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Kidney failure, also known as end-stage kidney disease, is a medical condition in which the
kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized ...

kidney
s are functioning at less than 15% of normal levels. Kidney failure is classified as either
acute kidney failure Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine Creatinine ( or ; from el, κρέας, kreas, flesh) is a ...
, which develops rapidly and may resolve; and
chronic kidney failure Chronic kidney disease (CKD) is a type of kidney disease The kidneys are two reddish-brown bean-shaped organs found in vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukary ...
, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired,
vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach The stomach is a muscular, Organ (anatomy), hollow organ in the gastrointestinal tract of humans and many other anim ...

vomiting
, loss of appetite, and
confusion In medicine, confusion is the quality or state of being bewildered or unclear. The term "acute mental confusion"
confusion
. Complications of acute and chronic failure include
uremia Uremia is the condition of having high levels of urea Urea, also known as carbamide, is an organic compound with chemical formula CO(NH2)2. This amide has two amidogen, –NH2 groups joined by a carbonyl (C=O) functional group. Urea serves a ...
,
high blood potassium Hyperkalemia is an elevated level of potassium Potassium is a chemical element Image:Simple Periodic Table Chart-blocks.svg, 400px, Periodic table, The periodic table of the chemical elements In chemistry, an element is a pure substanc ...
, and
volume overload Volume overload refers to the state of one of the chambers of the heart in which too large a volume of blood exists within it for it to function efficiently. Ventricular volume overload is approximately equivalent to an excessively high preload ...
. Complications of chronic failure also include
heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pumped b ...
,
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...
, and
anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

anemia
. Causes of acute kidney failure include
low blood pressure Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dia ...
, blockage of the
urinary tract The urinary system, also known as the renal system or urinary tract, consists of the kidneys, ureters, bladder The urinary bladder, or simply bladder, is a hollow muscular organ in humans and other vertebrates that stores urine Urine is ...
, certain medications, muscle breakdown, and
hemolytic uremic syndrome Hemolysis or haemolysis (), also known by several other names, is the rupturing (lysis Lysis ( ; Greek λύσις ''lýsis'', "a loosing" from λύειν ''lýein'', "to unbind") is the breaking down of the membrane of a cell, often by ...
. Causes of chronic kidney failure include
diabetes Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...

diabetes
,
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...
,
nephrotic syndrome Nephrotic syndrome is a collection of symptoms due to kidney damage. This includes proteinuria, protein in the urine, hypoalbuminemia, low blood albumin levels, hyperlipidemia, high blood lipids, and significant edema, swelling. Other symptoms ma ...
, and
polycystic kidney disease Polycystic kidney disease (PKD or PCKD, also known as polycystic kidney syndrome) is a genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome In the fields of molecular biology and ...
. Diagnosis of acute failure is often based on a combination of factors such as decreased urine production or increased
serum creatinine Creatinine ( or ; from el, κρέας, kreas, flesh) is a breakdown product of creatine phosphate from muscle and protein metabolism. It is released at a constant rate by the body (depending on muscle mass). Biological relevance Serum (blood), ...
. Diagnosis of chronic failure is based on a
glomerular filtration rate Renal functions include maintaining an acid–base balance An acid dissociation constant, ''K''a, (also known as acidity constant, or acid-ionization constant) is a quantitative measure of the strength of an acid An acid is a molecu ...
(GFR) of less than 15 or the need for
renal replacement therapy Renal replacement therapy (RRT) is therapy A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health Health is a state of physical, mental and social well-being Well-being, also known as '' ...
. It is also equivalent to stage 5
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which there is gradual loss of kidney function over a period of months to years. Initially there are generally no symptoms; later, symptoms may include pedal edema, leg swelling, feeling ...
. Treatment of acute failure depends on the underlying cause. Treatment of chronic failure may include
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant ...

hemodialysis
,
peritoneal dialysis Peritoneal dialysis (PD) is a type of dialysis which uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte proble ...

