August 19, 2013

FAQs

Causes of Kidney Failure (1)

Causes of Kidney Failure

What causes kidney failure?

The main cause of chronic kidney disease in America is diabetes, followed by high blood pressure.

Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes.

High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease.

Long standing hypertension deteriorates the small vessels of the kidneys. As a result, there is no proper handling of the salt and fluids. This causes the accumulation of salt and fluids, and more hypertension. As the small vessels of the kidney progressively harden, the kidney progressively loses its function.

Other conditions that affect the kidneys are the following:

• Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney’s filtering units. These disorders are the third most common type of kidney disease.
• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.
• Malformations that occur as a baby develops in its mother’s womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
• Lupus and other diseases that affect the body’s immune system.
• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Bacterial infections of the throat, urinary tact or, skin
• Syphilis,
• tuberculosis
• hepatitis(B and C)
• HIV disease
• Antibiotics( penicillins, Sulfa, Vancomycin, etc)
• Aspirin containing analgesics commonly used for pain
• Non-steroidal anti-inflammatory drugs (such as Motrin, Ibuprofen, Advil, Indocin)
• Diuretics ( hydrochlorothiazide, furosemide, etc)
• Kidney stones
• Tumors of the abdomen and pelvis
• Prostatic hypertrophy in men
• Dehydration due to excess heat exposure, nausea, vomiting or diarrhea
• Excess exercise may cause muscle damage and this can also cause severe renal injury.
• Protein in the urine, whether as a result of inherited or acquired diseases, may cause deterioration of renal function over time
• In addition, malignant diseases like colon cancer, multiple myeloma, lymphoma, and renal cell carcinoma, can affect the kidneys.
• More recently a new link of heavy smoking and kidney disease has been found as well.

Is anemia associated with kidney problems?

Yes. The kidneys produce the hormone erythropoietin. Low levels of this hormone (which may happen when the kidneys fail) generally result in anemia (low production of red cells).

Is kidney disease hereditary?

In some cases kidney condition may be hereditary. This is the case of polycystic kidney disease, which is inherited generation after generation.

Definitions (8)

What is kidney failure?

When the kidneys are not working properly, we call it kidney failure. Kidney failure results in a lot of salt and fluid in the body and higher blood pressure. Edema or swelling of limbs also occurs.

There is also excess nitrogen in the body which affects the nervous system producing lack of appetite, nausea, vomiting, fatigue, mental confusion and even convulsions.

What causes kidney failure?

The primary causes of kidney failure are diabetes, hypertension, HIV, hepatitis B, hepatitis C, lupus, illicit drugs (i.e. cocaine), medications (i.e. diuretics, non-steroidal anti-inflammatory drugs, antibiotics), low blood volume, dehydration, urinary obstruction (kidney stones), prostate disease, urethral narrowing, among others

What are the different types of dialysis?

The two main types of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. Hemodialyis is usually conducted in an outpatient dialysis treatment center three times per week, with treatment times between 3 to 6 hours.

Hemodialysis may also be conducted at home. A small but growing number of clinics offer home HD in addition to standard HD treatments. The patient starts learning to do treatments at the clinic, working with a dialysis nurse. Most people who do home HD have helpers who train with them at the clinic. The helper can be a family member, neighbor, or close friend. Some programs do not require a helper if the patient can do all the tasks alone.

In peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneal membrane as a natural semi-permeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane, and into a special dialysis solution, called dialysate, in the abdominal cavity which has a composition similar to the fluid portion of blood.

The peritoneal membrane is a layer of tissue containing blood vessels that lines and surrounds the peritoneal, or abdominal, cavity. The dialysate is left there for a period of time to absorb waste products, and then it is drained out through the tube and discarded. This cycle or “exchange” is normally repeated 4-5 times during the day. Peritoneal dialysis is carried out at home by the patient.

What is dialysis?

Dialysis is the process of filtering the accumulated waste products from the blood of a patient whose kidneys are not functioning properly, using a dialysis machine. Dialysis treatments replace some of the kidney’s functions through waste removal and fluid removal.

In hemodialysis, the patient’s blood is pumped through the blood compartment of a dialysis filter called a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semi-permeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions. The cleansed blood is then returned back to the body.

In the US, hemodialysis treatments are typically given in a dialysis center three times per week

Is anemia associated with kidney problems?

Yes. The kidneys produce the hormone erythropoietin. Low levels of this hormone (which may happen when the kidneys fail) generally result in anemia (low production of red cells).

Can high blood pressure cause kidney disease?

Yes. Long standing hypertension deteriorates the small vessels of the kidneys. As a result, there is no proper handling of the salt and fluids, causing their accumulation and more hypertension.

As the small vessels of the kidney progressively harden, the kidney progressively loses its function.

What is a nephrologist?

A nephrologist is a doctor who has been trained in the diagnosis and management of kidney disease. The nephrologist manages kidney disease by regulating blood pressure, regulating electrolytes, balancing fluids in the body, and administering dialysis. Nephrologists treat many different kidney disorders including acid-base disorders, electrolyte disorders, kidney stones, hypertension (high blood pressure), acute kidney disease and end-stage renal disease. Nephrology is a subspecialty of internal medicine.

What are the kidneys and what is their function?

The human body has two kidneys. Each kidney is composed of about 1million nephrons. The nephrons are units, which are mainly composed of blood vessels. It is through these vessels that toxin excretion and filtration occurs and water is let out.

The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste products, but also by balancing levels of electrolytes in the body, controlling blood pressure, and stimulating the production of red blood cells. The kidneys also help in creation of vitamin D (essential for the bones).

How is Kidney Failure Diagnosed (1)

How is Kidney Failure Diagnosed?

