Renal failure is a growing health problem that affects millions of people worldwide. It not only causes serious damage to kidney function but can also be life-threatening if not diagnosed and treated promptly.
With the increase in risk factors such as diabetes and hypertension, the incidence of chronic kidney disease is increasing, creating a heavy burden on the health system. Care and prevention of renal failure is a vital factor in protecting public health.
Renal failure can lead to dangerous levels of waste in the body.
Types of Renal Failure
Renal failure is a serious disorder in which the kidneys' blood-filtering function is severely impaired, leading to the accumulation of toxins and homeostasis. There are two main types of renal failure, each with its own pathogenesis, progression, and specific treatment strategies.
Acute Kidney Injury (AKI)
Acute renal failure occurs suddenly, usually within hours to days, causing the kidneys to lose their ability to maintain fluid and electrolyte balance. Causes can include reduced renal perfusion (due to shock, dehydration), direct injury (drug toxicity, acute glomerulonephritis), or urinary tract obstruction (kidney stones, tumors). If treated promptly, kidney function can be completely or almost completely restored.
Chronic Kidney Disease (CKD)
In contrast to the acute course, chronic renal failure progresses silently over many years. The disease begins with long-term kidney damage due to diabetes, hypertension, or autoimmune disease. The early stages may be asymptomatic, but when the loss of function exceeds the compensation threshold, the patient may have edema, anemia, and bone metabolism disorders. When the disease progresses to the end stage, kidney transplantation or dialysis is the only option.
Causes and Risk Factors for Renal Failure
Renal failure is the result of many complex pathological mechanisms, where the kidney's blood filtration function is impaired due to acute injury or chronic degeneration. The impact of risk factors on the glomerular, renal tubular and renal vascular systems can lead to homeostasis, toxic accumulation and eventually irreversible functional failure.
Causes of Renal Failure
- Renal hypoperfusion: Prolonged hypotension, septic shock, severe bleeding or heart failure causes tissue hypoxia, leading to kidney cell death.
- Structural damage to the kidney: Acute glomerulonephritis, kidney infection, drug poisoning (NSAIDs, aminoglycoside antibiotics), or exposure to heavy metals destroys the functional unit.
- Urinary tract obstruction: Large kidney stones, tumors compressing the ureter or prostate enlargement causing hydronephrosis, increasing intramedullary pressure, leading to parenchymal damage.
Risk Factors
- Underlying diseases: Diabetes, hypertension, lupus erythematosus damage the renal microvasculature.
- Age: Aging reduces the ability to compensate, making the kidneys more vulnerable to external agents.
- Lifestyle: A diet high in salt, smoking, and alcohol abuse create a metabolic burden on the kidneys, accelerating the deterioration process.
Symptoms of Renal Failure
Renal failure, whether acute or chronic, leads to serious disorders in the mechanism of blood filtration, detoxification and maintenance of homeostasis. Clinical manifestations of the disease depend not only on the underlying cause but also on the rate of progression, the extent of damage and the body's ability to adapt.
Early Symptoms
- Fatigue and weakness: The accumulation of blood urea and metabolic disorders cause a state of prolonged weakness.
- Reduced urine output: A manifestation of acute renal failure when the filtration function suddenly decreases, or the progressive stage of chronic renal failure.
- Edema: The decrease in the ability to excrete sodium and water causes the patient to have swelling of the legs, face or whole body.
Progressive Symptoms
- Digestive disorders: Vomiting, nausea, loss of appetite due to high blood urea levels irritating the stomach lining.
- Hypertension: Renin-angiotensin system disorders cause vasoconstriction, increasing intravascular pressure.
- Dyspnea: Fluid accumulation in the lungs or metabolic acidosis causes the patient to breathe rapidly.
End-Stage Symptoms
- Confusion, seizures: Severe electrolyte disturbances, especially hyperkalemia and metabolic acidosis.
- Dark gray skin, severe itching: Due to phosphate and urea deposition, stimulating sensory nerve endings.
- Ammonia-smelling breath: A sign of severe uremia when the body tries to eliminate it through the respiratory tract.
Diagnosis of Renal Failure
Diagnosis of renal failure requires a combination of clinical assessment, paraclinical tests and imaging methods to determine the extent of kidney damage, differentiate between acute and chronic renal failure, and find the underlying cause. The right approach from the beginning helps prevent disease progression and minimize dangerous complications.
Blood Test
- Serum creatinine and glomerular filtration rate (GFR): Elevated creatinine reflects impaired filtration function, decreased GFR helps classify the degree of kidney failure.
- BUN (Blood Urea Nitrogen): Blood urea index increases in renal failure, especially when there is a protein metabolism disorder.
- Electrolyte chart: Hyperkalemia, metabolic acidosis and hyponatremia are common signs.
Urine Test
- Proteinuria: High protein excretion warns of severe glomerular damage.
- Urine sediment: Red blood cells, white blood cells, and urinary casts are present, specific to each kidney disease.
- Urine specific gravity: Helps distinguish between functional and structural kidney damage.
Imaging Diagnosis
- Renal ultrasound: Assesses the size, thickness of the renal cortex, signs of obstruction or chronic damage.
- CT or MRI scan: Determines anatomical abnormalities, kidney stones, or compressing tumors.
- Renal biopsy: Indicated when histological analysis is needed to accurately diagnose the cause.
Stages of Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD) is an irreversible, progressive process in which kidney function gradually declines over time, leading to serious metabolic, endocrine, and hemodynamic abnormalities. The National Kidney Foundation (NKF) classifies CKD into five stages based on glomerular filtration rate (GFR), which helps guide treatment and prognosis.