peritoneal dialysis
, or a
kidney transplant Kidney transplant or renal transplant is the organ transplant Organ transplantation is a medical procedure in which an organ (anatomy), organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ ...

kidney transplant
. Hemodialysis uses a machine to filter the blood outside the body. In peritoneal dialysis specific fluid is placed into the
abdominal cavity The abdominal cavity is a large body cavity in humans and many other animals that contains many Organ (anatomy), organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shape ...

abdominal cavity
and then drained, with this process being repeated multiple times per day. Kidney transplantation involves surgically placing a kidney from someone else and then taking
immunosuppressant Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications are drugs that inhibit or prevent activity of the immune system The immune system is a network of biological processes that pro ...
medication to prevent rejection. Other recommended measures from chronic disease include staying active and specific dietary changes. Depression is also common among patients with kidney failure, and is associated with poor outcomes including higher risk of kidney function decline, hospitalization, and death. A recent PCORI-funded study of patients with kidney failure receiving outpatient hemodialysis found similar effectiveness between nonpharmacological and pharmacological treatments for depression. In the United States acute failure affects about 3 per 1,000 people a year. Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly developing the condition each year. Acute failure is often reversible while chronic failure often is not. With appropriate treatment many with chronic disease can continue working.


Classification

Kidney failure can be divided into two categories:
acute kidney failure Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine Creatinine ( or ; from el, κρέας, kreas, flesh) is a ...
or
chronic kidney failure Chronic kidney disease (CKD) is a type of kidney disease The kidneys are two reddish-brown bean-shaped organs found in vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukary ...
. The type of renal failure is differentiated by the trend in the serum
creatinine Creatinine ( or ; from el, κρέας, kreas, flesh) is a breakdown product of creatine phosphate Phosphocreatine, also known as creatine phosphate (CP) or PCr (Pcr), is a phosphorylated creatine molecule that serves as a rapidly mobilizable ...
; other factors that may help differentiate acute kidney failure from chronic kidney failure include
anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

anemia
and the kidney size on
sonography Medical ultrasound (also known as diagnostic sonography or ultrasonography) is a diagnostic imaging technique, or therapeutic application of ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible ...
as chronic kidney disease generally leads to anemia and small kidney size.


Acute kidney failure

Acute kidney injury Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in renal function, kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both. Cause ...
(AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of
renal function Assessment of kidney function occurs in different ways, using the presence of symptoms and signs, as well as measurements using urine tests, blood tests, and medical imaging. Functions of a healthy kidney include maintaining a person's fluid ...
, generally characterized by
oliguria Oliguria or hypouresis is the low output of urine specifically more than 80 ml/day but less than 400ml/day.Boon et al, Davidson's Principles & Practice of Medicine (20th Ed), p475 The decreased output of urine may be a sign of dehydration, kidney f ...
(decreased
urine Urine is a liquid by-product A by-product or byproduct is a secondary product derived from a production process, process or ; it is not the primary product or service being produced. A by-product can be useful and marketable or it can be cons ...

urine
production, quantified as less than 400 mL per day in adults, 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 experience AKI, sometimes requiring
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant ...

hemodialysis
. The underlying cause must be identified and treated to arrest the progress, and
dialysis In medicine, dialysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its populatio ...

dialysis
may be necessary to bridge the time gap required for treating these fundamental causes.


Chronic kidney failure

Chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease A disease is a particular abnormal condition that negatively affects the str ...
(CKD) can also develop slowly and, initially, show few symptoms. CKD can be the long term consequence of irreversible acute disease or part of a disease progression.


Acute-on-chronic kidney failure

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 Creatinine ( or ; from el, κρέας, kreas, flesh) is a breakdown product of creatine phosphate Phosphocreatine, also known as creatine phosphate (CP) or PCr (Pcr), is a phosphorylated creatine molecule that serves as a rapidly mobilizable ...

creatinine
. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the person has not been monitored by a
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
and no baseline (i.e., past) blood work is available for comparison.


