Definition of Renal Failure

Renal FailureRenal Failure – the inability of the kidneys to adequately filter toxins from the body. Generally the kidneys reach the point of renal failure when they have less than 15 percent functional capacity.

Failure can be acute (occur suddenly) or chronic (develop slowly over time). Though the term failure implies the condition is permanent, but this is not necessarily the case.

Most people who experience acute renal failure fully recover with appropriate treatment.

When the deterioration of kidney function is progressive and irreversible, however, renal failure is not only permanent but also eventually becomes complete. This irreversible condition is end-stage renal disease (esrd). A person who has ESRD requires long-term renal dialysis or kidney transplantation to sustain life.

Acute Renal Failure

Acute renal failure can occur in response to any circumstance that overwhelms the body, such as systemic infection, severe burns, or a toxic assault such as a drug overdose or massive exposure to a nephrotoxin. Dehydration and lack of blood flow to the kidney (such as may occur with severe atherosclerosis or a blood clot) also can cause acute renal failure.

Acute renal failure may require short-term dialysis to cleanse the blood while the kidneys recover as well as appropriate treatment for the cause of the renal failure.

Common Causes of Acute Renal Failure

Acute nephritisAlcohol poisoning
DehydrationDrug overdose
Extensive burnsGentamicin
Heart failureHeat stroke
Hemolytic uremic syndromeLiver failure
Major surgeryMultisystem failure
Nephrotoxin exposureReaction to contrast dye
Renal ischemiaSepticemia

Chronic Renal Failure

Chronic renal failure develops gradually over time, often years to decades. The most common causes of chronic renal failure are nephropathy of diabetes and nephropathy of hypertension (high blood pressure).

Other causes include long-term exposure to nephrotoxins, long-term daily use of nephrotoxic drugs such as nonsteroidal antiinflammatory drugs (nsaids) and other analgesic medications (pain relievers), notably codeine. Chronic failure may also consist of repeated bouts of acute renal failure that leave minor residual damage.

Over time this damage becomes cumulative, causing scarring in the nephrons that impairs their ability to function.

About 20 million Americans live with chronic renal failure.

Common Causes of Chronic Renal Failure

Alport’s syndromeChronic hydronephrosis
DiabetesFanconi’s syndrome
Goodpasture’s syndromeHeavy-metal poisoning
HypertensionLupus nephropathy
Organic solvent exposurePolycystic kidney disease
Renal artery atherosclerosisRenal cancer

Symptoms and Diagnostic Path

Symptoms of renal failure depend on whether failure is acute or chronic. Acute failure typically causes neurologic symptoms. Anemia, hypertension (high blood pressure), congestive heart failure, and osteoporosis (loss of bone density and strength) often accompany chronic renal failure.

The diagnostic path includes urine and blood tests to assess kidney function, diagnostic imaging procedures such as ultrasound and computed tomography (ct) scan, and often kidney biopsy to microscopically examine the nephrons.

Acute Renal FailureChronic Renal Failure
Gastrointestinal bleedingFatigue
ConfusionOliguria (diminished urine production)
Loss of consciousnessHeadaches
SeizuresNausea, vomiting, and loss of appetite

Treatment Options and Outlook

Treatment targets the underlying cause. Acute renal failure requires immediate and intensive medical care, often including hemodialysis. Dietary modifications (such as reduced sodium, protein, and fluid intake) and medications to control conditions such as diabetes and hypertension allow many people to live with chronic renal failure for years to decades. When chronic renal failure progresses to ESRD, renal dialysis or kidney transplantation become necessary to sustain life.

Chronic renal failure in children impairs growth because it interferes with the ability of the kidneys to maintain calcium balance within the body and to produce erythrocytes (red blood cells). Without adequate calcium the bones cannot grow, resulting in short stature. Erythrocytes are necessary to carry oxygen, glucose, and other nutrients to cells throughout the body. Without these nutrients, cells slow their rate of division.

Doctors often prescribe calcitriol supplement, a form of vitamin D, for children who have chronic renal failure to improve the body’s ability to retain calcium. Many doctors also prescribe human growth hormone (HGH) supplement therapy to achieve normal growth patterns in children who have chronic renal failure, though not all doctors agree this is appropriate. Human growth hormone supplementation can have other deleterious effects on the body; it is important to balance such risks with the potential benefits.

Risk Factors and Preventive Measures

The major risk factors for chronic renal failure are diabetes and hypertension. Measures to reduce the risk for these conditions also lower the risk for kidney disease. Such measures include

  • Nutritious eating habits
  • Daily physical activity
  • Smoking cessation
  • Maintenance of healthy body weight

Diligent control of diabetes or hypertension if these conditions are present can slow their effects on the kidneys. Because chronic renal failure tends to be progressive, it is important to address symptoms of deteriorating kidney function promptly and aggressively for optimal quality of life.


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