Kidney Failure: Types, Symptoms, Causes & Management

By Dr. Waheed Zaman in Urology , Kidney Transplant

Dec 14 , 2023 | 9 min read

What is Kidney Failure? 

The main function of kidneys is to eliminate excess fluid and waste material from the blood. When the kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in the body, leading to a condition known as ‘kidney failure’ or ‘renal failure’. This may be due to various factors, including infections, autoimmune diseases, Diabetes Mellitus, hypertension, and kidney stones. Kidney failure usually occurs in the late stages of the disease process. Once kidney failure occurs, it requires immediate management, and even then, the prognosis is often not satisfactory unless kidney transplantation is done. That’s why it is important for those at risk to know the symptoms, diagnosis, and treatment for kidney failure. 

Types of Kidney Failure

There are two main types of kidney failure: Acute Kidney Failure (AKF) and Chronic Kidney Disease (CKD). Each of these types can be further categorised based on their causes and characteristics.

Acute Kidney Failure (AKF)

Acute kidney failure is a sudden and often reversible loss of kidney function that occurs over a short period, usually hours to days. It can be caused by various factors, including:

  • Prerenal AKF: This type is caused by issues that affect blood flow to the kidneys, such as severe dehydration, low blood pressure, or heart problems.
  • Intrarenal AKF: This type results from damage to the kidney tissue itself, often due to conditions like acute glomerulonephritis, kidney infections, or toxic substances (e.g., drugs, contrast agents).
  • Postrenal AKF: Postrenal AKF occurs when there is a blockage in the urinary tract that prevents the flow of urine from the kidneys. This can be caused by conditions like kidney stones, tumours, or enlarged prostate.

Chronic Kidney Disease (CKD)

Chronic kidney disease is a long-term condition characterised by the gradual loss of kidney function over months or years. It is typically caused by underlying health conditions or factors that damage the kidneys over time. CKD is staged based on the severity of kidney damage, with Stage 1 being mild and Stage 5 being end-stage renal disease (ESRD). Common causes of CKD include:

  • Diabetes: High blood sugar levels over time can damage the small blood vessels in the kidneys.
  • Hypertension (High Blood Pressure): Persistent high blood pressure can strain the blood vessels in the kidneys and lead to kidney damage.
  • Glomerulonephritis: Inflammation of the kidney's filtering units (glomeruli) can result from infections or immune system disorders.
  • Polycystic Kidney Disease (PKD): A genetic condition characterised by the growth of cysts in the kidneys, leading to kidney enlargement and loss of function.

End-Stage Renal Disease (ESRD)

ESRD is the final stage of chronic kidney disease when kidney function has deteriorated to the point where the kidneys are barely functioning or not functioning at all. Patients with ESRD require ongoing dialysis or kidney transplantation to stay alive.

Nephrotic Syndrome

Nephrotic syndrome is a condition characterised by excessive protein leakage into the urine (proteinuria), low blood protein levels, high cholesterol levels, and swelling (edema). It can result from various kidney diseases, including glomerulonephritis and diabetic nephropathy.

Hemolytic Uremic Syndrome (HUS)

HUS is a rare condition that can lead to acute kidney injury. It often follows an infection, such as E. coli infection, and can cause a range of symptoms, including kidney failure.

Obstructive Uropathy

Obstructive uropathy is a blockage of the urinary tract that can lead to kidney damage and potentially kidney failure. Causes include kidney stones, tumours, and congenital abnormalities.

These are the main types of kidney failure, each with its own causes, characteristics, and treatment approaches. Early detection and management of kidney disease can help prevent or 

Symptoms Of Kidney Failure

Whether acute or chronic, kidney failure presents a spectrum of symptoms, varying in onset and severity. Common symptoms encompass:

  • Reduced Urine Output: A significant decrease in the urine volume produced could indicate kidney issues. This symptom may be accompanied by darker urine than usual.
  • Generalised Swelling of the Body: Known as edema, this condition results from excess fluid retention due to impaired kidney function. It often leads to noticeable swelling in the hands, feet, face, or abdomen.
  • Blood in the Urine: Hematuria, or blood in the urine, can occur when the kidneys are damaged.
  • Increased Fatigue and Tiredness: Kidney problems can lead to a buildup of waste products in the blood, causing fatigue and weakness.
  • Nocturia (Increased Urination at Night): Frequent urination during the night, known as nocturia, can disrupt sleep and may be related to kidney issues.
  • Vomiting, Edema, and High Blood Pressure: Severe kidney problems can lead to complications such as vomiting, worsening oedema (swelling), and high blood pressure. These symptoms require immediate medical attention.
  • Loss of Appetite: Kidney issues can affect the appetite and lead to a lack of interest in food, contributing to weight loss.

