Kidney failure

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The kidneys purify the blood from substances and remove water that the body does not need. In the event of kidney failure, the kidneys are no longer able to do so and then harmful substances and water remain in the body. Renal failure can be acute or chronic. The treatment you receive depends on the type of kidney failure you have and what problems you have.

In the case of chronic kidney failure, the kidney’s function slowly deteriorates, over several years. Acute kidney failure develops faster, within a few days or a few weeks. The most common form is chronic kidney failure. 

symptoms

Chronic kidney failure and acute kidney failure have different causes, but cause about the same symptoms. However, the symptoms vary depending on how much of the kidney function is impaired.

Slight renal failure

If the function of the kidneys is only slightly impaired, you often get no symptoms. It is common to have symptoms only when the kidney function is very impaired.

However, the disease that has caused the slight renal failure can cause symptoms. For example, you may see blood in the urine a few days after an infection, the urine foaming or the body becoming swollen.

Severe kidney failure

In severe kidney failure, kidney function is more impaired. You may then have one or more of the following symptoms:

  • You feel tired.
  • You have itching on the body.
  • You have worse appetite.

Very severe kidney failure

In very severe renal failure, the symptoms of severe renal failure become more pronounced. You may also have one or more of the following symptoms:

  • You get sick and vomit.
  • You get swollen legs.
  • You get hard to breathe.
  • You get heart bumps.
  • You start to bleed more easily.

When should I seek care?

Contact a health care center if any of the following is true of you:

  • You are very tired, feel sick and have itching on your body.
  • You have blood in the urine or you have foamy urine.
  • You pee significantly less than usual.

Seek care directly at a health care center or emergency room if you cannot urinate even though you are in need of a kiss.

Investigation

The examination goes the same way whether you have acute kidney failure or chronic kidney failure. 

You can tell us about your problems at the health center. Then you can have blood tests , urine tests and your blood pressure measured .

Blood sample

Often a blood test is used that measures the level of creatinine in the blood. Creatinine is formed in the muscles and filtered out through the kidneys. When the creatinine value in the blood rises, it is often due to the kidneys not functioning properly. The higher the creatinine value, the worse the kidney function.

You may also be given a blood test that measures the level of Cystatin C in your blood. It is also a substance that is filtered through the kidneys.

You may also be able to do an examination when the substance iohexole is added to the blood. After a few hours, the amount of iohexole remaining in the blood is measured by a blood test. The faster the substance disappears from the blood, the better the kidneys work. Sometimes a substance called chrom51-EDTA is used instead of iohexole.

Urine sample

You may also submit urine samples.

kidney Biopsy

You can also have a kidney biopsy. In a biopsy, a sample is taken from a tissue. The study is done to find out what type of kidney damage or specific kidney disease has caused kidney failure.

Sampling is done in hospitals. You lie down when the sample is taken. The doctor starts by examining your kidneys using ultrasound . The images from the ultrasound are transferred to a screen where the doctor can review the results. It doesn’t hurt to be examined with ultrasound.

Then you will be stunned in the skin where the sting is going to happen. Once you have been anesthetized, insert a thin needle against one of the kidneys. When the needle is pulled out, a very small part of the kidney follows. It’s called a tissue test.

The sample is then analyzed in a laboratory with a microscope.    

The sting itself can hurt but the pain is usually short-lived. After the examination, you are allowed to stay in the hospital for 24 hours. This is because there is a small risk that it may start bleeding in the area where the sample was taken.

It is important that you understand the information

In order for you to be active in your care and to make decisions, it is  important that you understand the information you receive from the healthcare personnel . Ask questions if you don’t understand. You can also ask to have the information printed so that you can read it peacefully.

You also have the right to  get help from an interpreter if you have a hearing loss .

Different types of kidney failure

Renal failure can develop rapidly, within a few days or a few weeks. It is called acute renal failure. But it is most common for the kidneys to deteriorate slowly, often for several years. It is called chronic kidney failure.

Causes of acute renal failure

There may be several causes of acute kidney failure. This is usually not due to a kidney disease, but because too little blood passes through the kidneys or the urine cannot leave the kidneys.

Sudden fluid deficiency is a common cause of acute renal failure

The fact that too little blood passes through the kidneys is usually due to fluid deficiency, for example due to severe diarrhea or severe vomiting. When you have a lack of fluid, the amount of blood in the body decreases and blood pressure drops.

Often, the body itself can dilate the blood vessels that lead to the kidneys so that they still get enough blood. In some, this function is impaired, which increases the risk of fluid deficiency leading to kidney failure. This applies mainly to you who are older, have problems with vein obesity or if you are taking certain medicines.

