Kidney (Renal) Failure Treatment in Delhi, India

Kidney failure occurs when the kidneys lose their ability to effectively filter waste and excess fluids from the blood. This condition can be acute, developing suddenly due to factors like severe dehydration or infection, or chronic, progressing over time due to underlying conditions such as diabetes or high blood pressure. When kidneys fail, waste builds up in the body, leading to symptoms like swelling, fatigue, and changes in urine output. Prompt diagnosis and treatment are essential to manage the condition and maintain overall health.

There are two main types of kidney failure:

Acute Kidney Failure

Acute kidney failure, also known as acute renal failure, occurs suddenly and can progress rapidly within hours or days. It is often triggered by conditions that cause a sudden drop in blood flow to the kidneys, such as severe dehydration, blood loss, or a serious infection. It can also result from an obstruction in the urinary tract, such as kidney stones or an enlarged prostate, or from toxic reactions to medications or chemicals. While acute kidney failure can be severe and life-threatening, timely medical intervention can often reverse the condition and restore normal kidney function.

Chronic Kidney Failure

Chronic kidney failure, or chronic renal failure, develops gradually over a period of months or years. It is commonly caused by long-term health issues such as diabetes and high blood pressure, which cause ongoing damage to the kidneys. Other causes include chronic glomerulonephritis (inflammation of the kidney’s filtering units), polycystic kidney disease, and long-term use of certain medications. As the kidneys’ ability to filter waste diminishes, symptoms may become more noticeable and severe. Chronic kidney failure is usually progressive and irreversible, often leading to end-stage kidney disease where dialysis or a kidney transplant becomes necessary.

Acute Kidney Failure Causes

• Severe Dehydration: Drastically reduces blood flow to the kidneys, impairing their function.
• Acute Infections: Infections, particularly severe ones like sepsis, can lead to kidney failure by affecting the kidneys directly or causing systemic issues.
• Urinary Tract Obstruction: Conditions such as kidney stones, enlarged prostate, or tumours can block urine flow, causing kidney damage.
• Toxic Reactions: Certain medications, contrast dyes used in imaging, or exposure to harmful substances can directly injure kidney tissue.

Chronic Kidney Failure Causes

• Diabetes: Long-term high blood sugar levels damage kidney blood vessels, leading to impaired function.
• High Blood Pressure: Persistent hypertension causes damage to the kidneys’ blood vessels, reducing their ability to filter waste.
• Chronic Glomerulonephritis: Ongoing inflammation of the kidney's filtering units leads to gradual loss of kidney function.
• Polycystic Kidney Disease: A genetic disorder that causes fluid-filled cysts to develop in the kidneys, affecting their ability to function properly.

• Family History: A genetic predisposition to kidney disease can increase the likelihood of developing kidney failure.
• Age: The risk of kidney failure rises with age, as kidney function naturally declines over time.
• Chronic Kidney Disease: Having a history of chronic kidney disease makes individuals more susceptible to kidney failure.
• Lifestyle Factors: Poor dietary choices, lack of exercise, smoking, and excessive alcohol consumption can contribute to conditions that increase the risk of kidney failure.

The symptoms of kidney failure can vary depending on whether the condition is acute or chronic. Generally, they include:

• Fatigue: Persistent tiredness or weakness, often due to the build-up of waste products and fluid imbalance.
• Swelling: Fluid retention causing swelling in the legs, ankles, feet, or face, due to impaired fluid regulation by the kidneys.
• Changes in Urine Output: Decreased urine production, or conversely, increased urine production with frequent urination, especially at night.
• Shortness of Breath: Fluid build-up in the lungs can lead to difficulty breathing or shortness of breath.
• Nausea and Vomiting: Accumulation of toxins in the blood can cause gastrointestinal symptoms such as nausea, vomiting, and loss of appetite.
• Confusion or Difficulty Concentrating: Build-up of waste products can affect mental function, leading to confusion or difficulty focusing.
• High Blood Pressure: Elevated blood pressure can result from fluid overload and imbalanced electrolytes.
• Itchy Skin: The accumulation of waste products can cause itching or dry skin.
• Metallic Taste in Mouth: Waste build-up can alter taste and cause a metallic or ammonia-like taste in the mouth.
• Persistent Back Pain: Discomfort or pain in the lower back may occur, particularly if kidney stones or infections are present.

