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Kidney Failure

Kidney Failure

UNDERSTANDING KIDNEY DISEASE — THE BASICS

What Is Kidney Disease?

The kidneys are two organs located on either side of your spine in the middle of your back, just above the waist. They perform several life-sustaining roles: They cleanse your blood by removing waste and excess fluid, maintain the balance of salt and minerals in your blood, and help regulate blood pressure. When the kidneys become damaged, waste products and fluid can build up in the body, causing swelling in your ankles, vomiting, weakness, sleeplessness, and shortness of breath. If left untreated, diseased kidneys may eventually stop functioning completely. Loss of kidney function is a serious — and potentially fatal — condition. Each bean-shaped kidney is 4-5 inches long and contains about a million nephrons, which are like tiny pouches. Each nephron has a filter at one end, called a glomerulus, to filter your blood. Your overall kidney function can be measured by how quickly blood is filtered through these glomeruli. This measurement is called the glomerular filtration rate.

Healthy kidneys handle several specific roles:

•  Maintain a balance of water and concentration of minerals, such as sodium, potassium, and phosphorus, in your blood

•  Remove waste by-products from the blood after digestion, muscle activity, and exposure to chemicals or medications

•  Produce renin, an enzyme that helps regulate blood pressure

•  Produce erythropoietin, which stimulates red blood cell production

•  Produce an active form of vitamin D, needed for bone health

What Causes Acute Kidney Injury (Acute Renal Failure)?

The loss of kidney function is called acute kidney injury, also known as acute renal failure (ARF). This can occur following a traumatic injury with blood loss, the sudden reduction of blood flow to the kidneys, damage to the kidneys from shock during a severe infection called sepsis, obstruction of urine flow, or damage from certain drugs or toxins. Acute kidney injury can also occur from pregnancy complications, such as eclampsia and pre-eclampsia, or related HELLP Syndrome. Marathon runners and other athletes who don’t drink enough fluids while competing in long-distance endurance events may suffer acute renal failure due to a sudden breakdown of muscle tissue. This muscle breakdown releases a chemical called myoglobin that can damage the kidneys.Obstruction of urine flow, such as with an enlarged prostate, also can lead to acute kidney injury.

What Causes Chronic Kidney Disease?

Kidney damage and decreased function that lasts longer than 3 months is called chronic kidney disease (CKD). Chronic kidney disease is particularly dangerous, because you may not have any symptoms until considerable, often irreparable, kidney damage has been done. Diabetes (types 1 and 2) and high blood pressure are the most common causes of chronic kidney disease (CKD). Other causes are:

1.  Immune system conditions, such as lupus, and chronic viral illnesses such as HIV/AIDS, hepatitis B, and hepatitis C.

2.  Urinary tract infections within the kidneys themselves, called pyelonephritis, can lead to scarring as the infection heals. Multiple episodes can lead to kidney damage.

3.  Inflammation in the tiny filters (glomeruli) within the kidneys; this can happen after strep infection and other conditions of unknown cause.

4.  Polycystic kidney disease, in which fluid-filled cysts form in the kidneys over time. This is the most common form of inherited kidney disease.

5.  Congenital defects, present at birth, are often the result of a urinary tract obstruction or malformation that affects the kidneys. One of the most common involves a valve-like mechanism between the bladder and urethra. These defects, sometimes found while a baby is still in the womb, can often be surgically repaired by a urologist.

6.  Drugs and toxins, including long-term exposure to some medications and chemicals; overuse of NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen and naproxen; and use of intravenous “street” drugs.

UNDERSTANDING KIDNEY DISEASE — PREVENTION

The key to prevention or delay of severe kidney disease is early detection and aggressive intervention — while there’s still time to slow down the progression to kidney failure.  Medical care with early intervention can change the course of chronic kidney disease and prevent the need for dialysis or a kidney transplant. Diabetes and high blood pressure account for two thirds of all cases of chronic kidney disease. By aggressively managing diabetes and high blood pressure with diet, exercise, and medications, you may be able to prevent kidney failure and help keep as much kidney function as possible.

 

Know Your Risks for Kidney Disease

Since diabetes and high blood pressure put you at risk of kidney disease, know where you stand with these risks. Do you have diabetes or high blood pressure? If so, is the diabetes or hypertension under control? If you can, find out if diabetes, hypertension, or kidney disease runs in your family. Certain ethnic groups, such as African-Americans, Hispanics, Pacific Islanders, Native Americans, and senior citizens, are also at higher risk for chronic kidney disease.

 

Get Tested Regularly

At your next doctor’s visit, and at least within the next year if you haven’t had these tests done:

•  Ask for a urine test to see if you have excess protein, glucose, or blood in the urine.

•  Ask for a blood pressure reading, to see if your blood pressure is elevated.

•  Ask for a fasting blood glucose test, to see if you have too much glucose (sugar) in your blood. Another blood test that can be used to determine diabetes is a hemoglobin A1C which will indicate your average blood glucose level over the past two to three months.

•  Ask for a creatinine test. This blood test measures the amount of waste from muscle activity. When the kidneys are not working properly, the creatinine rises.

If any of these tests are abnormal, your doctor will need to do other tests to more clearly define the problem.

Control Diabetes

If you have diabetes, work with your doctor to keep your blood sugar levels under the best possible control. A program of diet, regular exercise, glucose monitoring, and medications to control blood sugars and protect kidney function can help.

Control High Blood Pressure

If you have high blood pressure, work with your doctor to get your blood pressure within target ranges. A program of diet, regular exercise, and medications can help.

Consider Seeing a Nephrologist

If you’ve already lost some kidney function, or your doctor tells you that you’re likely to have more kidney damage in the future, ask about a referral to a nephrologist (a kidney disease specialist). A nephrologist can provide specialized testing, evaluate your condition, and tellyou possible ways to slow down the progress of kidney disease.

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