Kidney Failure
Disease Details
Family Health Simplified
- Description
- Kidney failure, or renal failure, is a medical condition where the kidneys lose their ability to filter waste and excess fluids from the blood, which can lead to a build-up of these substances in the body and potentially cause life-threatening complications.
- Type
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Kidney failure is generally categorized into two types: acute kidney failure (or acute kidney injury) and chronic kidney failure (or chronic kidney disease).
The genetic transmission of kidney failure can be complex and vary depending on the underlying cause. Some forms of chronic kidney disease, such as polycystic kidney disease, are inherited in an autosomal dominant or autosomal recessive manner. However, not all cases of kidney failure have a genetic basis; many are due to environmental factors, lifestyle, or other medical conditions. - Signs And Symptoms
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Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When the kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.Symptoms of kidney failure include the following:
High levels of urea in the blood, which can result in:
Vomiting or diarrhea (or both) that may lead to dehydration
Nausea
Weight loss
Nocturnal urination (nocturia)
More frequent urination, or in greater amounts than usual, with pale urine
Less frequent urination, or in smaller amounts than usual, with dark coloured urine
Blood in the urine
Pressure, or difficulty urinating
Unusual amounts of urination, usually in large quantities
A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
Itching
Bone damage
Nonunion in broken bones
Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)
A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
Abnormal heart rhythms
Muscle paralysis
Failure of kidneys to remove excess fluid may cause:
Swelling of the hands, legs, ankles, feet, or face
Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
Pain in the back or side
Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
Feeling tired or weak
Memory problems
Difficulty concentrating
Dizziness
Low blood pressure
Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred, after which symptoms include:
Foamy or bubbly urine
Swelling in the hands, feet, abdomen, and face
Other symptoms include:
Appetite loss, which may include a bad taste in the mouth
Difficulty sleeping
Darkening of the skin
Excess protein in the blood
With high doses of penicillin, people with kidney failure may experience seizures - Prognosis
- Prognosis for kidney failure (end-stage renal disease) varies but is generally considered serious, often requiring long-term dialysis or a kidney transplant. Without treatment, life expectancy is significantly reduced. With proper management, including dialysis or transplant, patients can live many years; however, complications can affect overall health and longevity. Individual factors such as age, overall health, and response to treatment play crucial roles in determining outcomes.
- Onset
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Onset: Kidney failure can develop quickly (acute kidney failure) or gradually (chronic kidney disease leading to end-stage renal disease).
Nan: "Nan" typically refers to a specific measure "nanometer" or a notation for "Not a Number" in computational contexts. If you are asking about "NaN" and its relevance to kidney failure, it is not directly applicable to the medical context of kidney failure symptoms, diagnosis, or treatment. Please clarify if you meant a specific term or context. - Prevalence
- The global prevalence of chronic kidney disease (CKD), which can lead to kidney failure, is about 9.1% of the population. This translates to approximately 700 million people affected worldwide. End-stage renal disease (ESRD), the final stage of CKD requiring dialysis or transplantation, has a lower prevalence, with variations based on geographic regions and healthcare infrastructure.
- Epidemiology
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Epidemiology:
Kidney failure, also known as end-stage renal disease (ESRD), is a significant global health issue. The prevalence of chronic kidney disease (CKD), which frequently precedes kidney failure, is estimated to affect about 10% of the global population. ESRD incidence rates vary by region but are notably high in countries with greater access to healthcare and kidney replacement therapies. Key risk factors include diabetes mellitus, hypertension, and cardiovascular disease. It is also influenced by demographic factors such as age, with older populations being more susceptible. Additionally, certain ethnic groups, including African Americans, Native Americans, and Hispanics, are at higher risk compared to other populations. - Intractability
- Kidney failure, also known as end-stage renal disease (ESRD), is not necessarily intractable, but it requires significant medical intervention. Treatments include dialysis or a kidney transplant. While these treatments manage the disease and can sustain life, they do not cure the underlying cause of kidney failure.
- Disease Severity
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Kidney failure, also known as renal failure, can vary in severity:
1. **Acute Kidney Injury (AKI)**: This is a sudden and often reversible condition where the kidneys abruptly stop working properly. The severity can range from mild, with minor increases in serum creatinine levels, to severe, where dialysis is required.
2. **Chronic Kidney Disease (CKD)**: This involves the gradual loss of kidney function over time. CKD severity is categorized into five stages based on the glomerular filtration rate (GFR):
- **Stage 1**: Normal or high GFR (≥90 mL/min/1.73 m²) with some signs of kidney damage.
- **Stage 2**: Mild reduction in GFR (60-89 mL/min/1.73 m²).
- **Stage 3**: Moderate reduction in GFR (30-59 mL/min/1.73 m²).
- **Stage 4**: Severe reduction in GFR (15-29 mL/min/1.73 m²).
- **Stage 5**: Kidney failure (GFR <15 mL/min/1.73 m²) often requiring dialysis or transplantation.
