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Chronic and acute renal failure Causes, Symptoms and Treatment

Each minute, the kidneys filter about 1 liter of blood, one-fifth of the amount pumped by the heart. The chronic renal failure is a serious disease that causes gradual and irreversible deterioration of the kidneys’ ability to filter blood and excrete certain hormones. The products of metabolism and the excess water pass less and less into the urine and accumulate in the body.

The chronic renal failure resulting from complications of diabetes, hypertension and other illnesses. The acute renal failure , in turn, occurs suddenly. It often occurs as a result of a reversible decrease in renal blood flow. There are many causes, such as dehydration, severe infections, an obstruction such as enlarged prostate, or exposure to substances that are toxic to the kidneys such as contrast media used in radiology. Too high a level of uric acid is also a symptom of kidney failure.

How kidneys work

The kidneys’ essential function is to remove excess fluid and metabolic waste from the blood. The kidneys receive blood through the renal arteries that carry oxygenated blood from the heart. By penetrating the kidneys, the blood circulates in smaller and smaller vessels which each end in a nephron , a kind of miniature kidney.

A nephron is made up of a glomerulus that filters water, mineral salts, calcium, amino acids and waste and a tubule that carries water and all collected materials. The blood then reabsorbs materials that the body can use again, and the rest is collected in the pelvis , a kind of funnel connected to the ureter that carries urine to the bladder .

When to consult

If you have diabetes or another illness that can cause kidney failure , your doctor will monitor the health of your kidneys on a regular basis through blood and urine tests. If symptoms occur between visits, do not hesitate to contact your doctor.

Even if you are not at risk for kidney failure, contact your doctor immediately if the volume of your urine changes significantly or if your urine contains traces of blood .

Symptoms of chronic and acute renal failure

The progression of chronic renal failure is so slow that symptoms are often imperceptible in the early years because the kidneys adapt and compensate for their loss of function. Many patients only become aware of their health problem when their kidneys are operating at less than 25% of their normal capacity.

Some nonspecific symptoms , such as fatigue, may be the only manifestation of the disease for a long time. In people at risk, monitoring by blood and urine tests is essential to detect signs of kidney failure.

Once the disease is well established, the following symptoms may occur:

  • Swelling of feet, ankles, legs or eyelids;
  • Pain in urination and decrease in urine volume;
  • More frequent urination
  • Foamy urine, cloudy or dark in color;
  • High blood pressure;
  • Fatigue and weakness more marked;
  • Nausea and vomiting;
  • Loss of appetite and bad taste in the mouth;
  • Unexplained weight loss
  • Drowsiness, psychomotor retardation;
  • Headache ;
  • Sleeping troubles ;
  • Pain in the middle, lower back or on the sides of the pelvis;
  • Involuntary contractions of muscles and cramps;
  • Persistent itching.

Risk factors for chronic renal failure

The most common cause of chronic renal failure  is type 1 or type 2 diabetes. In fact, diabetes damages small blood vessels, including those inside the kidneys. . In general, diseases that cause cardiovascular problems are also risk factors for kidney disease. Older age, high blood pressure, obesity, diabetes, smoking and low HDL cholesterol (“good cholesterol”) . Other risk factors may cause chronic kidney failure, including:

  • Pyelonephritis (kidney infection);
  • Polycystic kidney disease;
  • Autoimmune diseases, such as systemic lupus erythematosus;
  • Obstruction of the urinary tract (as in enlarged prostate);
  • Use of drugs metabolized by the kidneys, such as some chemotherapy agents for cancer.

Prevention of renal failure

In some cases, the disease is impossible to prevent. However, the two main causes are diabetes (type 1 and 2) as well as high blood pressure . Good control of these diseases greatly reduces the risk of progression to kidney failure. However, healthy lifestyle habits can help reduce risk.

  • Follow closely the treatments recommended by your doctor if you have a chronic condition such as diabetes, lupus or hypertension.
  • Take or take your blood pressure on a regular basis.
  • Avoid the abuse of alcohol, drugs and medications , including those over the counter, such as aspirin, acetaminophen or ibuprofen.
  • Get treatment promptly if you have a urinary tract infection or any other urinary tract disease.

