Chronic Kidney Failure

What is chronic kidney failure?

Chronic kidney (renal) failure is a gradual shutdown of your kidneys. This problem is also called chronic renal failure or chronic renal insufficiency.

Your kidneys are located on each side of your spine above your waist. They make urine by filtering waste products from your blood. They control the balance of salt and water in your body and help regulate your blood pressure. As long as you have at least one kidney that is working, your body can get by.

When you have kidney failure, the kidneys are no longer able to make urine, rid your body of wastes, or keep a healthy balance of minerals such as sodium and potassium. Chronic kidney failure usually occurs in middle-aged and older people.

How does it occur?

Chronic kidney failure is caused by continuous damage to the kidneys over the years by diseases such as:

• high blood pressure (hypertension)
• diabetes
• heart or lung disease
• cysts in the kidney (usually hereditary).

Acute kidney failure, which is a sudden shutdown of your kidneys, may develop into chronic kidney failure. Prolonged use of nonprescription painkillers, such as acetaminophen, aspirin, and NSAIDS (ibuprofen or naproxen), can also cause chronic kidney failure.

What are the symptoms?

Symptoms include:

• a need to pass urine often, or urinating less often or not at all
• pale and dilute-looking urine
• tiredness, weakness
• headaches
• loss of appetite, nausea, vomiting
• coated tongue
• itchy skin
• yellowish skin
• skin or breath that smells like urine
• trouble concentrating
• muscle cramps
• collapse or coma.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and your medical history, including medicines that you are taking. Your provider will examine you. You will have urine and blood tests to see how well your kidneys are working.

You may also have special X-rays and ultrasound scans of your kidneys. In some cases you may need to have a biopsy, a test in which tissue or cell samples are taken from the kidney and examined.

Your provider will look for disease that may be causing damage to your kidneys, such as high blood pressure; diabetes; heart, lung or arterial disease; or cysts.

How is it treated?

Your healthcare provider will probably prescribe medicine to:

• Treat the disease that is causing the kidney failure.
• Keep your blood pressure normal.
• Keep the balance of liquids in your body normal.
• Keep the balance of minerals in your body normal.

You may need to change your diet. Follow your healthcare provider's guidelines for the amount of salt in your diet. Also, the amounts of liquids you drink must be balanced against how much you urinate. You may need to have less protein in your diet. You may also need to limit potassium because it may be hard for your body to get rid of extra potassium. With the right diet, you can reduce the work your kidneys must do.

If these treatments are not enough, you may need kidney dialysis. Dialysis is a mechanical way to do the work your kidneys normally do. It removes waste products and extra water from the blood and can be life-saving. Dialysis can be done in a medical center, but many people can learn to operate the equipment themselves in their own homes and are able to live a reasonably normal life other than the time they spend doing dialysis. Dialysis usually needs to be done several times a week.

Whether dialysis is used depends on:

• why your kidneys stopped working
• your other health conditions
• your overall health.

For many people, dialysis can extend life and improve quality of life. For others whose condition is extreme, dialysis may seem a burden that only prolongs suffering. Discuss this with your healthcare provider.

For people whose health is good other than their kidney failure, kidney transplants can be a welcome alternative to dialysis.

How long will the effects last?

Chronic kidney failure develops slowly, and you have it for the rest of your life unless you have a kidney transplant. Without treatment, kidney failure is fatal.

How can I take care of myself?

• Carefully follow your healthcare provider's instructions for treating your kidney failure.
• Take medicines exactly as you are directed by your provider.
• Follow your provider's instructions for balancing your fluids through the day.
• Make changes in your diet as recommended by your healthcare provider. Ask your provider or dietitian for written diet instructions.