Kidney failure

What is kidney failure? Kidney failure, also known as end-stage kidney disease, occurs when the kidneys are no longer able to adequately remove waste from your blood and control the level of fluid in your body.

Kidney failure can happen suddenly or gradually

People with kidney failure need dialysis or a kidney transplant to stay alive.

If you have kidney disease, it does not mean that you will develop kidney failure. One in ten Americans aged 18 and over (approximately 1.7 million people) has at least one sign of chronic kidney disease, and over 26,000 Americans receive dialysis or a kidney transplant for kidney failure.

You can lose up to 90 per cent of your kidney function before experiencing symptoms. In many cases, the signs of disease often aren’t noticed until the kidneys are close to failure.

In the early stages of kidney disease, people can have no symptoms

In fact, some people have no symptoms until over 90 per cent of their kidney function has gone. This is unfortunate because early detection of kidney disease and treatment is the key to preventing kidney failure. Symptoms of kidney disease can include: a metallic taste in the mouth.

These symptoms can be caused by other conditions, but if you are in a high-risk group for kidney disease, speak with your doctor. There are three treatment pathways for people approaching kidney failure: or kidney transplantation is needed when there is less than 10 per cent of kidney function left. These options are also known as renal replacement therapy (RRT).

Some people choose non dialysis comprehensive conservative care rather than dialysis or kidney transplantation.

There are two types of dialysis: Haemodialysis (HD) can be done by you at home

If you need access to special medical care or are unable to do HD at home you will need to have your HD at a dialysis centre.

Dialysis centres are sometimes located in a hospital or in the community (called a satellite centre).

During HD, your blood travels through a special filter called a ‘dialyser’ before being returned cleaned to your body. The dialyser has many tiny fibres (tubes).

Each fibre has tiny holes in its walls

A special fluid called dialysate washes around the fibres. The extra fluid and waste products travel from your blood through the fibres and into the dialysate. Clean blood flows back to your body and the dialysate goes down the drain.

Peritoneal dialysis (PD) is done at home by yourself, or a family member can be trained to help you.

Your health care team will organise training to show you how to manage at home

There are two types of peritoneal dialysis: the daytime bags Continuous Ambulatory Peritoneal Dialysis (CAPO) and the night-time cycler Automated Peritoneal Dialysis (APO).

Peritoneal dialysis uses your peritoneal membrane, a thin membrane or skin which surrounds and protects your organs in your abdomen (stomach) as a filter.

During peritoneal dialysis, your membrane is used to filter waste products and extra fluid from your blood. A special catheter (tube) is used to move a special dialysis fluid called dialysate in and out of your peritoneal cavity all the time, so your blood is continually being cleaned.

A kidney transplant involves the transplantation of one kidney from either a living or deceased donor into the body of another person (recipient).

A kidney transplant is a treatment for kidney disease but it is not a cure

A transplant offers a more active life, without needing dialysis.

A kidney transplant requires ongoing care. You will need to take medications to stop your body rejecting the kidney (anti-rejection) for as long as you have the transplanted kidney.

If a kidney transplant stops working, dialysis treatment will be necessary again

Another transplant may also be possible

Comprehensive conservative care is the treatment pathway you will be offered if you have decided that dialysis or transplantation are not right for you. People choose comprehensive conservative care for many reasons, and these include having other health issues, preferring an option that focuses on quality of life rather than extending life, or having tried dialysis choosing to stop this treatment.

With comprehensive conservative care you will still be monitored and supported by health professionals.

You may have medications and a special diet to improve your quality of life. Comprehensive conservative care will not extend your life when your kidneys fail completely. Some of the causes of kidney failure include: – swelling or inflammation of the tiny filtering units (nephrons) in the kidney.

Also known as nephritis (reflux nephropathy) – a bladder-valve problem that allows urine to flow back into the kidneys, causing scarring – some drugs such as lithium and cyclosporin can cause kidney failure. Continued misuse of compound analgesic preparations (now banned) was once a common cause of permanent kidney damage.

