Kidney failure is a severe deterioration of kidney function. Two principal classes of this condition are distinguished: acute and chronic kidney failure. However, some aspects of the pathophysiology are similar in acute kidney injury (AKI) and chronic kidney disease (CKD). For example, both can lead to end-stage kidney disease owing to the compensatory mechanisms of the kidney driving hypertrophy and hyperfiltration, which cause further injury in the residual nephrons [1].

Acute kidney failure (acute kidney injury, AKI) is due to a sudden injury, whereas chronic failure develops over a time scale of months, although AKI may contribute to the development of advanced chronic disease [2]. Classification of AKI is either by the rate of increase in serum creatinine or by the decrease in urine volume [3]. Acute failure can be classified as prerenal, intrinsic, and postrenal, depending on the site of the original lesion. Volume contraction (due to hemorrhage or other fluid loss) is a principal prerenal cause of decreased renal blood flow. Trauma to the kidneys can happen in the glomerular or tubular regions and may be due to hypoxia, drugs, or other reasons. Postrenal causes are attributable to downstream obstruction occurring in the ureter, bladder or urethra. About 1% of hospitalized patients undergoing general surgery will develop AKI [4]. Several conditions, the most important ones in the USA being diabetes and hypertension, are associated with or cause chronic kidney disease. The incidence of CKD is rapidly rising in the above 65-year-old age group, at least partially owing to the increase in the metabolic syndrome. The worldwide prevalence of CKD is a little over 10% [5]. Some hereditary conditions will result in CKD. Variants of proteins (such as apolipoprotein L1) and several polymorphisms have been found associated with increased incidence of CKD [6].

Patients with acute kidney injury complain of nausea and vomiting; they may be confused or have seizures in advanced stages. Oliguria is characteristic but not always present. Water and electrolyte level disturbances lead to fluid buildup. Dyspnea may result from fluid accumulation in the lungs, and chest pain may be present in cases of uremic pericarditis. The symptoms of the chronic disease are not unlike those occurring in AKI but develop more slowly. In the chronic disease (CKD), five stages are distinguished according to glomerular filtration rates (GFR), but in the initial stages, the GFR may be within normal limits. In the latter case, other markers (albuminuria, electrolyte disturbances) may be useful for classification. Symptoms are often lacking at the start of the disease (stages 1-3), but weight loss, tiredness, nocturia, and pruritus for extended times (months) may indicate CKD. In stage 4, when the GFR is less than a third of normal, signs of diminished kidney function are observed: hyperkalemia, hyperphosphatemia, peripheral and pulmonary edema indicate impaired electrolyte balance; anemia implies a decline in erythropoietin production; bone disease may, at least in part, be a consequence of hyperphosphatemia and acidosis; anorexia, nausea, encephalopathy, neuropathy, and seizures point to uremia. Other manifestations include cardiac and gastrointestinal problems.

• Fatigue

  We presented a case of biclonal gammopathy-as-sociated manifestation of IgD myeloma and light chain disease in a patient who initially had renal failure. 37-year-old male approximately one month before hospitalization began to feel malaise and fatigue [ncbi.nlm.nih.gov]

  General symptoms of CKD include: Fatigue, weakness, lack of energy and pale skin due to anemia Loss of appetite, nausea, and vomiting Frequent urination, especially at night Fluid retention, swelling around legs and eyes Itching Headaches Numbness in [kibowbiotech.com]

  Fatigue When kidneys fail, and side effects like anemia set in, you may experience tired muscles, weakness, and overall fatigue. [nationalkidneycenter.org]

  These include fatigue, drowsiness, decrease in urination or inability to urinate, dry skin, itchy skin, headache, weight loss, nausea, bone pain, skin and nail changes and easy bruising. [hopkinsmedicine.org]

  Some patients with kidney failure or nephrotic disease suffer from bone pain, fatigue caused by anemia, shortness of breath, trouble with exertion, or swelling of the knees or feet. [disabilitysecrets.com]

• Inflammation

  Our aim was to assess the impact of parameters that show dialysis adequacy on indices of nutrition or inflammation. [ncbi.nlm.nih.gov]

  […] of blood vessels lupus, an autoimmune disease that can cause inflammation of many body organs glomerulonephritis, an inflammation of the small blood vessels of the kidneys hemolytic uremic syndrome, which involves the breakdown of red blood cells following [healthline.com]

  A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. Renal ultrasound (also called sonography). [stanfordchildrens.org]

• Weight Gain

  Puffiness (oedema), particularly in the feet and legs, swelling of the abdomen and often weight gain, caused by the kidneys not removing excess fluid from the body. [gosh.nhs.uk]