Causes Of Kidney Failure

Kidney failure, a critical medical condition, can be triggered by a variety of factors. However, several other factors can contribute to this condition, putting individuals at risk. 

  • Diabetes: This is the most prevalent cause of kidney failure.
  • High Blood Pressure: Often referred to as hypertension, high blood pressure is the second leading cause of kidney failure.
  • Autoimmune Diseases: Conditions like lupus and IgA nephropathy can damage kidneys.
  • Genetic Diseases: Genetic disorders inherited from one or both parents, like polycystic kidney disease, can result in kidney failure.
  • Nephrotic Syndrome: This condition can also contribute to kidney problems.
  • Urinary Tract Issues: Problems within the urinary tract, including kidney stones, can impair kidney function.
  • Tobacco Smoking: Smoking tobacco is a lifestyle factor that can exacerbate kidney damage.

Kidney Failure Diagnosis

Kidney failure diagnosis, whether acute kidney failure (AKF) or chronic kidney disease (CKD), involves a combination of medical evaluations and tests. Here's an overview of the diagnostic process:

Medical History and Physical Examination: A healthcare provider will initiate the diagnostic process by taking a detailed medical history from the patient. This will include inquiries about any pre-existing medical conditions, medications the patient is taking, the patient's family medical history, and any symptoms the patient may be experiencing. Following this, a thorough physical examination will be performed to look for signs of kidney disease in the patient, such as swelling, hypertension (high blood pressure), and fluid retention.

Blood Tests: Blood tests are pivotal in assessing kidney function. Common blood tests that are typically conducted include:

  • Serum Creatinine: Elevated levels may indicate impaired kidney function.
  • Blood Urea Nitrogen (BUN): Elevated levels may suggest kidney dysfunction.
  • Glomerular Filtration Rate (eGFR): This is a calculation based on creatinine levels that provide an estimate of kidney function.
  • Complete Blood Count (CBC): This test checks for anaemia, which can be associated with kidney disease.
  • Electrolyte Levels: Imbalances can occur as a result of kidney dysfunction.

Urine Tests: Urine tests are employed to evaluate kidney function and identify any abnormalities. Common urine tests include:

  • Urinalysis:< This test detects the presence of blood, protein, or other substances in the urine.
  • Urine Albumin-to-Creatinine Ratio (ACR): The amount of albumin (a type of protein) in the urine can indicate kidney damage.

Imaging Studies: Imaging tests, such as ultrasound, CT scans, or MRI scans, may be utilised to visualise the kidneys and detect structural abnormalities, tumours, or obstructions.

Kidney Biopsy: In certain cases, where the cause of kidney disease is unclear or a more detailed examination of kidney tissue is needed, a kidney biopsy may be recommended. It's important to note that this procedure is relatively invasive and is typically reserved for specific cases.

Additional Tests: Depending on the suspected cause of kidney disease, the healthcare provider may consider other specialised tests, such as autoimmune antibody tests or genetic testing.

Kidney Failure Treatment 

The kidney/renal failure treatment depends on whether it is acute kidney failure (AKF) or chronic kidney disease (CKD) and its underlying cause. Here are the main approaches to treatment for kidney diseases:

Acute Kidney Failure Treatment

  • Address the Underlying Cause: The primary focus in AKF is identifying and treating the underlying cause. This may involve discontinuing medications that harm the kidneys, treating infections, or removing obstructions from the urinary tract.
  • Fluid and Electrolyte Balance: Managing fluid and electrolyte imbalances is crucial. This often requires adjustments in fluid intake, monitoring electrolyte levels, and administering intravenous (IV) fluids as needed.
  • Medications: Medications can be prescribed depending on the specific cause and symptoms. For example, diuretics can help remove excess fluid, and medications to manage blood pressure or treat infections may be necessary.
  • Dialysis: In severe cases, especially if the kidneys are not functioning, hemodialysis or peritoneal dialysis can also be required temporarily to remove waste products and excess fluid from the blood.

