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Kidney Failure

Kidney failure may be due to acute injury or may develop as a result of slow progression. Chronic kidney disease occurs most frequently in those older than 65 years, often caused by diabetes and hypertension. Treatment of both acute and chronic conditions requires addressing the underlying condition, and carefully managing the water and electrolyte balance and other conditions resulting from the declining kidney function. Dialysis and kidney transplantation may be necessary.


Presentation

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.

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]
Renal Artery Stenosis
  • Cause and Diagnosis of Renal Artery Stenosis There are two main causes of renal artery stenosis.[vascularcures.org]
  • Narrowing of the artery taking blood to the kidney (renal artery stenosis) Polycystic kidney disease. Find out more about polycystic kidney disease . Blockages to the flow of urine, and repeated kidney infections.[patient.info]
  • Narrowing of the artery taking blood to the kidney (renal artery stenosis) Polycystic kidney disease. Find out more about polycystic kidney disease. Blockages to the flow of urine, and repeated kidney infections.[patient.info]
Hypertension
  • PREDICTOR: CKF versus essential hypertension without cardiovascular disease.[ncbi.nlm.nih.gov]
  • PREDICTOR: Clinically documented primary indication for dialysis therapy initiation, as categorized into 4 groups: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload or hypertension, and other/unknown[ncbi.nlm.nih.gov]
  • We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'.[ncbi.nlm.nih.gov]
  • This case report describes acute kidney failure probably due to intra-abdominal hypertension following an unknown bite.[ncbi.nlm.nih.gov]
  • Renal vasoconstriction in HRS is due to severe vasodilation of the splanchnic arteries associated with portal hypertension, leading to a decrease in effective arterial blood volume and arterial pressure.[ncbi.nlm.nih.gov]
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]
  • OUTCOMES: Incident CVD events, kidney failure, all-cause mortality, a composite of CVD events or mortality, and a composite of kidney failure or mortality.[ncbi.nlm.nih.gov]
  • […] of kidney failure is as likely due to chance as to causal association.[ncbi.nlm.nih.gov]
  • KEYWORDS: Basiliximab; Kidney failure; Lung transplantation[ncbi.nlm.nih.gov]
  • Kidney failure occurred in 16.1% of cases.[ncbi.nlm.nih.gov]

Workup

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.

Nephrolithiasis
  • The diagnosis of PH1 must be considered in the differential diagnosis of patients presenting with ESRD with a history of recurrent nephrolithiasis.[ncbi.nlm.nih.gov]

Treatment

  • […] and reduced treatment burden.[ncbi.nlm.nih.gov]
  • All three patients improved after starting etanercept treatment and their steroid requirements were decreased.[ncbi.nlm.nih.gov]
  • A liver transplant is the preferred treatment for HRS. Pharmacologic treatment with vasoconstrictors to reverse splanchnic vasodilation, together with albumin, is effective in 40%-50% of patients with type 1 HRS and improves survival.[ncbi.nlm.nih.gov]
  • The recovery of renal function in these patients suggests therapy with warfarin may play a role in the treatment of scleroderma renal failure.[ncbi.nlm.nih.gov]
  • Its treatment can stabilize the clinical condition, or possibly improve it.[ncbi.nlm.nih.gov]

Prognosis

  • In addition, renal prognosis may be good despite highly advanced tubulointerstitial nephritis and fibrosis.[ncbi.nlm.nih.gov]
  • Prognosis was excellent due to an early diagnosis leading to cessation of the causative agents. Levetiracetam was started with a good response.[ncbi.nlm.nih.gov]
  • For patients with a poor prognosis, such treatment may not result in significantly different survival or quality of life when compared with dialysis.[ncbi.nlm.nih.gov]
  • STUDY SELECTION: Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease. DATA EXTRACTION AND SYNTHESIS: Data were obtained and statistical analyses were performed between July 2012 and June 2015.[ncbi.nlm.nih.gov]
  • To improve prediction of renal prognosis for advanced diabetic nephropathy may require different approaches with combining clinical and pathological parameters that were not measured in the KFRE and the RPS DN Classification.[ncbi.nlm.nih.gov]

Etiology

  • 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]
  • This case report case is notable not only because it presents a rare complication of hypothyroidism (kidney failure), but also because patients with chronic kidney failure of any etiology may suffer increased renal dysfunction as a result.[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]
  • These included HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies (Bostrom and Freedman 2010 ).[doi.org]
  • The government has even come up with a name for it: CKDu, chronic kidney disease of unknown etiology. Since 2009, the health ministry and WHO have embarked on the world’s largest and most comprehensive study of CKDu.[publicintegrity.org]

Epidemiology

  • Author information 1 Departments of Epidemiology and atin1@jhu.edu. 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]
  • .), the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.E.G., Y.S., K.M., S.B., J.C.), and the Departments of Surgery and Epidemiology, Johns Hopkins University (E.K.H.C., D.L.S.) - all in Baltimore; the Division of Nephrology[ncbi.nlm.nih.gov]
  • . 10 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand. 11 Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden. 12 Departments of Medicine and Epidemiology[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]
  • Furthermore, after years without a common renal failure definition with scientific literature providing dissimilar epidemiological studies, RIFLE and AKIN finally created a common epidemiological framework of reference.[doi.org]
Sex distribution
Age distribution

Pathophysiology

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

Prevention

  • 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]
  • 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]
  • These results suggest GSTM1 function is a potential treatment target for the prevention of kidney and heart failure. Copyright 2017 by the American Society of Nephrology.[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]
  • CONCLUSIONS: Receiving RAAS blockade for 1 year or longer could prevent both CKD progression to ESRD and premature mortality.[ncbi.nlm.nih.gov]

References

Article

  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.

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Last updated: 2019-07-11 22:01