  Physical activity can help lower blood pressure, control diabetes, and prevent weight gain. Ask your health care provider about physical activities that would be right for you. Avoid certain drugs and supplements. [choosingwiselycanada.org]

  For those taking prednisone for long periods of time, these effects can be significant, including weight gain (especially around the face and trunk), moodiness, sleep disturbances, cataracts, and osteoporosis (weakening of the bones). [kidshealth.org]

• Amyloidosis

  One type of kidney problem found in people with longstanding RA is amyloidosis. [arthritis.org]

  "Amyloidosis and Kidney Disease." Updated: Sep 2014. [rxlist.com]

  "Amyloidosis and Kidney Disease." Updated: Sep 2014. CONTINUE SCROLLING FOR RELATED SLIDESHOW [medicinenet.com]

• Recurrent Urinary Tract Infection

  […] abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache Stunted growth Malaise High urine output or no urine output Recurrent urinary tract infections Urinary incontinence Pale [stanfordchildrens.org]

• Easy Bruising

  These include fatigue, drowsiness, decrease in urination or inability to urinate, dry skin, itchy skin, headache, weight loss, nausea, bone pain, skin and nail changes and easy bruising. [hopkinsmedicine.org]

  bruising, bleeding and poor blood clotting Bone pain and fractures Decreased sexual interest and erectile dysfunction Change in energy level or strength Lightheadedness High blood pressure – (although high blood pressure is a sign and not a symptom, [kibowbiotech.com]

  bruising, and pale skin (from anemia); ... [emedicinehealth.com]

• Pleural Effusion

  Shortness of breath from fluid buildup in the space between the lungs and the chest wall (pleural effusion). What testing is common during end-stage kidney failure? Your doctor will do regular blood tests to check on how you're doing. [northshore.org]

  Additionally, medical evidence should describe any instances of ascites, pericardial effusion, or pleural effusion. Finally, the records must include serum albumin and proteinuria levels. [disabilitysecrets.com]

• Nausea

  Conversely, sonograms displaying small kidneys, chronic manifestations such as anemia, fatigue, nausea, and pruritus, and decreased estimated GFR indicate CKD. The tests can also show the source of the damage. [symptoma.com]

  Reduced kidney function is another common symptom of multiple myeloma that results in a several different symptoms which include increased or decreased urination, increased thirst, nausea, vomiting, confusion or restlessness. [themmrf.org]

  Other symptoms of acute tubular necrosis include tiredness, swelling, lethargy, nausea, vomiting, abdominal pain, kidney pain, loss of appetite, and rash. Sometimes there are no symptoms. [emedicinehealth.com]

  General symptoms of CKD include: Fatigue, weakness, lack of energy and pale skin due to anemia Loss of appetite, nausea, and vomiting Frequent urination, especially at night Fluid retention, swelling around legs and eyes Itching Headaches Numbness in [kibowbiotech.com]

• Vascular Disease

  […] due to more severe diabetic vascular disease in patients with diabetic kidney disease. [circ.ahajournals.org]

  CHRONIC KIDNEY DISEASE (CKD) Dementia Predicts CKD Progression, Death in Type 2 Diabetes In type 2 diabetes patients, a dementia diagnosis preceded vascular events such as kidney disease progression by a mean 2998 days or roughly 8 years. [renalandurologynews.com]

  Cardiovascular ailments from congestive heart failure and coronary artery disease to pericarditis and occlusive vascular disease. [kibowbiotech.com]

  During the progression of kidney disease, renal function becomes less and less efficient. This can often lead to renal vascular disease – a condition that narrows the blood vessels carrying blood to the kidneys. [kidneyresearchuk.org]

  Earlier and late referred patient groups had similar prevalence of diabetes; Ischaemic heart disease, peripheral vascular disease, chronic heart failure, chronic obstructive pulmonary disease and cerebrovascular disease compared to late referral groups [doi.org]

• Tachycardia

  Thrombose Hartritmestoornissen Palpitation Hartritmestoornissen Syncope Bradycardie Hartfalen Ritmestoornissen Behandelmogelijkheden Coronaire hartziekte Hartaanval Perifere arteriële aandoening (PAD) Cardiac Arrhythmia Bradycardie Hartkloppingen behandelen Tachycardia [biotronik.com]

  Generalized swelling ( edema ) Generalized weakness due to anemia Loss of appetite Lethargy Fatigue Congestive heart failure Metabolic acidosis High blood potassium ( hyperkalemia ) Fatal heart rhythm disturbances (arrhythmias) including ventricular tachycardia [rxlist.com]