Blood Tests

Blood tests are essential for diagnosing kidney failure and assessing kidney function. Key tests include:

• Serum Creatinine: Measures the level of creatinine, a waste product, in the blood. Elevated levels can indicate impaired kidney function.
• Blood Urea Nitrogen (BUN): Measures the amount of urea nitrogen in the blood, which can increase when kidney function is compromised.
• Electrolytes: Tests levels of electrolytes such as sodium, potassium, and calcium to assess how well the kidneys are maintaining balance.
• Glomerular Filtration Rate (GFR): Estimates how well the kidneys are filtering blood. A decreased GFR can indicate kidney failure.

Urine Tests

 Urine tests provide information about kidney function and detect abnormalities. Key tests include:

• Urinalysis: Examines the appearance, concentration, and content of urine. It can reveal signs of kidney damage, such as protein or blood in the urine.
• Urine Albumin-to-Creatinine Ratio (UACR): Measures the amount of albumin (a type of protein) in the urine relative to creatinine. Elevated levels can indicate kidney damage.
• 24-Hour Urine Collection: Measures the total amount of waste products excreted in a day, helping to evaluate kidney function.

Imaging Tests

Imaging tests provide visual insights into kidney structure and potential causes of kidney failure. Key tests include:

• Ultrasound: Uses sound waves to create images of the kidneys, helping to detect abnormalities such as blockages, kidney stones, or cysts.
• CT Scan (Computed Tomography): Provides detailed cross-sectional images of the kidneys to identify structural problems, tumours, or obstructions.
• MRI (Magnetic Resonance Imaging): Offers detailed images of the kidneys and surrounding structures, useful for diagnosing complex conditions.
• Renal Scan: A nuclear medicine scan using radioactive tracers to assess kidney function and structure, detecting issues such as blockages or abnormal filtering.
• Intravenous Pyelogram (IVP): An X-ray imaging technique with contrast dye injected into a vein to visualise the kidneys, ureters, and bladder, identifying structural issues or obstructions.
• Cystoscopy: A procedure using a thin tube with a camera inserted into the bladder through the urethra to examine the urinary tract and detect issues affecting urine flow.

Kidney Biopsy

This involves taking a small sample of kidney tissue for examination under a microscope to diagnose specific kidney diseases and assess the extent of damage.

To ensure accurate diagnosis and effective management of kidney failure, it's crucial to consult with some of the best nephrologists in India, who have the expertise to interpret diagnostic tests and recommend appropriate treatment accordingly.

Stage I

In Stage I of kidney failure, kidneys are still functioning at near-normal levels, with a Glomerular Filtration Rate (GFR) of 90 or above. This stage is characterised by the presence of kidney damage, which might be detected through abnormalities in urine tests, such as elevated protein levels, or other indicators of kidney stress. At this stage, symptoms are usually absent, and the condition may be discovered during routine medical examinations or in individuals with risk factors such as diabetes or high blood pressure.

Stage II

Stage II of kidney failure is marked by a further decline in kidney function, with a GFR ranging from 60 to 89. While kidney function is still relatively preserved, the decrease is noticeable compared to normal levels. At this stage, kidney damage may become more evident through additional testing, but symptoms are still minimal or absent. Regular monitoring and lifestyle adjustments are essential to manage risk factors and slow the progression of the disease. Patients may be advised to make dietary changes, control blood pressure, and manage underlying health conditions to protect kidney function. 

Stage III

In Stage III, kidney function is moderately reduced, with a GFR between 30 and 59. Symptoms may begin to appear, such as fatigue, swelling in the legs and ankles, and changes in urine output. The kidneys are less able to filter waste and maintain fluid balance, leading to more noticeable signs of kidney impairment. Management at this stage often involves more intensive monitoring and intervention, including medication adjustments and lifestyle modifications to manage symptoms and address complications. 