Chronic Kidney Disease Treatment

  • Lifestyle Modifications: Lifestyle changes are critical in managing CKD. These may include dietary adjustments to limit salt, phosphorus, and potassium intake. Maintaining a healthy weight, regular exercise, and smoking cessation are also important.
  • Blood Pressure Control: High blood pressure (hypertension) is common in CKD and needs to be well-controlled. Medications and lifestyle changes are often used to manage blood pressure.
  • Medications: Various medications can be prescribed depending on the CKD stage and specific complications. These can include medications to manage anaemia, control calcium and phosphate levels, and protect the kidneys.
  • Dietary Changes: A registered dietitian may work with individuals to create a kidney-friendly diet plan that addresses their nutritional needs and restrictions.
  • Dialysis: In advanced CKD stages, when the kidneys are functioning at a minimal level or not at all, dialysis (hemodialysis or peritoneal dialysis) can become necessary for long-term management.
  • Kidney Transplant: Kidney transplantation is a viable option for eligible patients. A healthy kidney from a living or deceased donor replaces the failing kidney, offering the potential for a near-normal life.

Recovery from Kidney Failure

Recovery from kidney failure hinges on various factors, including its type, underlying cause, and choosing a kidney hospital in Delhi or elsewhere. Acute kidney failure (AKF) often offers a good chance of recovery when treated promptly. Conversely, chronic kidney disease (CKD) is generally seen as irreversible, but early interventions and lifestyle adjustments can slow its progression, leading to an improved quality of life. 

Read more- What is Chronic Kidney Disease(CKD)?

Life Expectancy After Kidney Failure

The life expectancy of individuals facing kidney failure, also known as end-stage renal disease (ESRD), is influenced by several factors. These include age, overall health, access to medical care, and the available treatment options.

Reducing the Risks of Kidney Diseases

Preventing kidney failure or reducing the risk of kidney disease involves adopting a healthy lifestyle and managing underlying medical conditions. Here are some key preventive measures:

Control High Blood Pressure: Monitor and manage hypertension (high blood pressure) through medication, dietary changes (e.g., low-sodium diet), exercise, and stress reduction techniques.

Maintain a Healthy Diet: Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit salt, saturated fats, and processed foods. Monitor phosphorus and potassium intake if a person has kidney disease.

Stay Hydrated: Drink an adequate amount of water daily to keep the kidneys properly hydrated. Consult with a healthcare professional for personalised recommendations.

Exercise Regularly: Engage in regular physical activity to maintain a healthy weight and improve overall cardiovascular health. 

Manage Medications: Take prescribed medications as directed and discuss potential kidney side effects with the healthcare provider. Avoid over-the-counter pain relievers like NSAIDs if they are not recommended for a person.

Maintain a Healthy Weight: Achieve and maintain a healthy body weight through diet and exercise. Obesity can increase the risk of kidney disease.

Avoid Dehydration: Stay hydrated by drinking enough fluids, especially in hot weather or during physical activity.

Limit Exposure to Toxins:Minimise exposure to environmental toxins, chemicals, and heavy metals that can harm kidney function.

Kidney Screening: If a person has risk factors or a family history of kidney disease, consider kidney function screening tests, including blood pressure checks and urine tests for protein.

Final Words

Kidney diseases and failure pose a significant health challenge all over the world, including in India. While exact numbers might fluctuate, it's estimated that about 17-20% of the Indian population suffers from some renal disease. This staggering statistic is attributed to the rising incidence of non-communicable diseases like diabetes and hypertension, both potent precursors to kidney issues. That’s why it is extremely important to consult an experienced kidney specialist if any of the symptoms mentioned in the article persist. The sooner the diagnosis, the better the treatment.