• Hypotension

  […] clinical picture of multiple organ failure: in case, unfortunately, probability of surviving is still dramatically low: a correct dialysis prescription and delivery, avoidance of dialysis underdosing and prevention of harmful complications (such as hypotension [doi.org]

  LVH by ECG HF, hypotension, IHD Stress imaging is an important modality for testing for myocardial ischemia. [circ.ahajournals.org]

• Osteoporosis

  Of all the possible side effects of these drugs, the most concerning isn't kidney failure, it's osteoporosis, Clarke, who wasn't involved in the study, said by email. [nydailynews.com]

  […] home Salt and blood pressure Animal studies Epidemiological studies Intervention studies Population studies Mortality studies Treatment trials Salt and health factsheets Blood pressure Stroke and heart disease Kidney disease and kidney stones Obesity Osteoporosis [worldactiononsalt.com]

  While you wait for a kidney, you may face other health challenges from kidney disease, such as sleep problems, osteoporosis or heart disease. [loyolamedicine.org]

  For those taking prednisone for long periods of time, these effects can be significant, including weight gain (especially around the face and trunk), moodiness, sleep disturbances, cataracts, and osteoporosis (weakening of the bones). [kidshealth.org]

• Restless Legs Syndrome

  Neurologic ailments ranging from encephalopathy with dizziness and mental change to peripheral neuropathies (restless leg or burning feet syndromes) and muscle weakness. [kibowbiotech.com]

  Walking and strength training make bones stronger and stimulate muscles and nerves that can help ease "restless leg syndrome" and other nervous system problems sometimes associated with kidney disease. [kidshealth.org]

  On the other hand, there are some reports that suggest home hemodialysis in “short daily” or “nocturnal” schedules may mean less medications for complications of dialysis, improvements in neuropathy and restless leg syndrome, more energy, better sleep [draxe.com]

• Fear

  I was inexperienced, naïve, and out of fear of not being accepted began to produce sides of myself for the world that weren’t me. [climbing.com]

• Kidney Failure

  This study validates a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation. [ncbi.nlm.nih.gov]

  نحن نعالج الترجمة Kidney failure, also known as end-stage kidney disease, is the condition in which a person’s kidneys have stopped working. It’s divided into 2 types: acute kidney failure and chronic kidney failure. [bumrungrad.com]

• Uremia

  Urophanic substances are not eliminated sufficiently from the blood anymore - this results in pre-uremia. Creatinine values lie between 6-12 mg/dl. [flexikon.doccheck.com]

  This review considers the pathogenesis and course of uremia. Funding and Disclosures Supported by grants from the National Institutes of Health (R33 DK71251, to Dr. Meyer, and R21 DK077326, to Dr. Hostetter). [doi.org]

  No studies have examined whether this is related to impaired cardiovascular compliance as a consequence of loss of adaptive structural alterations, resulting from chronic uremia or hypertension. STUDY DESIGN: Prospective matched-cohort study. [ncbi.nlm.nih.gov]

  Use of the term uremia [ edit ] Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urea. [en.wikipedia.org]

• Oliguria

  Sudden and sustained deterioration of the kidney function characterized by decreased glomerular filtration rate, increased serum creatinine or oliguria. [icd9data.com]

  Early identification of potentially reversible causes of acute oliguria and institution of appropriate therapy are crucial, since the therapeutic window is often small. 1 Oliguria can have many causes. [doi.org]

  Observations that indicate AKI are daily increases in creatinine or BUN concentrations, oliguria, and relatively large kidneys detected on sonograms. [symptoma.com]

  A 10-year-old boy with congestive heart failure (CHF) complicated by advanced chronic kidney disease (CKD) presented with oliguria and generalized edema. [ncbi.nlm.nih.gov]

• Renal Injury

  What is renal failure? Renal failure occurs due to damage to the functions of the kidneys that lead to failure of the normal filtration process. This could be sudden or rapid in onset in case of acute renal injury or damage or acute renal failure. [news-medical.net]

  "I would not restrict proton pump inhibitors based on this study alone; the overall risk of (kidney failure) in the study population was still quite low and the association with proton pump inhibitors and renal injury is still only an association," said [nydailynews.com]

  A risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery. J Crit Care 2012 Apr 3. [doi.org]

