Renal Failure (Kidney Failure & Diabetic Nephropathy):

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 as Anemia.

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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