Stage IV

Stage IV represents severe kidney damage, with a GFR between 15 and 29. At this stage, kidney function is significantly compromised, and symptoms become more pronounced, including persistent fatigue, severe swelling, shortness of breath, and an increased risk of complications like high blood pressure and anaemia. The focus of treatment shifts towards preparing for potential dialysis or kidney transplant, along with intensive management of symptoms and complications. 

Stage V

Stage V, also known as end-stage renal disease (ESRD), is the final stage of kidney failure, with a GFR below 15. Kidney function is severely diminished, and waste products and fluid build-up in the body, leading to serious health issues. Symptoms are severe and can include extreme fatigue, persistent swelling, and significant changes in mental and physical health. At this stage, dialysis or a kidney transplant is usually necessary to sustain life.

Medications

Medications play a crucial role in managing the symptoms and complications of kidney failure. Depending on the stage of kidney failure, different types of medications may be prescribed. These can include:

• Blood Pressure Medications: To control high blood pressure, which can worsen kidney damage.
• Diuretics: To help remove excess fluid from the body and reduce swelling.
• Erythropoiesis-Stimulating Agents (ESAs): To treat anaemia by stimulating the bone marrow to produce more red blood cells.
• Phosphate Binders: To reduce phosphate levels in the blood, helping to prevent bone damage.
• Vitamin D Supplements: To support bone health and regulate calcium levels.

Medications are tailored to manage specific symptoms, prevent further kidney damage, and improve overall quality of life.

Dialysis

Dialysis is a life-sustaining kidney failure treatment used when the kidneys can no longer adequately filter waste and excess fluids from the blood. There are two main types of dialysis:

• Hemodialysis: Blood is passed through a machine that filters out waste products and excess fluids before returning it to the body. Hemodialysis is typically done in a clinic several times a week, but can also be performed at home.
• Peritoneal Dialysis: In this method, the blood is cleaned inside the body using the peritoneal membrane in the abdomen. A special fluid is introduced into the abdominal cavity, where it absorbs waste and excess fluids, which are then drained away. Peritoneal dialysis can be done at home, often overnight while the patient sleeps.

Dialysis helps manage the symptoms of kidney failure and removes toxins from the body, but it is not a cure for kidney failure.

Kidney Transplant

A kidney transplant is often considered the best long-term treatment option for individuals with end-stage kidney failure. In this procedure, a healthy kidney from a living or deceased donor is surgically placed into the patient’s body to take over the functions of the failing kidneys.

• Living Donor Transplant: A kidney donated by a living person, often a family member or close friend.
• Deceased Donor Transplant: A kidney obtained from someone who has passed away, with the family's consent. A successful kidney transplant can significantly improve the quality of life and eliminate the need for dialysis. However, lifelong medications (immunosuppressants) are required to prevent the body from rejecting the new organ.

• Fluid Retention: Excess fluid build-up in the body leads to swelling (oedema) in the legs, ankles, feet, and face, and can cause shortness of breath due to fluid in the lungs.
• High Blood Pressure (Hypertension): Kidney failure often causes high blood pressure due to disrupted fluid balance and hormone regulation, which can further damage the kidneys.
• Anaemia: Reduced erythropoietin production in kidney failure leads to anaemia, causing fatigue, weakness, and pale skin due to a lack of red blood cells.
• Bone Disease: Imbalances in calcium and phosphorus levels weaken bones, increasing the risk of fractures and causing bone pain.
• Cardiovascular Disease: Waste build-up and fluid overload from kidney failure increase the risk of heart attacks, strokes, and heart failure.
• Hyperkalaemia: The kidneys' inability to filter out excess potassium can result in muscle weakness and potentially life-threatening heart rhythm disturbances.
• Metabolic Acidosis: Kidney failure can lead to an accumulation of acid in the body, causing rapid breathing, confusion, and fatigue.
• Uremia: Waste products like urea build up in the blood, leading to symptoms like nausea, vomiting, loss of appetite, and in severe cases, seizures or coma.
• Pericarditis: Inflammation of the heart's covering (pericardium) due to toxin build-up can cause chest pain and serious complications if untreated.
• Nervous System Damage: Late-stage kidney failure can damage the nervous system, leading to concentration difficulties, memory loss, and severe cases of confusion or coma.