To diagnose kidney failure, blood tests are generally used to measure the buildup of waste products in the blood. The two major blood chemical levels that are measured are the “creatinine level” and the “blood urea nitrogen” (BUN) level. With kidney failure, BUN and creatinine become elevated, and the glomerular filtration rate decreases. The glomerular filtration rate is the rate with which blood is filtered through the kidneys and can be calculated based upon the creatinine level, age, race, and gender of the patient.

Doctors use a urine test, the “creatinine clearance,” to measure the level of kidney function. The patient saves urine in a special container for one full day. The waste products in the urine and in the blood are estimated by measuring the creatinine. By comparing the blood and urine level of this substance, the doctor has an accurate idea of how well the kidneys are working. This result is called the creatinine clearance.

Urine tests may also be used to measure the amount of protein, to detect the presence of abnormal cells, or to measure the concentration of electrolytes. Abdominal ultrasound can also be used to assess the size of the kidneys and to help identify whether any obstruction exists. A biopsy of the kidney may also be done to get bits of kidney tissue to examine under the microscope.

Risk Factors for Kidney Disease? (1)

Risk factors for kidney disease

Risk factors for kidney disease are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for kidney disease makes the chances of getting a condition higher but does not always lead to kidney disease. Also, the absence of any risk factors does not necessarily protect you against getting kidney disease.

Factors that may increase your risk of chronic kidney failure include:

 Diabetes
 High blood pressure (hypertension)
 Heart disease
 Smoking
 Obesity
 High cholesterol
 African-American, American Indian or Asian-American race
 A family history of kidney disease
 Age 65 or older
 Kidney stones
 Drug Abuse

Family history is a significant risk factor. For example a patient with HIV disease whose parents or relatives suffer from renal failure or are on dialysis have much higher risk for renal failure than the general population without the same family history. In addition, a family history of polycystic kidney disease, hepatitis B or C, HIV, increases the risk as well.

Proteinuria of any origin increases the chances of renal failure as well as the risks for cardiovascular disease. Proteinuria means the presence of an excess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy. Since serum proteins are readily reabsorbed from urine, the presence of excess protein indicates either an insufficiency of absorption or impaired filtration by the kidneys. The most common cause of proteinuria is diabetes.

According to a study by the American Journal of Medicine, race as well as lower social economic level are increased factors for kidney disease. African Americans in particular have been found to be genetically linked to renal failure and its complications. African Americans, Asian Americans, Hispanics/Latinos, and Pacific Islander Americans are three times more likely to suffer from kidney failure than Americans of European descent. Studies have also shown that the African American population fares worse after renal transplantation and have a higher mortality level once on dialysis.

Symptoms of Chronic Kidney Disease? (1)

What are the symptoms of chronic kidney disease or renal failure?

Most people may not have any severe symptoms until their kidney disease is advanced:

With Chronic Kidney Disease, you may experience the following:

High blood pressure
Feel more tired and have less energy
Have trouble concentrating
Have a poor appetite
Have trouble sleeping
Have muscle cramping at night
Have swollen feet and ankles
Have puffiness around your eyes, especially in the morning
Have dry, itchy skin
Need to urinate more often, especially at night
Poor appetite
Weight loss
Weakness
Trouble sleeping
Heart arrhythmias
Decreased muscle function

In the beginning, kidney failure may not produce any symptoms. Unrecognized or untreated, life-threatening circumstances can develop, however.

As kidney function decreases, symptoms related to the inability to regulate water and electrolyte balances, to clear waste products from the body, and to promote red blood cell production will appear. These symptoms will include weakness, shortness of breath and generalized swelling. Generalized weakness also can be due to anemia because lower levels of erythropoietin do not adequately stimulate the bone marrow.

As waste products build in the blood, loss of appetite, lethargy, and fatigue become apparent. This will progress to the point where mental function will decrease and coma may occur.

When the kidneys cannot address the rising acid load in the body, breathing will become more rapid

Blood pressure also may rise because of the excess fluid, and this fluid can be deposited in the lungs, causing congestive heart failure.

Metabolic acidosis, or increased acidity of the body due to the inability to manufacture bicarbonate, will alter enzyme and oxygen metabolism, causing organ failure.

Inability to excrete potassium and rising potassium levels in the serum is associated with fatal heart rhythm disturbances

Rising urea levels in the blood (uremia) can affect the function of a variety of organs ranging from the brain with alteration of thinking, to inflammation of the heart lining, to decreased muscle function because of low calcium levels.

What diet should I follow if I have Kidney Disease? (1)

What Diet Should I Follow if I have Kidney Disease or am on Dialysis?

If you have chronic kidney disease, diet and nutrition are important concerns. The following are general diet guidelines if you have been diagnosed with chronic kidney disease:

• Limit fluids
• Eat a low-protein diet
• Restrict salt
• Restrict potassium
• Restrict phosphorous and other electrolytes
• Get enough calories if you are losing weight

Foods high in potassium, which should be restricted, include bananas, apricots, and salt substitutes. Foods with high phosphorus content, which should be restricted, include milk, cheese, nuts, and cola drinks.

If you have diabetes along with kidney disease, a low-carbohydrate diet may be necessary.

The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluids in patients who are on dialysis. The special renal diet is important because dialysis alone does not effectively remove all toxins and waste products. Waste products can build up between dialysis treatments.

Most dialysis patients urinate very little or not at all. For this reason, fluid restriction between treatments is very important. Otherwise fluid will build up in the body and may lead to excess fluid in the heart, lungs, and ankles.

It is important that patients with chronic kidney disease or on dialysis be monitored by a dietician knowledgeable as to renal diets.

What is Chronic Kidney Disease or CKD? (1)

What is Chronic Kidney Disease?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease.

These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders.

Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life