• Sexual Dysfunction

  Gastrointestinal upset (nausea, vomiting, constipation or diarrhea) and at times GI bleeding Endocrine disturbance from sexual dysfunction to menstrual disturbances and thyroid dysfunction Bone disease or renal osteodystrophy Skin disorders with uremic [kibowbiotech.com]

  dysfunction Shortness of breath Skin has turned darker or lighter Swelling in the hands and feet Vomiting (often in the morning) Symptoms of acute kidney failure: Bad breath Bloody stools Changes in urination (little or no urination, frequent bathroom [loyolamedicine.org]

• Confusion

  Hypothyroidism is more prevalent in the elderly and its symptoms can be confused with other changes due to aging. Doctors caring for the elderly need to be attentive to this diagnostic possibility. [ncbi.nlm.nih.gov]

  Reduced kidney function is another common symptom of multiple myeloma that results in a several different symptoms which include increased or decreased urination, increased thirst, nausea, vomiting, confusion or restlessness. [themmrf.org]

  Making more or less urine than usual Blood in the urine (typically only seen through a microscope) Urine that is foamy or bubbly (may be seen when protein is in the urine) Kidney failure symptoms from anemia Fatigue Shortness of breath Weakness Mental confusion [davita.com]

  Symptoms can include urinating at night, fatigue, nausea, itching, muscle twitching and cramps, loss of sensation, confusion, difficulty breathing, and yellow-brown skin. Diagnosis is by blood and urine tests. [merckmanuals.com]

  Patients with acute kidney injury complain of nausea and vomiting; they may be confused or have seizures in advanced stages. Oliguria is characteristic but not always present. Water and electrolyte level disturbances lead to fluid buildup. [symptoma.com]

• Headache

  These include fatigue, drowsiness, decrease in urination or inability to urinate, dry skin, itchy skin, headache, weight loss, nausea, bone pain, skin and nail changes and easy bruising. [hopkinsmedicine.org]

  These include: Pruritus Uremic fetor Anemia due to erythropoietin deficiency Renal osteopathy with bone pain Polyneuropathy with somnolence, paresthesia and paralysis Hormonal disorders Edemas of the eyelids and on the lower legs Headaches, tiredness, [flexikon.doccheck.com]

  General symptoms of CKD include: Fatigue, weakness, lack of energy and pale skin due to anemia Loss of appetite, nausea, and vomiting Frequent urination, especially at night Fluid retention, swelling around legs and eyes Itching Headaches Numbness in [kibowbiotech.com]

  […] infection Pale skin History of taking certain medications History of trauma Swelling of the tissues Inflammation of the eye Detectable abdominal mass Exposure to heavy metals or toxic solvents Chronic symptoms may include: Poor appetite Vomiting Bone pain Headache [stanfordchildrens.org]

• Altered Mental Status

  mental status Restless legs syndrome Chest pain due to inflammation around the heart Shortness of breath from fluid in the lungs Easy bruising, bleeding and poor blood clotting Bone pain and fractures Decreased sexual interest and erectile dysfunction [kibowbiotech.com]

A careful history is essential for the identification of the underlying disease. For the diagnosis of AKI, it is vital to review drug use and exposure to possible nephrotoxic substances (diagnostic contrast material), as well as events leading to loss of fluids. The most important elements of workup are serum (electrolytes, blood urea nitrogen, i.e., BUN, creatinine, and phosphate) and urine analysis, complete blood count, imaging, and renal biopsy.

When suspicion of impaired kidney function arises, often because of an incidental finding of high serum creatinine, the chronic or acute nature of the condition needs to be clarified. Observations that indicate AKI are daily increases in creatinine or BUN concentrations, oliguria, and relatively large kidneys detected on sonograms. Conversely, sonograms displaying small kidneys, chronic manifestations such as anemia, fatigue, nausea, and pruritus, and decreased estimated GFR indicate CKD. The tests can also show the source of the damage. A very high BUN to creatinine ratio suggests prerenal causes of AKI. If the urine does not become concentrated in the presence of volume contraction (indicated by oliguria), it points to an intrinsic kidney defect in AKI. Misshapen red blood cells in the urine point to glomerular injury (glomerulonephritis), whereas urine sediment that contains tubular cells reveals tubular damage. Ultrasonography helps in identifying obstructive pathologies. Additional tests may be carried out for specific diseases that are frequently associated with or known to cause kidney failure. The furosemide stress test, if it demonstrates the inability of the kidney to respond to the diuretic, can predict the progression of the acute disease [7].

New biomarkers for kidney function are being sought and found: cystatin C may have a role as a marker for glomerular filtration, and urinary neutrophil gelatinase-associated lipocalin as a predictor of AKI progression [8]. Ultrasonography can be used to determine the size of the kidney, to detect renal disease, and to locate the sites of obstruction. Renal biopsy may be performed in some cases.

