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Kidney failure
Kidney failure occurs when the kidneys are no longer able to remove waste and maintain the level of fluid and salts that the body needs. Kidney failure may be gradual or sudden in its onset. It may be reversible, or it may lead to permanent renal (kidney) failure requiring dialysis or transplantation. It is estimated that approximately 60,000 Australians aged between 12 and 74 years have severely impaired kidney function. In many cases, symptoms aren’t apparent until the disease has advanced into its later stages.
A range of causes
Some of the causes of kidney failure include:
- Hypertension - high blood pressure.
- Some drugs - for example, chronic abuse of compound analgesic preparations (now banned) was once a common cause of permanent kidney damage and non-steroidal anti-inflammatory drugs (NSAIDS) may occasionally cause acute kidney failure.
- Glomerulonephritis - inflammation of the filtering units (nephrons) within the kidney.
- Diabetic nephropathy - poorly controlled diabetes eventually damages the nephrons.
- Polycystic kidney disease - an inherited condition that causes cysts to form within the kidneys.
- Reflux nephropathy - a faulty bladder valve allows urine to backflow into the kidneys.
Acute renal failure is a sudden loss of kidney function that affects nearly 2,500 Australian adults each year. Acute renal failure can be life threatening and requires immediate hospitalisation and intensive treatment. This may include short term dialysis. While acute renal failure is often reversible, in some cases it can progress to chronic renal failure or ‘end stage’ renal disease. In fact, close to half of all people diagnosed with acute renal failure die within three months. Men are two to three times more likely to develop acute renal failure than women at any age. Most children with acute renal failure make a full recovery.
Chronic renal failure
Chronic renal failure is the gradual and progressive loss of kidney function. About 2000 Australian adults commence dialysis each year, half of whom are aged over 60 years. The risk of developing chronic renal failure increases with age and is more common in men than women. The risk of progressing to end stage renal disease, which requires dialysis or transplantation, depends on the severity of the kidney impairment.
End stage kidney disease
End stage kidney disease is failure of the kidney to function and requires chronic dialysis or a kidney transplant. Glomerulonephritis (inflammation of the kidney filters) and diabetes cause more than half of the cases of end stage kidney disease.
Diagnosis methods
Signs that kidney disease may be present include high blood pressure, abnormal urine tests and the need to get up during the night to urinate. Kidney disease can be diagnosed with a blood test.
Treatment options
The treatment options for kidney failure include:
- Haemodialysis
- Peritoneal dialysis
- Kidney transplantation.
Haemodialysis is the use of a special filter, connected to a machine, that clears wastes and extra fluids and salts from the blood. Tubes connected to the patient deliver the blood into the dialyser, which then filters the blood before returning it to the body via another set of tubes. The patient is awake and alert during the procedure, and feels no pain. (A local anaesthetic is injected before the tubes are inserted.) Haemodialysis takes about four to six hours and is normally performed about three times per week. Important points to consider include:
- Haemodialysis can be done at home, at a self-care ‘satellite’ dialysis centre, or at a hospital renal unit.
- Low blood pressure and muscle cramps can be side effects of the treatment, as the body has to adjust to comparatively fast changes in fluids and chemicals. It may take a few months for the body to adjust to haemodialysis.
- Necessary dietary changes include reducing fluids, limiting dairy foods, avoiding salty foods and regulating the amount of potassium.
The peritoneal membrane lines the abdominal cavity and surrounds the abdominal organs. Peritoneal dialysis involves using the peritoneal membrane to filter the blood. A tube (catheter) is permanently inserted into the abdomen. During treatment, a special cleansing liquid (called dialysate) is pumped through the catheter. Wastes, extra body fluids and chemicals migrate from the blood vessels in the peritoneal cavity into the dialysate. The dialysate is removed from the abdominal cavity after a few hours, and fresh dialysate allowed to run in under gravity. This is called an exchange. The number of exchanges needed differs from one person to the next but is usually 4-5 per day. The two main types of peritoneal dialysis include:
- Continuous ambulatory peritoneal dialysis (CAPD) - dialysate flows into the abdominal cavity via a plastic bag attached to the catheter. Then, the catheter is capped and the specified number of hours allowed to pass (usually about four to six). A drain bag is attached, and the dialysate allowed to drain. A fresh bag of dialysate is then introduced into the abdominal cavity, and the procedure starts again.
- Automated peritoneal dialysis (APD) - a machine regulates the movement of dialysate in and out of the abdominal cavity. The person attaches the machine to their catheter at night. About six to eight exchanges will take place while the person sleeps. During the day, the abdominal cavity still contains dialysate to allow filtering to occur, although very slowly.
Kidney transplantation involves placing a healthy donor kidney from another person into the patient’s body. It is important that the donor’s tissues and blood match the patient’s as closely as possible to reduce the risk of complications, such as rejection (the patient’s immune system attacks and attempts to destroy the donated tissue). A typical procedure includes:
- The donated kidney is placed inside the pelvis and attached to the patient’s blood vessels and urinary tract.
- The patient’s old kidneys are usually left in place.
- The operation takes up to three hours.
- The patient no longer needs dialysis or special diets.
- Drugs to suppress immune system activity (immunosuppressive drugs) are needed (for the rest of the person’s life) to reduce the risk of rejection.
- Donor kidneys come from two sources: deceased organ donors or living donors, such as family or friends.
- Living donors now outnumber deceased donors. In Australia, the average waiting time for a non-family donor kidney is about three to four years.
- Your doctor
- Your local community health centre
- Kidney Health Australia information line Tel. 1800 682 531
- TTY 1800 005 881
- Kidney failure can be sudden or gradual.
- Kidney failure can be life threatening and requires immediate treatment.
- Some kidney conditions are reversible, while others may require long term dialysis or transplantation.
Better Health Channel - Related Quiz.Related articles:
Haemolytic uraemic syndrome.
Kidney disease - prevention.
Kidney problems - polycystic kidney disease.
Kidney reflux.
Kidneys - age related problems.
Kidneys - Q & A.
Kidneys explained.
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Article publication date: 18/07/2000
Last reviewed: 31/05/2004
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