• Maintain a Healthy Diet: Eating a balanced diet that is low in sodium, saturated fats, and processed foods can help manage blood pressure and prevent diabetes, both of which are risk factors for kidney failure. Include plenty of fruits, vegetables, whole grains, and lean proteins.
• Stay Hydrated: Drinking enough water helps the kidneys flush out toxins and waste. Aim for at least 8 glasses of water a day, or as recommended by your healthcare provider, to support kidney function.
• Regular Exercise: Engaging in regular physical activity helps control blood pressure and blood sugar levels, reducing the risk of conditions that can lead to kidney failure. Aim for at least 150 minutes of moderate exercise per week.
• Monitor Blood Pressure: Keeping blood pressure within a healthy range is crucial for kidney health. Regularly check your blood pressure and follow your doctor’s advice on managing it if it’s elevated.
• Avoid Smoking: Smoking can damage blood vessels and impair kidney function. Quitting smoking helps improve overall health and reduces the risk of developing kidney problems.
• Limit Alcohol Consumption: Excessive alcohol intake can harm the kidneys and lead to high blood pressure. Limit alcohol consumption to moderate levels or abstain entirely.
• Use Medications Wisely: Use over-the-counter and prescription medications as directed by your healthcare provider. Some medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs), can harm the kidneys if used excessively.

How often should I get my kidney function tested if I have a family history of kidney disease?

If you have a family history of kidney disease, it’s important to monitor your kidney function regularly to catch any potential issues early. Typically, individuals with a family history should get their kidney function tested at least once a year. However, your healthcare provider may recommend more frequent testing based on your overall health and specific risk factors.

Are there specific foods or diets that can support kidney health?

A kidney-friendly diet usually includes foods low in sodium, potassium, and phosphorus to reduce stress on the kidneys. Focus on eating fresh fruits, vegetables, whole grains, and lean proteins. Avoid processed foods, high-sodium items, and excessive protein. Drinking plenty of water and maintaining a balanced diet can support kidney health and function.

Can kidney failure be hereditary?

Yes, certain types of kidney disease, including polycystic kidney disease and some forms of glomerulonephritis, can be hereditary. If you have a family history of kidney disease, you may be at higher risk of developing similar conditions. Regular check-ups and early monitoring can help manage risks and catch potential issues early.

What should I do if I notice early symptoms of kidney problems?

If you notice symptoms such as swelling in the legs or ankles, changes in urination, fatigue, or persistent back pain, it’s important to consult a healthcare provider promptly. Early diagnosis and treatment can help manage kidney problems effectively and prevent further progression.

How does kidney failure affect other organs in the body?

Kidney failure can impact multiple organs due to the build-up of waste products and fluid imbalances. For example, it can lead to cardiovascular issues such as heart disease and hypertension, cause bone disease due to imbalances in calcium and phosphorus, and affect the nervous system, resulting in cognitive changes and muscle weakness.

Can kidney failure be reversed with treatment, or is it always permanent?

Kidney failure is typically progressive and not fully reversible, especially in advanced stages. However, with appropriate treatment, including medications, dialysis, or a kidney transplant, it is possible to manage symptoms, slow progression, and improve quality of life. Early intervention can help preserve kidney function and prevent further deterioration.

Are there any specific precautions I should take if I’m undergoing dialysis?

If you’re undergoing dialysis, it’s important to follow your healthcare provider's instructions carefully. Precautions include maintaining a prescribed diet, managing fluid intake, and keeping regular appointments for dialysis sessions. Monitor for any signs of complications, such as infection or excessive bleeding, and report any issues to your doctor immediately.

What should I discuss with my doctor before starting kidney failure treatment?

Before starting treatment for kidney failure, discuss your treatment options, including the benefits and risks of each. Ask about lifestyle changes, dietary adjustments, and potential side effects of medications or procedures. Understanding your treatment plan and setting realistic goals with your doctor can help you manage your condition effectively.

Reviewed By Dr Kulwant Singh - Principal Consultant Nephrology, Kidney Transplant on 14 Oct 2024.