The severity of kidney failure impacts treatment options and overall prognosis. - Healthcare Professionals
- Disease Ontology ID - DOID:1074
- Pathophysiology
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In kidney failure, the pathophysiology involves the gradual loss of kidney function, which impairs the kidneys' ability to filter waste products and excess fluids from the blood. This can be acute (acute kidney injury) or chronic (chronic kidney disease).
1. **Acute Kidney Injury (AKI)**:
- Often caused by conditions that reduce blood flow to the kidneys, direct damage to the kidneys, or blockages in the urinary tract.
- Results in a rapid decline in glomerular filtration rate (GFR), leading to the accumulation of waste products and an imbalance of electrolytes and fluids.
2. **Chronic Kidney Disease (CKD)**:
- Progresses over months to years and is often associated with long-standing conditions such as hypertension, diabetes, and glomerulonephritis.
- Persistent inflammation and fibrosis cause a gradual decline in GFR.
Key pathophysiological changes include:
- **Reduced GFR**: Leads to the accumulation of metabolic waste in plasma.
- **Uremia**: High levels of waste products causing symptoms like nausea, fatigue, and confusion.
- **Electrolyte Imbalance**: Dysregulation of sodium, potassium, calcium, and phosphate levels.
- **Acid-Base Imbalance**: Development of metabolic acidosis.
- **Volume Overload**: Fluid retention causing edema and hypertension. - Carrier Status
- Carrier status is not applicable to kidney failure, as it is a condition rather than a genetic trait passed from parents to offspring. Kidney failure, or end-stage renal disease (ESRD), occurs when the kidneys lose their ability to filter waste and excess fluids from the blood effectively. This condition can result from various underlying causes, such as diabetes, hypertension, and chronic kidney disease. Management typically involves dialysis or a kidney transplant.
- Mechanism
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Kidney failure, also known as renal failure, occurs when the kidneys lose their ability to filter waste products and excess fluids from the blood effectively. Here are the primary mechanisms and molecular mechanisms involved:
### Mechanism
1. **Reduced Blood Flow (Prerenal Causes):**
- Conditions such as severe dehydration, heart failure, and liver cirrhosis can lead to a significant drop in blood flow to the kidneys, impairing their function.
2. **Damage to Kidney Tissue (Intrinsic Causes):**
- Factors like glomerulonephritis, acute tubular necrosis, and nephrotoxins (e.g., certain medications, toxins) can damage the kidney tissue directly.
3. **Obstruction of Urine Flow (Postrenal Causes):**
- Blockages in the urinary tract from conditions like kidney stones, tumors, or an enlarged prostate can prevent urine from leaving the kidneys, causing pressure buildup and damaging the kidneys.
### Molecular Mechanisms
1. **Inflammation:**
- Inflammatory processes involving cytokines and chemokines can lead to glomerular and tubular injury. Specific molecules include Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-1 (IL-1).
2. **Oxidative Stress:**
- Reactive oxygen species (ROS) can cause damage to renal cells by oxidizing lipids, proteins, and DNA, contributing to cellular dysfunction and apoptosis.
3. **Fibrosis:**
- Chronic kidney injury often leads to fibrosis, characterized by the accumulation of extracellular matrix proteins such as collagen. This is mediated by transforming growth factor-beta (TGF-β) signaling pathways.
4. **Apoptosis:**
- Programmed cell death mechanisms, often regulated by proteins such as p53, Bax, and Bcl-2, contribute to the loss of functional renal cells.
5. **Endothelial Dysfunction:**
- Damage to the endothelial cells lining the blood vessels within the kidneys can impair their ability to regulate blood flow and filtrate formation. Molecules like endothelin and nitric oxide play a significant role here.
6. **Ischemia and Hypoxia:**
- Hypoxic conditions in renal tissue due to impaired blood flow can activate hypoxia-inducible factors (HIFs), leading to cellular stress responses that further kidney damage.
Understanding these mechanisms helps in developing targeted therapies to prevent or manage kidney failure effectively. - Treatment
- The treatment of acute kidney injury depends on the cause. The treatment of chronic kidney failure may include renal replacement therapy: hemodialysis, peritoneal dialysis, or kidney transplant.
- Compassionate Use Treatment
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Compassionate use treatment for kidney failure typically involves experimental therapies that are not yet approved but may be available under special circumstances. These treatments could include new medications, biologics, or dialysis technologies.
Off-label treatments are those where approved medications or therapies are used in a manner different from that described in their official labeling. For kidney failure, this might involve using drugs approved for other conditions to manage symptoms or complications associated with kidney failure, such as certain blood pressure medications or diuretics.
Experimental treatments can vary widely but may include advanced forms of dialysis, stem cell therapies, or novel gene therapies targeting the underlying causes of kidney failure. Clinical trials are often the avenue through which these experimental treatments are evaluated and made accessible to patients.
