Kidney failure, also called end-stage renal disease (ESRD), is the last stage of chronic kidney disease. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant
What causes kidney failure?
In most cases, kidney failure is caused by other health problems that have done permanent damage (harm) to your kidneys little by little, over time.
When your kidneys are damaged, they may not work as well as they should. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease, or ESRD for short.
Diabetes is the most common cause of ESRD. High blood pressure is the second most common cause of ESRD. Other problems that can cause kidney failure include:
Autoimmune diseases, such as lupus and IgA nephropathy
Genetic diseases (diseases you are born with), such as polycystic kidney disease
Urinary tract problems
Sometimes the kidneys can stop working very suddenly (within two days). This type of kidney failure is called acute kidney injury or acute renal failure. Common causes of acute renal failure include:
Illegal drug use and drug abuse
Not enough blood flowing to the kidneys
Urinary tract problems
This type of kidney failure is not always permanent. Your kidneys may go back to normal or almost normal with treatment and if you do not have other serious health problems.
Having one of the health problems that can lead to kidney failure does not mean that you will definitely have kidney failure. Living a healthy lifestyle and working with your doctor to control these health problems can help your kidneys work for as long as possible.
Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body.
You may notice one or more of the following symptoms if your kidneys are beginning to fail:
Nausea and vomiting
Not feeling hungry
Swelling in your feet and ankles
Too much urine (pee) or not enough urine
Trouble catching your breath
If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:
Abdominal (belly) pain
Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.
Treatment of kidney failure
If you have kidney failure (end-stage renal disease or ESRD), you will need dialysis or a kidney transplant to live. There is no cure for ESRD, but many people live long lives while on dialysis or after having a kidney transplant.
There are just a few options for treating kidney failure, including kidney transplant and several types of dialysis. Your doctor can help you figure out which treatment is best for you.
New to dialysis
Starting dialysis often means creating a new normal for yourself and your family. There’s a lot to think about, from choosing a treatment option to finding new ways to enjoy your favourite activities, to managing a new diet. The FIRST30 program is all about helping you through this period of adjustment. Here, you’ll find videos featuring people like you, who once were new to dialysis, as well as a checklist of important questions to ask your health care team.
Adjusting to kidney failure
Learning that you have kidney failure can come as a shock, even if you have known for a long time that your kidneys were not working well. Having to change your lifestyle to make time for your treatments can make coping with this new reality even harder. You may have to stop working or find new ways to exercise. You may feel sad or nervous. All is not lost. You can get help to feel better and have a fulfilling life.
Complications of kidney failure
Your kidneys do many jobs to keep you healthy. Cleaning your blood is only one of their jobs. They also control chemicals and fluids in your body, help control your blood pressure and help make red blood cells. Dialysis can do only some, not all, of the jobs that healthy kidneys do. Therefore, even when you are being treated for kidney failure, you may have some problems that come from having kidneys that don’t work well.
We can’t always predict when something will happen to derail our treatment plans. There are some simple steps you can take to make sure you are prepared and have access to the things you need to stay healthy in the event of a disaster.
Kidney failure/ESRD diet
Dialysis helps to do some of the work that your kidneys did when they were healthy, but it cannot do everything that healthy kidneys do. Therefore, even when you are on dialysis, you will need to limit what and how much you eat and drink. Your diet needs may depend on the type of dialysis you are on (hemodialysis or peritoneal dialysis) and your treatment schedule
What causes acute kidney failure?
Renal causes of kidney failure (damage directly to the kidney itself) include:
Sepsis: The body’s immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually does not occur with simple urinary tract infections.
Medications: Some medications are toxic to the kidney including:
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin, and others), and naproxen (Aleve, Naprosyn)
Antibiotics like aminoglycosides gentamicin (Garamycin), tobramycin
lithium (Eskalith, Lithobid)
Iodine-containing medications such as those injected for radiology dye studies
Rhabdomyolysis: In rhabdomyolysis, there is significant muscle breakdown in the body, and the damaged muscle fibres clog the filtering system of the kidneys. Massive muscle injury may occur because of trauma, crush injuries, and burns. Some medications used to treat high cholesterol may cause rhabdomyolysis.
Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys. Many diseases can cause this inflammation including:
Systemic lupus erythematosus
Hemolytic uremic syndrome: This condition results from abnormal destruction of red blood cells. It most often occurs in children after certain infections, but also may be caused by medications, pregnancy, or can occur for unknown reasons.
Postrenal kidney failure causes
Postrenal causes of kidney failure (post=after + renal= kidney) are due to factors that affect the outflow of the urine:
Obstruction of the bladder or the ureters can cause back pressure because the kidneys continue to produce urine, but the obstruction acts like a dam, and urine backs up into the kidneys. When the pressure increases high enough, the kidneys are damaged and shut down.
Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying.
Tumours in the abdomen that surround and obstruct the ureters.
Kidney stones. Usually, kidney stones affect only one kidney and do not cause kidney failure. However, if there is only one kidney present, a kidney stone may cause the remaining kidney to fail.
What causes chronic kidney failure?
Chronic renal failure develops over months and years. The most common causes of chronic renal failure are related to
poorly controlled diabetes,
poorly controlled high blood pressure, and
Less common causes of chronic renal failure include:
Polycystic kidney disease
Reflux nephropathy (damage caused by urine backflow from the bladder into the ureters and kidney)
Does kidney failure cause pain?
Kidney failure in itself does not cause pain. However, the consequences of kidney failure may cause pain and discomfort in different parts of the body.
Normal functioning kidneys filter amyloid (a protein) from the bloodstream. In kidney failure amyloid proteins in the blood rise, and can separate and clump together forming amyloid deposits into a variety of tissue and organs, including joints and tendons. This can result in symptoms of:
Patients who are on dialysis may have discomfort when on the dialysis machine.
Underlying chronic disease pain
Pain is often a consequence of the underlying chronic disease that led to kidney failure, for example:
People with poorly controlled diabetes may develop diabetic neuropathy pain.
People who have the peripheral vascular disease also may have pain in their extremities and may develop claudication (leg pain that occurs with walking).