Signs and symptoms

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 Azotemia (''azot'', "nitrogen" + '' -emia'', "blood condition") is a medical condition characterized by abnormally high levels of nitrogen Nitrogen is the chemical element with the Symbol (chemistry), symbol N and atomic number 7. It was first ...
. Very low levels of azotaemia 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. Symptoms of kidney failure include the following: *High levels of
urea Urea, also known as carbamide, is an organic compound In , organic compounds are generally any s that contain - . Due to carbon's ability to (form chains with other carbon s), millions of organic compounds are known. The study of the prop ...

urea
in the blood, which can result in: **
Vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach The stomach is a muscular, in the of humans and many other animals, including several s. The stomach has a dilat ...

Vomiting
or
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery defecation, bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration of ...
(or both) may lead to
dehydration In physiology, dehydration is a lack of total body water In physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology Biology is the natural science that studie ...

dehydration
**
Nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomiting, vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, upper abdomen, or ...

Nausea
** Weight loss ** Nocturnal urination (
nocturia Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding (''i.e. to urinate'').” The term is derived from Latin Latin (, or , ) is a classical ...
) ** 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 Hematuria or haematuria is defined as the presence of blood or Red blood cell, red blood cells in the urine. It can be classified according to the quantity, the anatomical origin of bleeding and the occurrence during bleeding. * As per the quantit ...
** Pressure, or difficulty urinating ** Unusual amounts of urination, usually in large quantities *A buildup of
phosphates In chemistry Chemistry is the scientific discipline involved with Chemical element, elements and chemical compound, compounds composed of atoms, molecules and ions: their composition, structure, properties, behavior and the changes they un ...
in the blood that diseased kidneys cannot filter out may cause: ** Itching ** Bone damage **
Nonunion Nonunion is permanent failure of healing With physical damage or disease suffered by an organism, healing involves the repair of living tissue(s), organs An organ is a group of tissues with similar functions. Plant life and animal life ...

Nonunion
in broken bones **
Muscle cramps A cramp is a sudden, involuntary muscle contraction or overshortening; while generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the affected muscle. Muscle cramps are common and are often as ...
(caused by low levels of calcium which can be associated with
hyperphosphatemia Hyperphosphatemia is an electrolyte disorder Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They h ...
) *A buildup of
potassium Potassium is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, b ...

potassium
in the blood that diseased kidneys cannot filter out (called
hyperkalemia Hyperkalemia is an elevated level of potassium Potassium is a chemical element upright=1.0, 500px, The chemical elements ordered by link=Periodic table In chemistry Chemistry is the science, scientific study of the propertie ...
) may cause: ** Abnormal heart rhythms ** Muscle paralysis *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 Polycystic kidney disease (PKD or PCKD, also known as polycystic kidney syndrome) is a genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome In the fields of molecular biology and ...
, 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 Erythropoietin (; EPO), also known as erythropoetin, haematopoietin, or haemopoietin, is a glycoprotein Glycoproteins are protein Proteins are large s and s that comprise one or more long chains of . Proteins perform a vast array of f ...

erythropoietin
that stimulates the
bone marrow Bone marrow is a semi-solid tissue Tissue may refer to: Biology * Tissue (biology), an ensemble of similar cells that together carry out a specific function * ''Triphosa haesitata'', a species of geometer moth found in North America * ''Triphos ...
to . 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 Hemoglobin or haemoglobin (spelling differences Despite the various English dialects Dialect The term dialect (from Latin , , from the Ancient Greek word , , "discourse", from , , "through" and , , "I speak") is used in two distinct wa ...

hemoglobin
, a condition known as
anemia Anemia (American and British English spelling differences#ae and oe, also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia c ...

anemia
. This can result in: ** Feeling tired or weak ** Memory problems ** Difficulty concentrating **
Dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo Vertigo is a condition where a person has the sensation of moving or of surrounding objects moving when they are not. Often it feels like a spinnin ...