It's essential for patients and healthcare providers to discuss all available options, including potential risks and benefits, before considering compassionate use, off-label, or experimental treatments. - Lifestyle Recommendations
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**Lifestyle Recommendations for Kidney Failure:**
1. **Dietary Adjustments**:
- **Limit Sodium**: Reduce salt intake to help control blood pressure.
- **Monitor Protein**: Balance protein intake as excessive protein can burden the kidneys.
- **Control Potassium and Phosphorus**: Avoid high-potassium and high-phosphorus foods that can be harmful in kidney disease.
2. **Fluid Management**:
- Work with a healthcare provider to determine appropriate fluid intake to prevent fluid overload.
3. **Regular Exercise**:
- Engage in moderate physical activity approved by a healthcare provider to maintain overall health and manage weight.
4. **Avoid Smoking and Limit Alcohol**:
- Smoking can worsen kidney disease progression, and excessive alcohol can harm kidneys.
5. **Medication Adherence**:
- Take prescribed medications as directed to manage underlying conditions like high blood pressure and diabetes.
6. **Monitor Blood Pressure and Blood Sugar**:
- Keep these levels under control to reduce the burden on kidneys.
7. **Regular Medical Check-Ups**:
- Have frequent follow-ups with healthcare providers to monitor kidney function and adjust treatment as necessary.
8. **Healthy Weight Management**:
- Maintain a healthy weight to avoid additional stress on the kidneys.
9. **Stress Management**:
- Practice techniques like meditation or yoga to manage stress, which can indirectly affect kidney health.
Implementing these lifestyle changes can help manage kidney failure and improve quality of life. Always consult healthcare providers for personalized guidance. - Medication
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In the context of kidney failure, "nan" might be interpreted as "not a number" or potentially as "not applicable/not available." However, when considering medication for kidney failure, it typically involves treatments aimed at addressing the underlying cause, managing symptoms, and slowing disease progression. Common medications may include:
1. **Blood Pressure Medications**: ACE inhibitors or ARBs to control hypertension.
2. **Diuretics**: To help reduce fluid buildup.
3. **Phosphate Binders**: To control phosphate levels when kidneys can't filter it out.
4. **Erythropoiesis-Stimulating Agents**: To treat anemia common in chronic kidney disease.
For specific recommendations, consultation with a healthcare professional is essential. - Repurposable Drugs
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Repurposable drugs for kidney failure, also known as chronic kidney disease (CKD), can include medications that were originally developed for other conditions but have shown potential benefits in treating CKD. Some examples are:
1. **Metformin** - Originally used for type 2 diabetes, it has shown potential in protecting kidney function.
2. **SGLT2 inhibitors** - Also used for diabetes, they have been found to reduce the risk of CKD progression.
3. **Statins** - Typically prescribed for high cholesterol, they may help in slowing the progression of kidney disease.
4. **ACE inhibitors and ARBs** - Initially for hypertension and heart failure, these drugs are beneficial in managing CKD and preventing further damage.
Always consult with a healthcare professional before starting any new medication. - Metabolites
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In cases of kidney failure, also known as renal failure, the kidneys lose the ability to effectively filter waste products from the blood. This leads to the accumulation of various metabolites in the body, including:
- **Creatinine**: A waste product from muscle metabolism.
- **Urea**: A waste product formed from the breakdown of proteins.
- **Electrolytes**: Such as potassium, phosphorus, and sodium, whose levels can become imbalanced.
- **Acidic compounds**: Accumulation can lead to metabolic acidosis.
- **Urates**: Leading to conditions like gout.
The dysfunction in kidney filtration affects these metabolites' elimination, resulting in their elevated levels in the blood. - Nutraceuticals
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Nutraceuticals for kidney failure may include antioxidants like Coenzyme Q10, omega-3 fatty acids from fish oil, and herbs such as turmeric (curcumin) and milk thistle, which can help reduce inflammation and oxidative stress. Always consult a healthcare provider before starting any supplementation.
For nanotechnology (nan), potential applications in kidney failure include the development of advanced drug delivery systems that target the kidneys more precisely, reducing side effects and improving efficacy. Nanoparticles can also be used in diagnostic tools for early detection and monitoring of kidney disease progression. Research is ongoing to explore these possibilities further. - Peptides
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In kidney failure, certain peptides and nanoparticles are being explored for their potential therapeutic benefits. Peptides like atrial natriuretic peptide (ANP) have shown promise in managing fluid overload in acute kidney injury. Additionally, antimicrobial peptides are being investigated for their role in reducing infections in dialysis patients.
Nanoparticles offer promising applications in diagnosing and treating kidney diseases. For example, gold nanoparticles are being studied for their ability to target and enhance imaging of damaged kidney tissues. Moreover, nanoparticle-based drug delivery systems are being developed to improve the efficacy and reduce the side effects of medications used in treating kidney failure.