Medical treatments for kidney failure

Without being able to cure chronic renal failure, treatment can slow down or even halt its progression. In cases of acute renal failure, the process is often reversible. The disease that causes kidney failure , such as diabetes or hypertension, is treated first . Kidney failure itself is treated in parallel.

Diet

The first measure proposed to patients is often the modification of the diet . The doctor may recommend a reduction in protein intake to slow down the accumulation of waste in the blood and limit nausea and vomiting. The risk of dialysis is reduced and mortality is reduced.

The intake of sodium (in salt) as well as in fat ( fat ) must be limited. Everything has to be adjusted to the severity of the kidney failure and the advice of a nutritionist will prove very useful in these circumstances.

The doctor may also prescribe a reduction in the consumption of liquids  : water, ice cubes, coffee, tea, soft drinks, juices, soups, milk, cream, ice cream and sorbets. It could for example limit this consumption to 1.5 liters per day.

To control thirst, patients are advised to rinse their mouths regularly with water, without swallowing. Sucking candy or chewing gum can also help moisten the inside of the mouth with saliva. An oral spray like Biotene can help.

Pharmaceuticals

When the diet is no longer sufficient to control imbalances in water and electrolytes (calcium, phosphorus, potassium, etc.), the introduction of drugs in addition to good eating habits will help achieve this goal: vitamin D, seguamer (Renagel ) to control phosphorus , sodium polystyrene sulfonate (Kayexalate) to control potassium , and calcium and calcimimetics cinacalcet (Sensipar) to regulate calcium .

Treatment will be offered as needed to maintain red blood cells at a certain level: darbopoietin (Aranesp) and erythropoietin (Eprex).

strict control of hypertension blood decreases the progression of kidney damage and medication will almost certainly be necessary to achieve the desired pressure values. The target is less than 140/90, even 130/80 in case of diabetes or proteinuria.

In addition, we will try to urinate “excess water” present in the body with diuretics  : furosemide (Lasix), hydrochlorothiazide (Hydrodiuril).

In diabetics, blood glucose should be kept at an acceptable level, through the use of oral medications or insulin if the diet is not enough. See the factsheet on diabetes .

Dialysis

Dialysis uses a membrane that acts as a filter and serves to remove toxins and excess fluid from the blood. There are two types of dialysis: peritoneal dialysis and hemodialysis . The choice of one method over the other depends on the age of the patient, his ability to manage his treatment (peritoneal dialysis requires a minimum of dexterity and autonomy), the presence of other diseases and the preference of the patient. Patient.

In peritoneal dialysis, the peritoneum is used to act as a filter. The peritoneum is the double membrane lining the wall of the abdomen (abdomen) and the abdominal organs (intestine, stomach, etc.). These two membranes are separated by a tiny space in which a catheter (a flexible tube, very small dimension) permanently. With this tube, the peritoneum is filled with a solution called dialysate , left a few hours in this cavity. The blood circulating in the vessels raking the peritoneum is then filtered: the toxins and the excess water pass on the side of the dialysate. Once the operation is complete, the dialysate is removed and replaced by another blank.

Peritoneal dialysis is usually done at home by the patient or a family member. The continuous ambulatory peritoneal dialysis is usually repeated every 6 hours. The automated peritoneal dialysis is 1 time per day, during the night, thanks to a programmed device.

The hemodialysis should be performed in the hospital or in a clinic. A machine called a “dialyzer” is used to filter the blood.

The blood is first pumped into the dialyzer. Inside the machine, it remains on one side of a membrane that serves as a filter. Waste and excess liquid pass through the membrane and pass to the other side where the dialysate is located. The filtered blood is returned to the body. In general, the procedure requires 4 hours. It should be repeated about 3 times a week.

Kidney transplant

For some patients, a kidney transplant is required. Applications are evaluated by very strict criteria to avoid any form of discrimination. A detailed assessment by a nephrologist specialized in kidney transplantation is necessary to establish whether this therapeutic option is adequate for a given patient.

The kidney can come from a living donor, often a parent, or from a donor who has just died. With a successful transplant, the recipient is able to lead an active, healthy life.

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