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, 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 ** ** Darkening of the skin ** Excess protein in the blood ** With high doses of
penicillin Penicillins (P, PCN or PEN) are a group of antibiotics An antibiotic is a type of antimicrobial An antimicrobial is an agent that kills microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism ...

penicillin
, people with kidney failure may experience
seizures An epileptic seizure, formally known as a seizure, is a period of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower tem ...


Causes


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. Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, along with bee stings 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 suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure. Among the accidental causes of renal failure is the
crush syndrome Crush may refer to: Film * Crush (1972 film), ''Crush'' (1972 film), a Hong Kong film * Crush (1992 film), ''Crush'' (1992 film), a New Zealand film by Alison Maclean * The Crush (1993 film), ''The Crush'' (1993 film), a film by Alan Shapiro, sta ...
, when large amounts of
toxin A toxin is a harmful substance produced within living cells or organisms; synthetic toxicants created by artificial processes are thus excluded. The term was first used by organic chemist Ludwig Brieger (1849–1919), derived from the word toxic ...
s are suddenly released in the
blood circulation The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits blood to circulate and transport nutrients (such as amino acids and electrolytes), oxygen, carbon dioxide, hormones, and bloo ...
after a long compressed
limb Limb can refer to: *Limb (anatomy), an appendage of a human or animal *Limb Music, a record label *Limb (album), an album by Foetus *Limb, in astronomy, the curved edge of the apparent disk of a celestial body, e.g. lunar limb *Limb, a large or mai ...
is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing
ischemia Ischemia or ischaemia is a restriction in blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells and transports metabolic waste products away fr ...
. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a
reperfusion injury Reperfusion injury, sometimes called ischemia-reperfusion injury (IRI) or reoxygenation injury, is the tissue damage caused when blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A n ...
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 Myoglobin (symbol Mb or MB) is an iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their ...

myoglobin
,
potassium Potassium is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, b ...

potassium
, and
phosphorus Phosphorus is a chemical element In chemistry, an element is a pure Chemical substance, substance consisting only of atoms that all have the same numbers of protons in their atomic nucleus, nuclei. Unlike chemical compounds, chemical el ...

phosphorus
– that are the products of
rhabdomyolysis Rhabdomyolysis is a condition in which damaged skeletal muscle breaks down rapidly. Symptoms may include myalgia, muscle pains, weakness, vomiting, and mental confusion, confusion. There may be tea-colored urine or an arrythmia, irregular heartb ...
(the breakdown of skeletal muscle damaged by
ischemic Ischemia or ischaemia is a restriction in blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum mechanics, incompressi ...
conditions). The specific action on the
kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized ...

kidney
s is not fully understood, but may be due in part to
nephrotoxicNephrotoxicity is toxicity in the kidneys. It is a poisonous effect of some chemical substance, substances, both toxic chemicals and pharmaceutical drug, medications, on kidney function. There are various forms, and some drugs may affect kidney funct ...
metabolite In biochemistry Biochemistry or biological chemistry, is the study of es within and relating to living s. A sub-discipline of both and , biochemistry may be divided into three fields: , and . Over the last decades of the 20th century, bio ...
s of myoglobin.


Chronic kidney failure

Chronic kidney failure has numerous causes. The most common causes of chronic failure are
diabetes mellitus Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
and long-term, uncontrolled
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not ...

hypertension
.
Polycystic kidney disease Polycystic kidney disease (PKD or PCKD, also known as polycystic kidney syndrome) is a genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome In the fields of molecular biology and ...
is another well-known cause of chronic failure. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses cause kidney failure, as well. Overuse of common drugs such as
ibuprofen Ibuprofen is a medication in the nonsteroidal anti-inflammatory drug (NSAID) class that is used for treating pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It may also ...

ibuprofen
, and
acetaminophen Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. At a standard dose, paracetamol only slightly decreases body temperature; it is inferior to ibuprofen in that respect, and the benefits of ...

acetaminophen
(paracetamol) can also cause chronic kidney failure. Some infectious disease agents, such as
hantavirus ''Orthohantavirus'' is a genus of single-stranded, enveloped, negative-sense RNA viruses in the family '' Hantaviridae'' of the order ''Bunyavirales''. Members of this genus may be called orthohantaviruses or simply hantaviruses. They normally c ...

hantavirus
, can attack the kidneys, causing kidney failure.


