Kidney Failure

  • 5:1 What is kidney failure and how does it occur

    When the kidneys stop functioning; it leads to retension of water and waste (poisonous) substances in the circulation; condition is called 'Kidney Failure'. When stoppage occurs due to sudden blockage of blood supply to both kidneys or blockage by stones, sudden 'acute kidney failure', occurs. If the kidneys stop working gradually over weeks and months. It is called 'chronic kidney failure'; common causes are : diabetes mellitus, hypertension, chronic glomerulonephritis, bilateral kidney stones with chronic infection (chronic pylonephrits), prolonged exposure to pain killers/NSAIDS) antibiotics etc. When kidney function is reduced to 5 percent and the damage caused is permanent, end stage kidney disease (ESRD)/Occurs patient can survive only on regular dialysis or after kidney transplantation.

  • 5:2 What happens when kidneys fail?
    • Accumulation of water leads to swelling on face and legs, high BP; that of poisonous substances like urea and creatinine causes lack of appetite, nausea, vomiting, muscle weakness, pallor, anemia.
    • Kidney manufactures hormone called 'erythopoetin' which stimulates bone marrow to produce red blood cells containing hemoglobin which is necessary for supplying oxygen to all parts of body; lack of oxygen in the blood causes lack of energy and tiredness.
    • Lack of vitamin D production by the kidneys leads to reduced calcium in the blood and bones; phosphate levels in the blood get elevated in kidney failure; this causes calcium be drawn out of the bones leading to osteo- malacia, ostoporosis, stiff cystic bones (osteodytophy) due to increase in the hormone called parathormone (PTH); such patients often complain of bone pains and backache.
  • 5:3 How do you evaluate kidney failure ?

    Besides the basic (1) Urine test of red colour urine (blood cells positive, protein test ++ glomerulonephritis ); sugar (diabetes); pus cells (cystitis, pfelonepnitis ) crytals (kidney stones) / elevated blood urea, creatinine, potassium and fall of hemoglobin occur.

    • Potassium kidney failure can cause disturbance in the heart rhythem which may prove fatal.
    • Hemoglobin levels fall (anaemia occurs) due to lack of erythropoetin production by the damaged kidneys.
    • Ultrasound, x-ray, CT-scan/often indicate structure defects and even kidney stones.
  • 5:4 What are the various treatment options for 'end stage kidney failure'

    ' When only 5 percent of kidney function is left, life can only be sustained either on regular maintenance dialysis or by kidney transplantation. Patients our 65 years, younger subjects with severe heart disease or those with primary kidney disease having high chances of recurrence in the transplanted kidney are advised to remain on dialysis; all younger patients are strongly advised to get kidney transplant done; diabetes is no longer a contraindication today.