Stage 1: Mild Kidney Damage (GFR ≥ 90 mL/min/1.73m²)
Kidney function is preserved but there is potential damage, manifested by proteinuria or structural kidney abnormalities. Patients are often asymptomatic, making detection primarily based on screening tests.
Stage 2: Mild Renal Impairment (GFR 60-89 mL/min/1.73m²)
Although GFR begins to decline, the body is still able to compensate. Some patients may experience mild fatigue, hypertension, or mild changes in urine analysis.
Stage 3: Moderate Impairment (GFR 30-59 mL/min/1.73m²)
The kidneys gradually lose their ability to maintain homeostasis, leading to anemia, hypertension, and calcium-phosphate metabolism disorders. Edema, nocturia, and fatigue become more evident.
Stage 4: Severe Impairment (GFR 15-29 mL/min/1.73m²)
Metabolic acidosis, hyperkalemia, and osteoporosis progress rapidly. Severe uremic symptoms such as nausea, itching, and ammonia-smelling breath appear, signaling the risk of end-stage renal failure.
Stage 5: End-Stage Renal Disease (GFR < 15 mL/min/1.73m²)
Kidney function is impaired, and the patient needs dialysis or a kidney transplant to maintain life. If left untreated, serious complications such as acute pulmonary edema, central nervous system dysfunction, and cardiac arrest can occur.
Treatment Options for Renal Failure
Renal failure, whether acute or chronic, requires a comprehensive treatment strategy to control the underlying cause, preserve remaining renal function, and prevent complications. Treatment regimens are individualized based on the degree of renal impairment, comorbidities, and patient response.
1. Conservative Treatment: Control of Underlying Diseases and Lifestyle Changes
- Control blood pressure: Use ACE inhibitors, angiotensin receptor blockers (ARBs) to reduce glomerular pressure.
- Glycemic management: Use insulin therapy or SGLT2i hypoglycemic drugs to slow the progression of renal failure.
- Diet: Reduce salt, protein, phosphorus, and potassium to reduce glomerular filtration load and prevent complications of electrolyte disturbances.
2. Blood Filtration: Removes Toxins When the Kidneys Lose Function
- Hemodialysis: Using a blood filtering machine outside the body to replace the impaired kidney function.
- Peritoneal Dialysis: Using the peritoneum as a natural filter, applied to patients who can take care of themselves at home.
3. Kidney Transplant: The Ideal Solution for End-Stage Renal Disease
A kidney transplant from a living or brain-dead donor helps patients escape dependence on dialysis.
Post-transplant immunosuppressive therapy to prevent rejection and maintain the function of the newly transplanted kidney.
The choice of treatment depends on the specific condition of each patient, with the goal of optimizing quality of life and prolonging life.
Preventing and Maintaining Kidney Health
Preventing kidney failure is a long-term strategy that requires a combination of healthy lifestyle habits, risk factor control, and proactive medical measures. Although chronic kidney disease can progress silently, maintaining kidney health early can help reduce the risk of serious illness and improve quality of life.
1. Managing Underlying Conditions
- Controlling blood pressure: High blood pressure is a major risk factor for kidney damage. Keeping blood pressure below 140/90 mmHg with appropriate medication can effectively protect the kidneys.
- Controlling blood sugar: For diabetics, maintaining stable blood sugar levels with a reasonable diet and hypoglycemic medications can help prevent kidney damage caused by prolonged high glucose.
2. Diet and Lifestyle
- Healthy eating: A diet low in salt, low in animal protein, and high in green vegetables and fruits helps reduce the burden on the kidneys and supports metabolic function.
- Drink enough water: Make sure you drink enough water to help your kidneys maintain their ability to filter and remove toxins effectively.
- Avoid drugs and toxins: Limit the use of nephrotoxic drugs, such as non-prescription pain relievers (NSAIDs), and avoid exposure to toxic chemicals.
3. Regular Health Check-ups
- Regular kidney tests: For people at high risk, such as diabetics and those with high blood pressure, tests such as creatinine, GFR, and proteinuria should be performed periodically to detect kidney damage early.
By maintaining these precautions, each person can protect their kidney health and minimize the risk of serious kidney failure in the future.
Conclusion
Renal failure, whether acute or chronic, is a serious condition with far-reaching effects on overall health. Early diagnosis and timely treatment are crucial in preventing irreversible kidney damage.
With modern treatment options such as dialysis and kidney transplantation, patients can improve their quality of life and prolong their life. However, prevention is still the key.
Proactively controlling risk factors, maintaining a healthy lifestyle, and performing regular tests will help protect kidney health effectively, preventing kidney failure before it is too late.
Frequently Asked Questions (FAQs)
- Can acute renal failure be reversed?
Acute renal failure can be reversed if detected and treated promptly. This depends on the cause and the extent of kidney damage. Proper treatment can restore kidney function. - Can chronic kidney disease be cured?
Chronic kidney disease cannot be cured, but it can be controlled to slow its progression. Treatment focuses on controlling underlying diseases and maintaining stable kidney function. - Does hemodialysis harm the body?
Hemodialysis helps sustain the life of patients with end-stage renal failure. Although there are some side effects, the benefits of maintaining body function far outweigh the risks. - How can kidney failure be prevented?
Prevention of kidney failure focuses on controlling blood pressure, maintaining stable blood sugar levels, limiting risk factors such as drugs that are harmful to the kidneys, and following a healthy diet. - When is a kidney transplant needed?
A kidney transplant is indicated when the kidneys are no longer able to function and the patient must depend on long-term dialysis. Kidney transplantation offers the opportunity to restore quality of life for patients with end-stage kidney disease.
