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Renal (Kidney) Failure

Many things can cause the kidneys to fail to function properly. The failure of their function can be very serious and should be investigated by a physician.

Renal failure is a condition where the kidneys stop working properly. This makes them less able to filter the blood within the body and to separate out waste for excretion.

Chronic renal failure the signs and symptoms of chronic renal failure include increased blood pressure, decreased production of red blood cells, increase in waste products within the body such as urea and excess minerals, edema, and atherosclerosis. Chronic renal failure can be caused by many things, the most common causes include problems relating to diabetes, high blood pressure, and diseases that target the main filtering unit of the kidney called the glomerulus.

Many things can lead to these causes such as medication or drugs, heart problems, problems with the vessels, autoimmune disorders, and problems with kidney stones and the prostate. In all cases the ability of the kidney to filter and excrete waste is altered. Acute renal failure signs and symptoms of acute renal failure include retaining fluid within the body, decreased urination, drowsiness, shortness of breath, confusion, fatigue, chest pain, and seizure or coma if severe enough.

There are many causes of acute renal failure and they can affect functioning of things that lead into the kidneys, the kidney specifically, or structures that the kidneys feed into. Problems that affect structures that lead into the kidney are called pre-renal and these include having low blood pressure. Things that damage the kidney itself include infection, inflammation due to vascular problems like lupus, kidney specific toxins like too much aspirin some antibiotics and lithium, break down of products that then go and get stuck in the kidney such as the breakdown of red blood cells, muscle cells. Things that affect the structures beyond the kidney (ureters, bladder, and urethra) include medication that prevent proper bladder emptying, kidney stones, tumors, or other obstructions.

Renal failure can be classified as chronic, occurring over months or years, and acute, occurring very rapidly over hours, or days.

Chronic renal failure the doctor can identify chronic renal failure using tests such as ultrasound, CT, MRI, and biopsy of the kidney, and blood tests. All of these tests are used to determine the extent of the damage to the kidneys and their ability to filter. There is no cure for chronic renal problems therefore the physician will work to manage the disease. This can be done by working to eliminate the factors that lead to the disease, by using medication to decrease blood pressure, managing diabetes in a better way, and altering diet to try to prevent the kidney from having to work too hard. When the kidneys are extremely damaged, working at 10-15% of normal, this called end stage kidney disease. At this point managing the things that cause the problem are no longer sufficient, it is at this point that a patient will be put on dialysis, or considered for kidney transplant.

Dialysis is a way that waste can be removed from the body by filtering the blood through a machine, or other vessels in the body, to remove waste products. Depending on the specific procedure, the dialysis can sometimes be done at home, but most commonly is done in the hospital.

Kidney transplant is usually a better option than dialysis because it provides for increased quality of life. Finding a donor can be difficult, and until one becomes available it is necessary to remain on dialysis. After transplant the patient will be immunosuppressed and at risk for infections and disease for the rest of their lives, they will also have to control and manage risk factors that lead to the chronic failure in the first place otherwise it will most likely recur. Transplants do not last forever and carry with them their own sets of complications.

The overall prognosis for people with chronic renal failure is guarded, and depends on the complexity of their situation; it is not without risks and complications.

Acute renal failure acute renal failure is usually diagnosed by looking at the levels of certain proteins (createnine and urea) in the blood. If they are elevated it is a sign of disease, one can use ultrasound to try to look for possible obstructions downstream of the kidney if that is thought to be the cause. Acute renal failure can occur in a patient with chronic renal failure or on its own. If treated early in the disease it can be reversed. It is important to keep an eye on fluid intake to prevent the body from having too much.

Medication is sometimes used to prevent changes in the biochemistry of the blood. If hypotension is the cause it is important to reverse this by raising blood pressure, something that mediation or increased fluids can accomplish. If treatment is not successful or damage is too extensive the patient may enter into end stage kidney failure and lifelong dialysis or kidney transplant will be necessary.

The body has two kidneys that are responsible for filtering the blood and removing waste products. They are also important for controlling the levels of some substances within the blood thereby controlling respiration, heart rate, and many other things. The functional unit of the kidney is called the glomerulus; this is what filters the blood and extracts waste. Each kidney has over one million glomeruli. If there are problems within the body these units can become damaged leading to problems such as kidney disease and failure.

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