- Trouble sleeping
When to Seek Help
If you notice the symptoms of kidney failure, do not “wait it out” to see if you’ll feel better. Go to the hospital immediately to receive the appropriate treatment.
Do you need help going to and from your medical appointments and routine tests? Consider our Medical Escort and Transport Service. We’ll assign you with an expert who will escort you to the clinic or hospital, take note of the doctor’s advice, collect any prescribed medications, and accompany you safely back home.
Kidney Failure Causes
After learning about the kidney failure symptoms, let’s now discuss the causes. As usual, let’s explain the causes of acute kidney injury and chronic kidney failure separately.
Causes of Acute Kidney Failure
Given that acute kidney injury happens in hours or days, it follows that an underlying health concern triggered the failure of the kidneys to perform their function. Some of the possible causes of kidney failure are:
- Severe dehydration
- Low blood flow, which might happen after a surgery or accident
- Certain medications that trigger problems in the kidneys (i.e., inflammation)
- Obstruction in the urinary tract (i.e., kidney stones)
- Severe hypertension
- Uncontrolled systemic disease (i.e., liver disease, heart disease, etc.)
In most cases, once you take care of the underlying health concern, the kidneys also recover, and kidney failure signs clear up.
Causes of Chronic Kidney Failure
What causes chronic kidney failure? Like mentioned earlier, chronic kidney failure is persistent and progressive. In other words, it doesn’t happen overnight.
Chronic kidney failure often results from chronic kidney disease (CKD), which usually stems from an underlying health condition that slowly damages the kidneys.
The two most common reasons for kidney failure from chronic kidney disease are diabetes, particularly Type 2, and hypertension.
Diabetes and Kidney Failure
According to reports, uncontrolled diabetes, specifically type 2 diabetes mellitus, is the most common cause of kidney failure. When a person has uncontrolled diabetes, they often have consistently high blood sugar levels, which can damage the blood vessels and organs, like kidneys.
Hypertension and Kidney Failure
The second most common cause of kidney failure is hypertension. Having high blood pressure means the blood passes through the blood vessels with more force than normal. In the long run, hypertension can damage the tissues of the kidneys, resulting in kidney failure.
Besides diabetes and hypertension, the other possible causes of CKD are:
- Lupus or other autoimmune diseases that affect multiple organs.
- Glomerular disease, such as glomerulonephritis, is a condition that negatively impacts how well our kidneys filter waste.
- Polycystic kidney disease, a condition where the kidneys develop fluid-filled sacs.
Kidney Failure Stages
Kidney failure from chronic kidney disease develops slowly; that’s why experts divided CKD into several stages.
To determine the CKD stage, doctors often rely on the estimated glomerular filtration rate or eGFR, a value representing how well the kidneys are functioning. The higher the eGFR, the better the kidney’s condition is.
Currently, eGFR considers the following: your gender, ethnic background, age, and creatinine level results.
Before we explain the progress of chronic kidney disease, let’s first clarify one thing: in this article, we’ll also refer to CKD stages as stages of kidney failure. However, note that complete kidney failure doesn’t occur until the last stage, referred to as ESRD or end-stage renal disease.
Stage 1 Kidney Failure
Among the CKD stages, stage 1 indicates a good kidney function, often with an eGFR score of 90 or greater. However, you still manifest some signs of kidney damage.
For instance, the doctor may notice protein in your urine. Normally, the kidneys do not let proteins pass their filtration system; so, if the lab tests reveal protein in the urine, it’s a clear indication of a renal problem.
Also, since you still have high kidney function, you’ll probably not experience any symptoms.
Stage 2 Kidney Failure
Stage 2 CKD means an eGFR score of 60 to 89 AND some indication of a kidney problem, like protein in the urine or physical injury to the kidneys. Note that under normal circumstances, a score of 60 to 89 means the kidneys are healthy and functioning well.
Furthermore, stage kidney failure may produce symptoms; however, they are non-specific, like fatigue, loss of appetite, or trouble sleeping.
Stage 3 Kidney Failure
Stage 3 chronic kidney disease shows a further decline in kidney function. Your eGFR score ranges from 30 to 59, meaning there are some damages to the kidneys, and they are not functioning as well as they should.
We further divide stage 3 CKD into two: stage 3a, with an eGFR score of 45 to 59, and stage 3b, with an eGFR of 30 to 44.
If you’re diagnosed with stage 3 kidney failure, you may or may not exhibit symptoms. But if you do, they are no longer non-specific. You may manifest kidney failure signs and symptoms, including:
- Peeing more or less than usual.
- Swelling in your hands and feet.
