Renal failure 1

Renal failure

Renal failureClassification and external resources

ICD-10 N17 [1]-N19 [2]

ICD-9 584 [3]-585 [4]

DiseasesDB 26060 [5]

MeSH C12.777.419.780.500 [6]

A hemodialysis machine, used to physiologicallyaid or replace the kidneys in renal failure

Renal failure (also kidney failure or renal insufficiency) is a medicalcondition in which the kidneys fail to adequately filter waste productsfrom the blood. The two main forms are acute kidney injury, which isoften reversible with adequate treatment, and chronic kidney disease,which is often not reversible. In both cases, there is usually anunderlying cause.

Renal failure is mainly determined by a decrease in glomerularfiltration rate, the rate at which blood is filtered in the glomeruli of thekidney. This is detected by a decrease in or absence of urine productionor determination of waste products (creatinine or urea) in the blood.Depending on the cause, hematuria (blood loss in the urine) andproteinuria (protein loss in the urine) may be noted.

In renal failure, there may be problems with increased fluid in the body(leading to swelling), increased acid levels, raised levels of potassium,decreased levels of calcium, increased levels of phosphate, and in laterstages anemia. Bone health may also be affected. Long-term kidneyproblems are associated with an increased risk of cardiovasculardisease.

Classification

Can be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure isdetermined by the trend in the serum creatinine. Other factors that may help differentiate acute kidney injury fromchronic kidney disease include anemia and the kidney size on ultrasound. Chronic kidney disease generally leads toanemia and small kidney size.

Acute kidney injuryAcute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renalfunction, generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day inadults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKIcan result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. The underlying causemust be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap requiredfor treating these fundamental causes.

Renal failure 2

Chronic kidney diseaseChronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms. CKD can be the longterm consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic renal failureAcute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic renalfailure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return thepatient to baseline renal function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult todistinguish from chronic kidney disease if the patient has not been monitored by a physician and no baseline (i.e.,past) blood work is available for comparison.

Signs and symptomsSymptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or noticesymptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, acondition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the diseaseprogresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Renal failureaccompanied by noticeable symptoms is termed uraemia.Symptoms of kidney failure include:•• High levels of urea in the blood, which can result in:

• Vomiting and/or diarrhea, which may lead to dehydration•• Nausea•• Weight loss•• Nocturnal urination•• More frequent urination, or in greater amounts than usual, with pale urine•• Less frequent urination, or in smaller amounts than usual, with dark coloured urine•• Blood in the urine•• Pressure, or difficulty urinating•• Unusual amounts of urination, usually in large quantities

• A build up of phosphates in the blood that diseased kidneys cannot filter out may cause:•• Itching•• Bone damage•• Nonunion in broken bones• Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)

• A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:•• Abnormal heart rhythms•• Muscle paralysis

•• Failure of kidneys to remove excess fluid may cause:•• Swelling of the legs, ankles, feet, face and/or hands•• Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)

•• Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, cancause:•• Pain in the back or side

• Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin,

Renal failure 3

a condition known as anemia. This can result in:•• Feeling tired and/or weak•• Memory problems•• Difficulty concentrating•• Dizziness•• Low blood pressure

•• Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when theglomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred, after whichsymptoms include:•• Foamy or bubbly urine•• Swelling in the hands, feet, abdomen, or face

•• Other symptoms include:•• Appetite loss, a bad taste in the mouth•• Difficulty sleeping•• Darkening of the skin•• Excess protein in the blood• With high dose penicillin, renal failure patients may experience seizures

Causes

Acute kidney injuryAcute kidney injury (previously known as acute renal failure) - or AKI - usually occurs when the blood supply to thekidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injuryinclude accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flowfor extended periods of time. Heart-bypass surgery is an example of one such procedure.Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also causethe onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acutekidney injury, allowing the patient to resume a normal life. People suffering from acute kidney injury requiresupportive treatment until their kidneys recover function, and they often remain at increased risk of developingfuture kidney failure.Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenlyreleased in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing theblood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destructionof the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism isbelieved to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, andphosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemicconditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxicmetabolites of myoglobin.

Renal failure 4

Chronic kidney diseaseChronic Kidney Disease (CKD) has numerous causes. The most common causes of CKD are diabetes mellitus andlong-term, uncontrolled hypertension. Polycystic kidney disease is another well-known cause of CKD. The majorityof people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses affectkidney function, as well.Overuse of common drugs such as aspirin, ibuprofen, and acetaminophen (paracetamol) can also cause chronickidney damage.Some infectious diseases, such as hantavirus, can attack the kidneys, causing kidney failure.

Genetic predispositionThe APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure inindividuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms offocal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to otheretiologies. Two western African variants in APOL1 have been shown to be associated with end stage kidney diseasein African Americans and Hispanic Americans.

