This describes a medical condition in which the
Kidneys fail to adequately clean the blood by filtering toxins and waste
products from the blood and removing them with the aid of urine, allowing
the waste to accumulate in the blood and the body instead, a condition
called Azotemia; it starts with poorly controlled blood glucose or blood
pressure levels that cause damage to the tiny blood vessels that supply
the kidneys; the blood vessels thicken or become irregular, so that
they are no longer able to filter waste products from the blood into
the urine, thus preventing the kidneys from doing their job properly.
Before the advancement of modern medicine, Renal Failure was
often referred to as Uremic poisoning; Uremia was the term used to describe
the contamination of the blood with urine; starting around 1847, this
term was used to describe reduced urine output, that was thought to
be caused by the urine mixing with the blood instead of being voided
through the Urethra; the term Uremia is now used to loosely describe
the illness accompanying Kidney Failure.
It is estimated that around a third of all Type 1 and
Type 2 Diabetics will develop Diabetic Nephropathy and most of them
will not notice any symptoms in the early stages, which is one of the
reasons why the annual review is so important.
There are two forms of Renal Failure Acute Kidney Injury or Failure
(AKI) and Chronic Kidney Disease or Failure (CKD); the type of Renal
Failure is determined by the trend in the serum creatinine; other factors
which may help differentiate AKI from CKD include anemia and the Kidney
size on ultrasound; CKD generally leads to Anemia and small Kidney size.
AKI is a rapidly progressive loss of renal function, generally characterised
by Oliguria (decreased urine production) and fluid and electrolyte imbalance;
AKI can result from a variety of causes, generally classified as prerenal,
intrinsic, and postrenal; an underlying cause must be identified and
treated to arrest the progress and dialysis may be necessary to bridge
the time gap required for treating these fundamental causes.
AKI usually occurs when the blood supply to the Kidneys is suddenly
interrupted or when the Kidneys become overloaded with toxins; causes
of AKI include accidents, injuries, or complications from surgeries
in which the Kidneys are deprived of normal blood flow for extended
periods of time; Heart Bypass surgery is an example of one such procedure.
Drug Overdoses, accidental or from chemical overloads of drugs such
as Antibiotics or Chemotherapeutics, may also cause the onset of AKI;
unlike in CKD, however, the Kidneys can often recover from AKI, allowing
the patient to resume a normal life; people suffering from AKI require
supportive treatment until their Kidneys recover function and they often
remain at increased risk of developing future Kidney Failure.
Amongst the accidental causes of Renal Failure is the Crush Syndrome,
where large amounts of toxins are suddenly released in the blood circulation
after a long compressed limb is suddenly relieved from the pressure
obstructing the blood flow through its tissues, causing Ischemia; the
resulting overload can lead to the clogging and the destruction of the
Kidneys; it is a reperfusion injury that appears after the release of
the crushing pressure; the mechanism is believed to be the release into
the bloodstream of muscle breakdown products, notably Myoglobin, Potassium
and Phosphorus, that are the products of Rhabdomyolysis (the breakdown
of skeletal muscle damaged by Ischemic conditions); the specific action
on the Kidneys is not fully understood, but may be due in part to Nephrotoxic
metabolites of Myoglobin.
CKD can develop slowly and, initially, show few symptoms; it can be
the long term consequence of irreversible acute disease or part of a
disease progression; Acute Kidney injuries can be present on top of
CKD, a condition called Acute on Chronic Renal Failure (AoCRF); the
acute part may be reversible and the goal of treatment, as with AKI,
is to return the patient to baseline renal function, typically measured
by serum creatinine; like AKI, AoCRF can be difficult to distinguish
from CKD if the patient has not been monitored by a physician and no
baseline, such as past blood work is available for comparison.
CKD is measured in five stages, which are calculated using a patientís
Glomerular Filtration Rate (GFR); Stage 1 CKD is mildly diminished renal
function, with few overt symptoms; Stages 2 and 3 need increasing levels
of supportive care from their medical providers to slow and treat their
renal dysfunction; Stages 4 and 5 usually require preparation of the
patient towards active treatment in order to survive; Stage 5 CKD is
considered a severe illness and requires some form of renal replacement
therapy (dialysis) or Kidney transplant whenever feasible.
CKD has numerous causes; the most common is Diabetes Mellitus; the second
most common is long standing, uncontrolled, Hypertension, or high blood
pressure; Polycystic Kidney disease is another well known cause of CKD;
the majority of people afflicted with Polycystic Kidney disease have
a family history of the disease; some other genetic illnesses can affect
Kidney function as well.
Overuse of common drugs such as Aspirin, Ibuprofen and Acetaminophen
(Paracetamol) can also cause CKD; some infectious diseases such as Hantavirus
can attack the Kidneys, causing Kidney Failure; the APOL1 gene has been
proposed as a major genetic risk locus for a spectrum of non Diabetic
Renal Failure in individuals of African origin, these include HIV Associated
Nephropathy (HIVAN), primary nonmonogenic forms of Focal Segmental Glomerulosclerosis
and Hypertension Affiliated CKD not attributed to other etiologies;
two west African variants in APOL1 have been shown to be associated
with end stage Kidney disease in African Americans and Hispanic Americans.
Problems frequently encountered in Kidney malfunction include abnormal
fluid levels in the body, deranged acid levels, abnormal levels of potassium,
calcium, phosphate and in the longer term anemia as well as delayed
healing in broken bones and long term Kidney problems have significant
repercussions on other diseases, such as Cardiovascular Disease.
Symptoms Of Kidney Failure Include:
High levels of urea in the blood, which can result in Vomiting and/or
Diarrhea, which may lead to Dehydration; Nausea; Weight Loss, Nocturnal
Urination, 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 and Pressure, or
difficulty in Urinating.
A build up of phosphates in the blood that diseased Kidneys cannot filter
out may cause Itching, Bone Damage, Non union in Broken Bones and Muscle
Cramps, caused by low levels of Calcium which can cause Hypocalcaemia;
a build up of Potassium in the blood that diseased Kidneys cannot filter
out, called Hyperkalemia, may cause Abnormal Heart Rhythms, Muscle Paralysis
and the Failure of Kidneys to remove excess fluid may cause Swelling
of the legs, ankles, feet, face and/or hands; 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 which 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
Anemia can result in Feeling Tired and/or Weak, Memory Problems, Difficulty
Concentrating, Dizziness, Low Blood Pressure, Proteins are usually too
big to pass through the Kidneys, but they can 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, or face, Appetite Loss,
a bad taste in the mouth, Difficulty Sleeping, Darkening of the skin
and Excess protein in the blood.
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