Kidney failure

Kidney failure
Other namesRenal failure, end-stage renal disease (ESRD), stage 5 chronic kidney disease[1]
A hemodialysis machine which is used to replace the function of the kidneys
SpecialtyNephrology
SymptomsLeg swelling, feeling tired, loss of appetite, confusion[2]
ComplicationsAcute: Uremia, high blood potassium, volume overload[3]
Chronic: Heart disease, high blood pressure, anemia[4][5]
TypesAcute kidney failure, chronic kidney failure[6]
CausesAcute:
[6]
Chronic:
[6]
Diagnostic methodAcute:

Chronic:
TreatmentAcute: Depends on the cause[7]
Chronic: Hemodialysis, peritoneal dialysis, kidney transplant[2]
FrequencyAcute: 3 per 1,000 per year[8]
Chronic: 1 per 1,000 (US)[1]

Kidney failure, also known as end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels.[2] Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible.[6] Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion.[2] Complications of acute and chronic failure include uremia, hyperkalemia, and volume overload.[3] Complications of chronic failure also include heart disease, high blood pressure, and anaemia.[4][5]

Causes of acute kidney failure include low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome.[6] Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease.[6] Diagnosis of acute failure is often based on a combination of factors such as decreased urine production or increased serum creatinine.[3] Diagnosis of chronic failure is based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy.[1] It is also equivalent to stage 5 chronic kidney disease.[1]

Treatment of acute failure depends on the underlying cause.[7] Treatment of chronic failure may include hemodialysis, peritoneal dialysis, or a kidney transplant.[2] Hemodialysis uses a machine to filter the blood outside the body.[2] In peritoneal dialysis specific fluid is placed into the abdominal cavity and then drained, with this process being repeated multiple times per day.[2] Kidney transplantation involves surgically placing a kidney from someone else and then taking immunosuppressant medication to prevent rejection.[2] Other recommended measures from chronic disease include staying active and specific dietary changes.[2] 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.[9]

In the United States, acute failure affects about 3 per 1,000 people a year.[8] Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly developing the condition each year.[1][10] In Canada, the lifetime risk of kidney failure or end-stage renal disease (ESRD) was estimated to be 2.66% for men and 1.76% for women.[11] Acute failure is often reversible while chronic failure often is not.[6] With appropriate treatment many with chronic disease can continue working.[2]

  1. ^ a b c d e f Cheung AK (2005). Primer on Kidney Diseases. Elsevier Health Sciences. p. 457. ISBN 1416023127.
  2. ^ a b c d e f g h i j "Kidney Failure". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 11 November 2017.
  3. ^ a b c d Blakeley S (2010). Renal Failure and Replacement Therapies. Springer Science & Business Media. p. 19. ISBN 9781846289378.
  4. ^ a b Liao MT, Sung CC, Hung KC, Wu CC, Lo L, Lu KC (2012). "Insulin resistance in patients with chronic kidney disease". Journal of Biomedicine & Biotechnology. 2012: 691369. doi:10.1155/2012/691369. PMC 3420350. PMID 22919275.
  5. ^ a b "Kidney Failure". MedlinePlus. Retrieved 11 November 2017.
  6. ^ a b c d e f g "What is renal failure?". Johns Hopkins Medicine. Archived from the original on 18 June 2017. Retrieved 18 December 2017.
  7. ^ a b Clatworthy M (2010). Nephrology: Clinical Cases Uncovered. John Wiley & Sons. p. 28. ISBN 9781405189903.
  8. ^ a b Ferri FF (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 37. ISBN 9780323529570.
  9. ^ Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, et al. (March 2019). "Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial". Annals of Internal Medicine. 170 (6): 369–379. doi:10.7326/M18-2229. PMID 30802897. S2CID 67876948.
  10. ^ Ferri FF (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 294. ISBN 9780323529570.
  11. ^ Turin TC, Tonelli M, Manns BJ, Ahmed SB, Ravani P, James MT, Hemmelgarn BR (September 2012). "Lifetime risk of ESRD". J Am Soc Nephrol. 23 (9): 1569–1578. doi:10.1681/ASN.2012020164. PMC 3431421. PMID 22904351.