Genetic predisposition

The ''
APOL1 Apolipoprotein L1 is a protein that in humans is encoded by the ''APOL1'' gene. Two transcript variants encoding two different isoforms have been found for this gene. Species distribution This gene is found only in humans, African green monkeys ...
'' 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 Focal segmental glomerulosclerosis (FSGS), also known as “focal glomerular sclerosis” or “focal nodular glomerulosclerosis,” is a histopathologic finding of scarring (sclerosis) of glomeruli ''Glomerulus'' () is a common term used in anat ...
, and hypertension affiliated
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which there is gradual loss of kidney function over a period of months to years. Initially there are generally no symptoms; later, symptoms may include pedal edema, leg swelling, feeling ...
not attributed to other etiologies. Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.


Diagnostic approach


Measurement for CKD

;Stages of kidney failure Chronic kidney failure is measured in five stages, which are calculated using the person's GFR, or
glomerular filtration rate Renal functions include maintaining an acid–base balance An acid dissociation constant, ''K''a, (also known as acidity constant, or acid-ionization constant) is a quantitative measure of the strength of an acid An acid is a molecu ...
. 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 In medicine, dialysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its populatio ...

dialysis
) or
kidney transplant Kidney transplant or renal transplant is the organ transplant Organ transplantation is a medical procedure in which an organ (anatomy), organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ ...
whenever feasible. ;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. The National Kidney Foundation offers an easy to use on-line GFR calculator for anyone who is interested in knowing their glomerular filtration rate. (A serum
creatinine Creatinine ( or ; from el, κρέας, kreas, flesh) is a breakdown product of creatine phosphate Phosphocreatine, also known as creatine phosphate (CP) or PCr (Pcr), is a phosphorylated creatine molecule that serves as a rapidly mobilizable ...

creatinine
level, a simple blood test, is needed to use the calculator.)


Use of the term ''uremia''

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urea. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. The term ''
uremia Uremia is the condition of having high levels of urea Urea, also known as carbamide, is an organic compound with chemical formula CO(NH2)2. This amide has two amidogen, –NH2 groups joined by a carbonyl (C=O) functional group. Urea serves a ...
'' is now used for the illness accompanying kidney failure.


Treatment

The treatment of acute kidney injury depends on the cause. The treatment of chronic kidney failure may include renal replacement therapy:
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant ...

hemodialysis
,
peritoneal dialysis Peritoneal dialysis (PD) is a type of dialysis which uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte proble ...

peritoneal dialysis
, or
kidney transplant Kidney transplant or renal transplant is the organ transplant Organ transplantation is a medical procedure in which an organ (anatomy), organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ ...

kidney transplant


Diet

In non-diabetics and people with
type 1 diabetes Type 1 diabetes (T1D), previously known as juvenile diabetes, is an autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response An immune response is a reaction which occurs within an organism for the purp ...
, 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 Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of ...
. A whole food,
plant-based diet A plant-based diet or a plant-rich diet is a diet consisting mostly or entirely of plant-based foods. Plant-based foods are foods derived from plants (including vegetables, grains, nuts, seeds, legumes, and fruits) with no animal-source foods or ...
may help some people with kidney disease. A high protein diet from either animal or plant sources appears to have negative effects on kidney function at least in the short term.


Slowing progression

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. Other methods of reducing disease progression include minimizing exposure to nephrotoxins such as NSAIDs and intravenous contrast.


References


External links

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