Chronic renal failure (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Chronic renal failure or End-stage kidney disease, as it is called, is the complete, or almost complete failure of the kidneys to function. The main function of the kidneys is to remove wastes and excess water from the body.

What are the symptoms of Chronic renal failure?
Symptoms may include: Other symptoms may develop, including: Brain and nervous system symptoms
 * General ill feeling and fatigue
 * Generalized itching (pruritus) and dry skin
 * Headaches
 * Weight loss without trying
 * Loss of appetite
 * Nausea
 * Abnormally dark or light skin and changes in nails
 * Bone pain
 * Drowsiness and confusion
 * Problems concentrating or thinking
 * Numbness in the hands, feet, or other areas
 * Muscle twitching or cramps
 * Breath odor
 * Easy bruising, nosebleeds, or blood in the stool
 * Excessive thirst
 * Frequent hiccups
 * Low level of sexual interest and impotence
 * Menstrual periods stop (amenorrhea)
 * Sleep problems, such as insomnia, restless leg syndrome, or obstructive sleep apnea
 * Swelling of the feet and hands (edema)
 * Vomiting, especially in the morning

What causes Chronic renal failure?
End-stage kidney disease (ESRD) occurs when the kidneys are no longer able to function at a level needed for day-to-day life. It usually occurs when chronic kidney disease has worsened to the point at which kidney function is less than 10% of normal.

ESRD almost always follows chronic kidney disease. A person may have gradual worsening of kidney function for 10 - 20 years or more before progressing to ESRD.

Patients who have reached this stage need dialysis or a kidney transplant.

The most common causes of ESRD in the U.S. are diabetes and high blood pressure.

Who is at highest risk?
Certain conditions increases your risk of chronic renal failure, which are as follows
 * Diabetes
 * High blood pressure (hypertension)
 * Heart disease
 * Smoking
 * Obesity
 * High cholesterol
 * African-American, American Indian or Asian-American race
 * Family history of kidney disease
 * Age 65 or older

When to seek urgent medical care?
You must make an appointment with the doctor, if you have any symptoms and sign listed above. If you have any chronic medical condition, your doctor might do a regular check of your Blood pressure and kidney functions.

Diagnosis
High blood pressure almost always occurs during end-stage kidney disease. A brain and nervous system (neurologic) examination may show signs of nerve damage. The health care provider may hear abnormal heart or lung sounds with a stethoscope.

Patients with end-stage kidney disease will make much less urine, or urine production may stop.

Treatment options
Dialysis or kidney transplantation is the only treatment for ESRD.

You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and the types of dialysis therapies, and placement of a dialysis access.

End-stage kidney disease changes the results of many tests. Patients receiving dialysis will need these and other tests done often: This disease may also change the results of the following tests:
 * Potassium
 * Sodium
 * Albumin
 * Phosphorous
 * Calcium
 * Cholesterol
 * Magnesium
 * Complete blood count (CBC)
 * Electrolytes


 * Erythropoietin
 * PTH
 * Bone density test

You may need to make changes in your diet.


 * Eat a low-protein diet
 * Get enough calories if you are losing weight
 * Limit fluids
 * Limit salt, potassium, phosphorous, and other electrolytes

Other treatments may include:
 * Extra calcium and vitamin D (always talk to your doctor before taking)
 * Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
 * Treatment for anemia, such as extra iron in the diet, iron pills, special shots of a medicine called erythropoietin, and blood transfusions.
 * Different treatments are available for problems with sleep or restless leg syndrome.

Patients with chronic kidney disease should be up-to-date on important vaccinations, including:


 * H1N1 (swine flu) vaccine
 * Hepatitis A vaccine
 * Hepatitis B vaccine
 * Influenza vaccine
 * Pneumococcal polysaccharide vaccine (PPV)

Where to find medical care for Chronic renal failure?
Directions to Hospitals Treating Chronic renal failure

What to expect (Outlook/Prognosis)?
Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body. Both of these treatments can have serious risks and consequences. The outcome is different for each person.

Possible complications

 * Anemia
 * Bleeding from the stomach or intestines
 * Bone, joint, and muscle pain
 * Brain dysfunction, confusion, and dementia
 * Changes in electrolyte levels
 * Changes in blood sugar (glucose)
 * Damage to nerves of the legs and arms
 * Fluid buildup around the lungs
 * Heart and blood vessel complications
 * Congestive heart failure
 * Coronary artery disease
 * High blood pressure
 * Pericarditis
 * Stroke
 * Hepatitis B, hepatitis C, liver failure
 * Hyperparathyroidism
 * Increased risk of infections
 * Malnutrition
 * Phosphorous levels become too high
 * Potassium levels become too high
 * Seizures
 * Skin dryness, itching/scratching, leading to skin infection
 * Weakening of the bones, fractures, joint disorders

Prevention
Treatment of chronic kidney disease may delay or prevent progression to ESRD. Some cases may not be preventable.