- Back pain
Moreover, since stage 3 CKD means your kidneys are no longer as healthy as they are supposed to be, waste can build up and result in complications, such as:
- Bone disease
- High blood pressure
Stage 4 Kidney Failure
Stage 4 kidney failure indicates an eGFR score of 15 to 29, indicating the kidneys have sustained moderate to severe damage. Stage 4 kidney failure is critical because it’s the last stage before ESRD.
At this point, you will most likely develop kidney failure symptoms, such as:
- Swelling in your hands and feet
- Back pain
- Peeing more or less than usual
Finally, complications may also arise from waste building up in the body.
Stage 5 Kidney Failure
Stage 5 kidney failure points to an eGFR score of less than 15. It means either of two things: the kidney is very close to failing or have already failed. The waste and toxins are also building up intensely that you’ll feel really sick.
If you’re diagnosed with stage 5 kidney failure, it follows that you’ll experience the symptoms of chronic kidney failure we discussed earlier.
Kidney Failure Diagnosis
Earlier, we mentioned something about creatinine levels and how doctors use them, along with other factors, to determine the estimated glomerular filtration rate.
Simply put, creatinine is a chemical, a waste product made when we produce energy. Our kidneys normally remove creatinine from the blood and excrete it through urination. Therefore, blood test results that reveal high creatinine levels mean the kidneys “fail” at filtering it.
But, what level of creatinine indicates kidney failure? For reference, remember that the normal creatinine level for men is 0.7 to 1.3 mg/dl and 0.6 to 1.5 mg/dl for women.
Below are the criteria for diagnosing acute and chronic kidney failure.
Acute Kidney Failure
According to reports, the Kidney Disease Improving Global Outcomes or KDIGO criteria for acute kidney injury include any of the following for AKI:
- An increase of 0.3 mg/dl in creatinine level within 48 hours
- Creatinine level increase equivalent to 1.5x the baseline within the last 7 days.
- A decrease in urine output, the volume of which is less than 0.5 ml/kg of body weight within 6 hours.
Chronic Kidney Failure
Now, what level of creatinine indicates chronic kidney failure? Experts say someone has chronic kidney failure when they have abnormally elevated creatinine levels for more than 3 months. Likewise, CKF also happens when the computed glomerular filtration rate is lower than 60 ml per minute/1.73 m2.
Of course, let’s not forget that we divide chronic kidney failure into five stages, which are heavily reliant on estimated glomerular filtration rate and kidney failure signs and symptoms.
Kidney Failure Treatment
How to treat kidney failure depends on several factors, such as the type (acute or chronic), stage, and overall health status.
Case in point: if you have acute kidney injury, it’s crucial to treat the underlying problem first so that your kidneys can recover. In some cases, you might need to undergo dialysis temporarily.
For chronic kidney failure, however, you need to be more aggressive in performing lifestyle modifications. Remember: the goal is to stave off complete renal failure for as long as you can.
Generally, kidney treatment involves:
- Controlling any underlying health condition you might have, such as hypertension and high blood sugar.
- Quitting smoking
- Staying physically active. Note: only choose an exercise routine approved by your doctor. Typically, staying physically active means exercising for 30 minutes daily for five days a week.
- Taking medicines prescribed by your doctor to protect your kidneys
- Being in constant communication with your physician and nephrologist (a doctor specializing in kidney health)
Kidney Failure Diet
Finally, dealing with kidney failure means you have to eat healthily. Your nephrologist may ask you to consult a dietician for an individualized dietary plan, but generally, the guidelines for a kidney failure diet include:
Choosing Foods Low in Sodium
Too much sodium can negatively affect your blood pressure.
As much as possible, choose fresh foods; often, processed ones and fast food products contain too much sodium. Instead of seasoning your food with salt, consider other herbs and spices. And finally, always check food labels and select foods with lower sodium content.
Having Adequate Amount of Proteins from the Right Sources
When our body uses protein, we also produce waste, which the kidneys eliminate. Consuming more protein than what the body needs will increase the kidneys’ workload.
As much as possible, choose only protein from lean meat, chicken, eggs, fish, and dairy. Nuts and seeds are also excellent sources of protein.
Choosing Heart-Healthy Foods
Heart-healthy foods boost your blood vessels’ health; this, in turn, makes for healthier kidneys. Heart-healthy essentially means choosing fresh foods over processed ones, lean protein, whole grains, healthy fats, and limiting alcohol consumption.
Picking Foods with Lower Phosphorus Content
A kidney failure diet also involves choosing foods with lower phosphorus. You see, phosphorus can build up in your blood and make things more difficult for your kidneys. Moreover, too much phosphorus can pull calcium out of the bones, making them weaker.
Some of the foods with lower phosphorus content are:
- Rice, bread, and pasta
- Fresh fruits and vegetables
- Corn and rice cereals
- Homemade iced tea
Choose Foods with the Right Amount of Potassium
Finally, a kidney failure diet also means you need to choose foods with the right amount of potassium, as they help muscles and nerves function well.