Non-steroidal anti-inflammatory drugs (NSAIDs), taken in normal therapeutic doses, may occasionally cause acute kidney failure – an inherited kidney disease that leads to the kidneys gradually losing their ability to work properly due to cysts in the centre of the kidneys.

Often, the development of kidney disease is gradual and kidney function worsens over a number of years.

If you permanently lose more than 40 per cent of your kidney function, it is called ‘chronic kidney disease’ (CKD).

This can lead to kidney failure

You are more at risk of CKD if you: have a family history of kidney failure or hereditary kidney disease in a first or second degree relative are of Aboriginal or Torres Strait Islander origin and 18 years and older. The risk of CKD resulting in kidney failure depends on your level of kidney damage.

If kidney disease is found early, medication, combined with diet and lifestyle changes, can prolong the life of your kidneys.

If you have one or more of the risk factors for developing CKD, it is important to ask your doctor to perform a kidney health check which will include a blood test, urine test and blood pressure check. A sudden drop in kidney function is called acute kidney failure.

This can be life threatening and requires immediate treatment

Causes of acute kidney failure can be divided into three groups: post-renal (obstructions in other parts of the urinary tract). Acute kidney failure is often short-lived and many people with acute kidney failure need dialysis while they are waiting for their kidneys to recover. Sometimes, treatment is a matter of controlling blood pressure and blood chemistry, while waiting for kidney function to return.

The outcome for people with acute kidney failure depends on the underlying cause and presence or absence of other medical conditions. In cases where the cause is pre-renal or post-renal, the kidneys often recover well once the factor causing it is removed. Acute kidney failure is less common than chronic (ongoing) kidney failure.

This includes:

• Tests for albumin (a type of protein) and/or blood in your urine. Kidney disease causes high blood pressure
• which can damage the small blood vessels in the kidneys

High blood pressure can also cause kidney disease

Computed Tomography scan (CT scan) to take a picture of your kidneys and urinary tract. These tests show the size of your kidneys, locate kidney stones or tumours and find any problems in the structure of your kidneys and urinary tract. You may also visit a kidney specialist (called a nephrologist) to help manage your care and decide if a kidney biopsy is needed.

During a kidney biopsy a small piece of kidney tissue is removed and looked at under a microscope to find out the type of kidney disease and check if your kidneys are damaged. helpline Tel. Symptoms of kidney disease tiredness loss of appetite difficulty sleeping headaches lack of concentration shortness of breath nausea and vomiting changes in the amount and number of times urine is passed changes in the appearance of urine or blood in the urine puffiness in the legs and ankles pain in the kidney area high blood pressure itching bad breath Treatment for kidney failure dialysis transplantation comprehensive conservative care Dialysis Dialysis Haemodialysis - home or dialysis centre Peritoneal dialysis Kidney transplant Comprehensive conservative care Causes of kidney failure diabetes (diabetic kidney disease) – even if it is well managed, diabetes can cause kidney damage high blood pressure (hypertension) glomerulonephritis polycystic kidney disease – an inherited condition that causes thousands of cysts to form in the kidneys urinary reflux medications medullary cystic kidney disease (MCKD) Chronic kidney disease (CKD) have diabetes have high blood pressure are obese are over 60 years of age have established heart problems ( heart failure or a past heart attack ) or have had a stroke smoke have a history of acute kidney injury Acute kidney failure pre-renal (decreases to the kidney’s blood supply) renal (damage to the kidney itself) Diagnosis of kidney failure If kidney disease A blood test to find out the level of waste products in the blood and calculate your glomerular filtration rate A blood pressure An ultrasound Where to get help Your GP (doctor) Kidney Health United States 1800 454 363 Kidney Health United States - Dialysis: Key facts factsheet Kidney Health United States - Comprehensive conservative kidney care factsheet .

Key Points

• You can lose up to 90 per cent of your kidney function before experiencing symptoms
• In the early stages of kidney disease, people can have no symptoms
• In fact, some people have no symptoms until over 90 per cent of their kidney function has gone
• unfortunate because early detection of kidney disease and treatment is the key to preventing kidney failure
• Symptoms of kidney disease can include: a metallic taste in the mouth