Diagnostic approach

Measurement for CKDStages of kidney failureChronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtrationrate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasinglevels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD isconsidered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplantwhenever feasible.Glomerular filtration rateA normal GFR varies according to many factors, including sex, age, body size and race. Renal professionals considerthe glomerular filtration rate (GFR) to be the best overall index of kidney function.[7] The National KidneyFoundation offers an easy to use on-line GFR calculator for anyone who is interested in knowing their glomerularfiltration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator).

Use of the term uremia

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia wasthe term for the contamination of the blood with urine.It is the presence of excessive amount of urea in blood.Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing withthe blood instead of being voided through the urethra.[citation needed] The term uremia is now used for the illnessaccompanying kidney failure.

Renal failure 5

References[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ N17[2] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ N19[3] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=584[4] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=585[5] http:/ / www. diseasesdatabase. com/ ddb26060. htm[6] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2013/ MB_cgi?mode=& term=Renal+ Failure& field=entry#TreeC12. 777. 419. 780. 500[7] Fadem, Stephen Z., M.D., FACP, FASN. Calculators for HealthCare Professionals. National Kidney Foundation. 13 Oct 2008 (http:/ / www.

kidney. org/ professionals/ KDOQI/ gfr_calculator. cfm)

External links• Connecting dialysis community around the World (US) (http:/ / www. RenalSite. com)• National Kidney Foundation (US) (http:/ / www. kidney. org)• The Kidney Foundation of Canada(CA) (http:/ / www. kidney. ca)

Article Sources and Contributors 6

Article Sources and ContributorsRenal failure  Source: http://en.wikipedia.org/w/index.php?oldid=572732071  Contributors: Aeusoes1, Alan Liefting, Alarchdu, Alex.tan, Amarpat, Antandrus, Anthonyhcole, Arcadian,Arcyqwerty, Artur Lion, BarkingFish, Bbb2007, Beetstra, BillpSea, Blethering Scot, Bloob101, Bluefist, Bobblewik, Bobrayner, Bonás, COMPFUNK2, Can't sleep, clown will eat me,Capricorn42, Casliber, Cella112, Chaldor, Chantal Cooper, Chirpy7, Chris Capoccia, Cmoupetr, Courcelles, Cwray, Cybercobra, Cybernetic, Davidruben, DeadEyeArrow, Denisarona, DerHexer,Diannaa, Diberri, Download, Doyley, Dr.robertg, DragonflySixtyseven, Drmies, Electriccatfish2, Epbr123, Eric Yurken, Escape Orbit, Euryalus, Fckskwl, Felix-felix, Fieryiceissweet, Freeseek,Gabbe, Gadfium, Gavia immer, Gdgourou, GermanX, Gesumari, Gfoley4, Gilliam, Gregory Benoit, Guaka, HaeB, Harej, Horcrux92, Hydro, ImGz, IndulgentReader, Jauerback, Jfdwolff,Jinkinson, Jionpedia, Jmh649, Job314, Jodie44, Jokl, Jonathan.s.kt, Josepaulopineda, Julesd, Karmosin, Karolfranks, Khazar, Kyoko, Ldon87, LeaveSleaves, Lenny Kaufman, Leolaursen,LilHelpa, Limjason, Magioladitis, Mani1, MarcoTolo, Markcox, Markjohndaley, MatchingDonors, Matt69er, McSly, Mikeewen101, Mlaszlo, MrBell, Nbauman, Nephron, Neutrality,Newmethod99, Nicewknd, Nick Wilson, NinjaKid, Nunh-huh, Nzohoury, Octane, Ohnoitsjamie, Okarol, OllieFury, PL290, Pakaran, PaperTruths, Papte, Peruvianllama, Pete in AZ, Peter Isotalo,Petersam, Philip Trueman, Pjwd31, Poromenos, RJaguar3, Rasenganz, Reach Out to the Truth, Redsox04, Repku, Reza luke, RickK, Rjwilmsi, Roadahead, Ronhjones, Rushbugled13, Sae1962,Sameboat, Sbluen, Shinkolobwe, Slazenger, Sonett72, Sonjaaa, SpaceFlight89, Spencer, Steinandrew, Stevietheman, Suffusion of Yellow, Swamp Ig, SweetNightmares, Syedsaad619, The ThingThat Should Not Be, TheEgyptian, Thebestofall007, Theillien, Tide rolls, Tom, Tommy2010, Totodu74, TylerDurden8823, Ufinne, Unckc, Volney, WikHead, Woohookitty, YSSYguy, Zanoni,Zerkalox, Zerzer88, Zodiiak, 313 ,225عدعساتك anonymous edits

Image Sources, Licenses and ContributorsFile:Hemodialysismachine.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Hemodialysismachine.jpg  License: GNU Free Documentation License  Contributors: Greg g, Landstuhli,Moscvitch, Smooth O, 2 anonymous edits

LicenseCreative Commons Attribution-Share Alike 3.0//creativecommons.org/licenses/by-sa/3.0/