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CHRONIC KIDNEY FAILURE - CHRONIC RENAL FAILURE

What is Chronic Kidney Failure ?

The job of the kidneys is to remove excess waste products and water from the blood, in the form of urine. Urine then passes down the ureters to the bladder. Chronic renal failure occurs when the kidneys slowly stop working. It also occurs when the ureters or the bladder are blocked. The symptoms which develop depend on how much function is left in the kidneys. They also depend on the length of time, over which the kidneys’ function has declined. Patients in whom the failure has been developing over a few years may have very few symptoms. As waste products accumulate in the blood however, the patient feels tired and loses appetite. With more severe kidney failure, the patient will become drowsy and start vomiting. Fluid overload will also occur as the kidneys fail to get rid of the excess water. This causes swelling (oedema) of the legs, and difficulty in breathing. Sometimes the patient may vomit blood. If treatment is further delayed, a fit may occur and finally coma develops.

How does Chronic Kidney Failure occur ?

Kidney failure may occur due to disease in the kidneys themselves. It may happen because there is obstruction or blockage to the ureters or bladder. Finally, it may result from not enough blood flowing to the kidneys. Damage to the kidneys can occur in a number of different ways: The commonest causes are diabetes, high blood pressure (hypertension) and glomerulonephritis. The kidney failure can develop over a period of a few weeks to many years. The kidney failure due to polycystic kidneys develops slowly over many years and usually shows up between the ages of 40 to 60 years. Diabetic kidney failure is most commonly found in patients who have been known to have diabetes for over 20 years. Patients with diabetic kidney disease usually have diabetic eye disease as well. In the condition of reflux nephropathy (chronic pyelonephritis) the kidneys become scarred due to repeated urinary infections in childhood. This is due to a back-flow of urine up the ureters whenever the bladder is emptied. This condition can be avoided if urinary infections in early childhood are diagnosed early and treated. Obstruction to the kidneys occurs when a stone or a growth blocks the ureters or bladder. It can also be caused by an enlargement of the prostate gland. When the obstruction is relieved, kidney function improves. When the arteries to the kidneys become blocked or narrowed by atherosclerosis (furring up of the arteries), not enough blood gets into the kidneys. This is a common cause of kidney failure in the elderly.

Why does Chronic Kidney Failure occur ?

This depends on the cause of the kidney failure. In most cases, it is not known why that person should develop the particular disorder causing the kidney failure.

Treatment Involved for Chronic Kidney Failure

The first step is to decide what is causing the kidney failure. The doctor will arrange a kidney ultrasound to show the size of your kidneys and the presence of any cysts or blockage. The machine used is like a radar instrument, using sound waves. If the kidneys are small and shrunken, it means that the kidney damage has been present for a long time, maybe years. In this case, not so much can be done in terms of treatment. If the kidneys are of normal size, a kidney biopsy may be done, since a treatable condition may be found. A biopsy involves taking a small piece of kidney through a thin needle for microscope examination. The needle is inserted through the side of the back. The severity of renal failure also needs to be measured and monitored. This is done by blood tests measuring two waste products called urea and creatinine. The treatment of kidney failure may involve taking water tablets (diuretics), to get rid of excess fluid. If blood pressure is raised, this is controlled very carefully. Good blood pressure control slows down the rate at which kidney function gets worse. It is a good idea to ask the doctor what blood pressure level is being aimed for. Having a diet which is low in protein may also improve the symptoms of kidney failure, such as tiredness and nausea. Your doctor may arrange for you to speak with a dietitian to get advice on this. There is a tendency for chronic kidney failure to get gradually worse in many patients. If it gets to a certain severity, then you will need dialysis.

During Treatment for Chronic Kidney Failure

Anaemia often develops during chronic kidney failure. It is not due to iron shortage. A blood transfusion may be needed: some people may be treated with the drug erythropoietin, which directly stimulates the bone marrow to make red blood cells. Vitamin D is not handled by the body properly in this condition. This leads to thin and sometimes painful bones, because they are short of calcium (osteomalacia). Vitamin D may be given as tablets and the calcium level in the blood regularly checked to see that the dose is right. Kidney function can get worse quite suddenly, causing worsening tiredness and vomiting. Acute fluid overload with ankle swelling and shortness of breath can also occur. If either of these problems occur, it is important to consult a doctor as soon as possible.

If Chronic Kidney Failure is Left Untreated

Not keeping in regular touch with doctors could allow the kidney failure to get out of hand. Regular blood tests are essential. Chronic renal failure if not properly treated is fatal.

Effects on Family of Chronic Kidney Failure

Any chronic illness can understandably cause despondency and depression. You will need a lot of support from those close to you.