Kidney Failure

The kidneys function by producing urine to excrete waste products from the body and maintain the homeostasis of fluids and electrolytes. If the kidneys are unable to produce sufficient urine, kidney failure may occur. Kidney failure can be classified as either acute or chronic. Both acute kidney failure and chronic kidney failure can lead to loss of kidney function, affecting the body’s ability to remove toxins and potentially becoming life-threatening.

Causes of Kidney Failure 

Chronic kidney failure: 

• Type 1 or type 2 diabetes 
• Hypertension 
• Glomerulonephritis 
• Interstitial nephritis 
• Polycystic kidney disease or other hereditary kidney conditions 
• Prolonged urinary tract obstruction caused by enlarged prostate, kidney stones, or cancer 
• Vesicoureteral reflux 
• Recurrent kidney infections 

Acute kidney failure: 

• Excessive blood loss 
• Blood pressure medications 
• Heart attack 
• Liver failure 
• Use of aspirin, ibuprofen, or related medications 
• Severe allergic reactions 
• Severe burns 
• Severe dehydration 
• Haemolytic uraemic syndrome 
• Viral infections including COVID-19 
• Lupus 
• Scleroderma 
• Rhabdomyolysis 
• Bladder cancer 
• Blood clots in the urinary tract 
• Cervical cancer 
• Kidney stones 
• Prostate cancer 
• Severe infection/sepsis 
• Diagnostic imaging (CT scan, MRI) contrast dyes 
  
  

Types of Kidney Failure 

• Pre-renal kidney failure
  Insufficient blood flow to the kidneys prevents them from filtering toxins from the blood. Over 50% of acute kidney injuries fall into this category. Common causes include major burns, significant haemorrhage, and shock.
  
  
• Intrinsic kidney injury
  Kidney damage caused by kidney-related diseases, such as acute tubular necrosis. This constitutes chronic kidney failure, where the damage to kidney function is irreversible.
  
  
• Post-renal kidney injury
  Less common, this results from urinary tract outflow obstruction that impedes the flow of urine from the kidneys the urethra from conditions such as ureteral stones and hypertrophy of the prostate gland. 
  
  

Symptoms of Kidney Failure 

• Nausea 
• Vomiting and loss of appetite 
• Fatigue and weakness 
• Insomnia 
• Increased or decreased urination 
• Reduced mental acuity 
• Muscle cramps 
• Swelling of the feet and ankles 
• Dry and itchy skin 
• Uncontrolled hypertension 
• Shortness of breath 
• Chest pain 
  
  

Diagnostic Methods for Kidney Failure 

• Blood tests: To check waste product levels in the blood, such as creatinine and urea. 

• Urine tests: To analyse urine samples to determine whether the condition is chronic kidney failure and to identify the cause of chronic kidney disease. 

• Ultrasound: To assess kidney structure and size using ultrasound imaging for diagnostic purposes. 

• Kidney biopsy: To extract a sample of kidney tissue for laboratory testing. 
  
  

Treatment of Kidney Failure 

• Antihypertensive medication
  Hypertension may worsen in patients with kidney disease. Blood pressure medication may initially reduce kidney function and alter electrolyte levels, so blood tests are needed to monitor the condition. Diuretics and a low-salt diet may also be recommended.
  
  
• Anti-oedema medication
  People with chronic kidney disease often experience fluid retention, which can cause leg swelling and high blood pressure. Diuretics can help maintain fluid balance.
  
  
• Anaemia medication
  Damage to kidneys affects its ability to synthesize erythropoietin which can cause anaemia. Erythropoietin replacement therapy can help stimulate the production of red blood cells and may relieve fatigue and weakness associated with anaemia. 
  
  
• Potassium-regulating medication
  If the kidneys cannot properly filter potassium from the blood, a doctor may prescribe calcium, glucose, or sodium polystyrene sulphonate (Kionex) to prevent potassium levels from accumulating dangerously in the blood. 
  
  
• Cholesterol-lowering medication
  Statins may be used to lower cholesterol levels as chronic kidney disease also lowers the activity of an enzyme that clears lipids from the blood. 
  
  
• Low-protein diet
  When the body processes protein, the kidneys must filter waste by-products from the blood. A low-protein diet can reduce the kidney’s workload.
  
  
• Dialysis
  When the kidneys can no longer perform filtration, dialysis is an option to remove waste products and excess fluid from the blood. 
  
  
• Intravenous fluids 
  Depending on the underlying cause, calcium or other fluids may be administered intravenously as treatment.
  
  
• Kidney transplant
  A surgical procedure in which a healthy kidney from a donor is implanted into the body of a patient with a failed kidney. Lifelong anti-rejection medication is required after transplantation. 
  
  

Prevention of Kidney Failure 

• Follow the instructions on the label when taking over-the-counter medications 
• Maintain a healthy weight 
• Avoid smoking 
• Manage blood pressure and blood sugar levels 
• Exercise regularly 
• Eat a balanced diet 
• Reduce salt intake 
• Do not abuse pain killers/anti-inflammatory medications (NSAIDS) like ibuprofen, naproxen and diclofenac 

OT&P Healthcare’s Advice 

Kidney failure can be classified as acute or chronic. Both acute and long-term chronic kidney failure can lead to loss of kidney function, affecting quality of life and potentially causing death. If you experience symptoms suggestive of kidney failure, you should seek medical attention promptly. You are welcome to book a consultation with one of our doctors. 

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References

1. Acute kidney failure. (2020, July 23). Mayo Clinic. Retrieved March 7, 2022, from https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048

2. Chronic kidney disease. (2021 September 3). Mayoclinic.Org. Retrieved March 7, 2022, from https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527

3. The Healthline Editorial Team. (2019, October 3). 11 tips to prevent kidney failure, treatment options & more. Healthline. https://www.healthline.com/health/kidney-health/how-to-prevent-kidney-failure

4. The Healthline Editorial Team, Holland, K., & Yetman, D. (2021, November 3). Everything you need to know about kidney failure. Healthline. https://www.healthline.com/health/kidney-failure

5. 甚麼會導致腎衰竭? (n.d.). Hkua.Org. Retrieved March 7, 2022, from https://www.hkua.org/%E7%94%9A%E9%BA%BC%E6%9C%83%E5%B0%8E%E8%87%B4%E8%85%8E%E8%A1%B0%E7%AB%AD/