• Hyponatremia

  Patients with hypervolemic hyponatremia and kidney failure pose a special therapeutic challenge. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Shortness of breath from fluid buildup in the space between the lungs and the chest wall (pleural effusion). What testing is common during end-stage kidney failure? Your doctor will do regular blood tests to check on how you're doing. [northshore.org]

  Additionally, medical evidence should describe any instances of ascites, pericardial effusion, or pleural effusion. Finally, the records must include serum albumin and proteinuria levels. [disabilitysecrets.com]

[…] and reduced treatment burden. [ncbi.nlm.nih.gov]

In addition, renal prognosis may be good despite highly advanced tubulointerstitial nephritis and fibrosis. [ncbi.nlm.nih.gov]

The main etiological agents of this condition are primary hyperparathyroidism, renal tubular acidosis, medullary sponge kidney, hyperoxaluria and taking certain drugs. [ncbi.nlm.nih.gov]

For subgroup analysis based on etiology for CKD, we grouped all studies done exclusively on type 2 diabetic patients together. [doi.org]

[…] nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies [en.wikipedia.org]

Author information 1 Departments of Epidemiology and [email protected] 2 Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland. 3 Divisions of Oncology. 4 Biostatistics and Bioinformatics. 5 Biostatistics, Johns Hopkins Bloomberg [ncbi.nlm.nih.gov]

Author Affiliations From the Welch Center for Prevention, Epidemiology, and Clinical Research (T.V.P., P.K.W., M.J.K.) and the Departments of Epidemiology (T.V.P., P.K.W., M.J.K.), Health Policy and Management (M.J.K.), and Medicine (P.K.W., M.J.K.), [doi.org]

[…] including: (1) genetics of CKD; (2) natural history of CKD and transition to renal failure; (3) screening for CKD in the general population; (4) optimal treatment to prevent progression; (5) optimal regime once renal replacement therapy is required; and (6) epidemiology [hopkinsmedicine.org]

This is indicated for example in patients on dialysis. 5 Pathophysiology In advanced renal failure, the kidneys don’t synthesize enough erythropoietin, which subsequently leads to renal anemia. [flexikon.doccheck.com]

However, some aspects of the pathophysiology are similar in acute kidney injury (AKI) and chronic kidney disease (CKD). [symptoma.com]

Overview: renal physiology and pathophysiology of aging. Am J Kidney Dis 1990;16:275-82. [Pubmed] [34] Pisoni R, Remuzzi G. How much must blood pressure be reduced in order to obtain the remission of chronic renal disease? J Nephrol 2000;13:228-31. [revistanefrologia.com]

Definition and diagnosis Apart from any pathophysiologic consideration, during AKI sudden reduction in renal function occurs: consequently, creatinine and urea accumulate. Commonly, but not necessarily, urine production is also reduced. [doi.org]

Chronic kidney disease (CKD) is a bodily risk factor for cardiovascular disease that is also reversible or preventable in their early stages, but may require more medical treatment. [netdoctor.co.uk]

Treating the condition that is causing the problem may help prevent or delay CKD. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke. [nlm.nih.gov]

Patients with kidney failure receiving hemodialysis need a renewed focus on self-care, prevention, and community-based health management to reduce healthcare costs and complications, and improve outcomes and quality of life, while living with an altered [ncbi.nlm.nih.gov]

Preventing and treating illnesses that can lead to acute kidney failure is the best method for avoiding the disease. [healthline.com]

1. Schnaper HW. Remnant nephron physiology and the progression of chronic kidney disease. Pediatr Nephrol. 2014;29(2):193-202.
2. Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011;6(11):2567-2572.
3. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and the Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-212.
4. Kheterpal S, Tremper KK, Heung M, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009;110(3):505-515.
5. Hill NR, Fatoba ST, Oke JL, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016;11(7):e0158765.
6. Friedman DJ, Kozlitina J, Genovese G, Jog P, Pollak MR. Population-Based Risk Assessment of APOL1 on Renal Disease. J Am Soc Nephrol. 2011;22(11):2098-2105.
7. Koyner JL, Davison DL, Brasha-Mitchell E, et al. Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity. J Am Soc Nephrol. 2015;26(8):2023-2031.
8. Tuladhar SM, Püntmann VO, Soni M, Punjabi PP, Bogle RG. Rapid detection of acute kidney injury by plasma and urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass. J Cardiovasc Pharmacol. 2009;53(3):261-266.