Just as too little potassium can be dangerous, too much can also do some damage. For this reason, talk to your doctor or dietician about how much potassium you need and the types of foods you should be consuming.
Dialysis and Transplantation
In stage 4 kidney failure and stage 5 CKD, your doctor will probably talk to you about the need for either dialysis or kidney transplantation.
Dialysis is the treatment that does the job your kidneys can no longer do: filter the blood. There are two types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis uses a machine to filter the blood and rid it of toxins and waste substances. Generally, blood goes out of the body, enters the device to be filtered, and then returns to the body.
How many times you need to undergo hemodialysis depends on your condition, but many patients have it three to four times weekly.
Peritoneal dialysis also cleans the blood, but instead of using a machine, it uses the abdominal lining as the filter and a solution that removes toxins and waste products (dialysate).
Basically, the dialysate will flow from a bag (hanged like an IV fluid) to the peritoneal (abdominal) cavity. The dialysate then absorbs the waste products and toxins from the blood vessels of the abdominal lining. Afterwards, the dialysate will be drawn out of the body and discarded through another tube.
Unlike hemodialysis, peritoneal dialysis can be done at home. However, it isn’t for everyone. The patient must have the ability to take care of themselves or at least have a capable caregiver.
Transplant is another option for people whose kidney failure symptoms are already severe (stage 4 or stage 5 kidney failure).
In this procedure, the surgeon removes the failing kidney and replaces it with a healthy one. The kidney may come from a deceased or living friend or relative. Note that you can live well with just one healthy kidney.
A kidney transplant is an excellent kidney failure treatment as it eliminates the need for dialysis; however, in many instances, the surgery is expensive, and finding a match is difficult. Additionally, undergoing a kidney transplant means you need to take some medications for life. The drugs prevent your body from rejecting the organ.
Kidney Failure Complications
Left untreated, the signs and symptoms of kidney failure significantly decrease the patient’s quality of life. Furthermore, it results in various complications that may eventually result in death.
Below are the potential kidney failure complications:
- Anaemia – Did you know that our kidneys also help our bone marrow make red blood cells? When kidneys fail, they may not produce enough erythropoietin, a protein essential in RBC production. This then leads to anaemia.
- CKD-associated bone and mineral disorders – Like mentioned earlier, our kidneys excrete excess phosphorus. Should kidneys fail, phosphorus might build up and draw calcium from the bones, resulting in bone disease.
- Hyperkalemia – Hyperkalemia, or too much potassium, might occur if you have kidney failure. This condition is dangerous. It leads to various symptoms like chest pain, muscle weakness, and heart palpitation.
- Heart Diseases – Failing kidneys will not be able to support other organs, such as the heart. In other words, kidney failure also increases cardiovascular risks.
- Fluid buildup – Kidney failure complications also include fluid buildup; that’s why one of the symptoms is oedema or swelling. Over time, fluid buildup further increases the heart’s workload and might even affect the lungs.
- Mental Health Issues – The physical effects of kidney failure, along with its implications (need for dialysis, job loss, etc.) might also take a toll on one’s mental health.
How to Prevent Kidney Failure
It’s no longer possible to reverse kidney failure (unless you undergo kidney transplantation); however, there are many ways to preserve your kidneys’ health and prevent kidney failure.
For one, be sure to control whatever underlying health condition you have, particularly hypertension and diabetes. You also need to be in constant communication with your doctor regarding your kidney status. If they ask you to undergo some tests, do so.
Finally, make some kidney-friendly lifestyle modifications. Eat a healthy, balanced diet, preferably one low in sodium, and avoid smoking.
Kidney Failure Support Groups & Resources
Kidney failure in Singapore is a rising health concern. According to reports, each day, five new patients are diagnosed with end-stage renal disease, and there is one new patient needing dialysis every 5 hours.
Suppose you have end-stage renal disease or renal failure. In that case, it’s incredibly beneficial for you to find and join support groups that offer programs to improve your quality of life significantly.
Get in touch with the National Kidney Foundation. They have dialysis treatment centres and kidney transplant support. They also have outreach programs, like Health Talks and Education Buses, to raise awareness of kidney diseases, their effects, and how they can be prevented.
Living with Kidney Failure
The best course of action in living with kidney failure is to work closely with your doctor, nephrologist, and dietician. Follow their recommendations in all aspects: diet, physical activity, medications, tests, and treatment.
Remember: the goal of intervention is to preserve your kidneys’ function for as long as possible. Should you have Stage 4 or Stage 5 kidney failure, listen closely to their advice about dialysis or transplantation.
Living with kidney failure may pose some challenges, both physical and mental. However, with correct information, treatment, and support, you’ll be able to improve your quality of life.
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