The drugs that can impair the blood flow to the kidneys are, for example, anti-inflammatory drugs with ibuprofen, naproxen or diclofenac. Some medicines for high blood pressure can have the same effect.

Acute kidney failure due to obstruction

Acute kidney failure can also be due to various types of obstructions that prevent the urine from leaving the kidneys. It can be, for example, a tumor, an enlarged prostate or a stone in the bladder.

The obstacle causes the urine to collect in the bladder. Finally, the bladder becomes full and the urine is pressed against the kidneys.

Then the function of the kidneys can be affected and if the obstacle affects both kidneys it leads to kidney failure. If the obstacle only affects one kidney, the other kidney usually has enough capacity left. 

More causes of acute renal failure

Acute kidney failure may also be due to other causes.

Sore fever can lead to acute kidney failure. It is a viral disease that is spread to people by infected forest cover. Common symptoms are high fever, muscle aches and a lot of stomach and back pain. Sork fever occurs mainly north of the Dalälven River, in Dalsland and in Värmland.

You can also get acute kidney failure if you have been poisoned by toxic fungi. The most poisonous fungus, which causes kidney damage, is poisonous toxin. It was formerly called a toxin poison spider blade.

Read more about poisonous fungi at the Poison Information Center.

Some blood disorders and some rheumatic diseases can also cause acute kidney failure.

You can also get acute kidney failure if you have suffered major damage to one or more muscles. Such injuries can occur in, for example, car accidents. This is because the substance myoglobin is released from the muscles and gets stuck in different parts of the kidneys.

Causes of chronic kidney failure     

In the case of chronic renal failure, kidney function usually deteriorates slowly for many years.

The most common causes of chronic kidney failure:

Uncommon causes of chronic kidney failure:

  • Hereditary kidney diseases such as polycystic kidney disease.
  • Some blood diseases and rheumatic diseases.
  • Obstacles that have hampered the discharge of urine and which have been there for a long time.

Polycystic kidney disease is a hereditary disease that causes many fluid-filled cysts, cysts, to form in the kidneys. As the cysts grow, the normal tissue in the kidneys is destroyed.

The most common cause of kidney failure is myeloma. Then some blood cells form harmful egg whites that can damage the kidneys.

The rheumatic diseases that can damage the kidneys are mainly inflammatory diseases of the body’s small blood vessels. Examples of such diseases are granulomatous polyangite and SLE.

Treatment for acute renal failure

You are being treated for the cause of kidney failure if you have acute kidney failure. For example, you may get fluid if you have a fluid deficiency or a urinary catheter if the prostate obstructs the urine.

Most people do not need to be treated in hospitals, but some may need to be treated in an intensive care unit until the kidneys have recovered. Most people become completely healthy after having acute kidney failure. 

Treatment for chronic kidney failure

There is no treatment that will make you fully healthy if you have chronic kidney failure, but your kidneys will slowly deteriorate. The treatment you receive should slow down the deterioration of the kidneys and relieve the symptoms that the kidney failure causes.

Here are some symptoms and how they can be treated.

Hypertension

You who have high blood pressure tend to get medicines that lower blood pressure.

Tiredness

Fatigue may be partly because you have low blood levels. Low blood levels mean you have low levels of hemoglobin in your blood . Then you can get syringes with iron and with the hormone erythropoietin which raises blood levels.   

Nausea and vomiting

Nausea and vomiting in renal failure may be due, among other things, to the formation of hydrogen ions in the body. Then you can get treatment with bicarbonate as tablets.

Swollen and difficult to breathe

You may be treated with liquid medicines if you are swollen and have difficulty breathing because you accumulate too much water.

Itching

You can get treatment with medicines that contain antihistamines and softening creams that can relieve the itching.

It is also good to use shower oil or bath oil instead of soap, because soap dries the skin. Using cotton clothing closest to the skin can also relieve itching. 

Light treatment with ultraviolet light in hospitals relieves itching, but you have to get the treatment often, sometimes several times a week. 

Sensitive to infections

You who have severe kidney failure are often sensitive to infections. Therefore, you are offered, among other things, vaccination against influenza.

Substances in metabolism

If you have more severe kidney failure, metabolic disorders occur. Some examples are changes in potassium balance and calcium balance.

A high level of potassium in the blood can be very stressful to the heart. It can help avoid eating foods that contain potassium such as nuts, chocolate, citrus fruits and bananas. There are also medicines that lower the potassium level.

High calcium and phosphate levels affect many organs, including the skeleton, blood vessels and parathyroid glands. Then you can get vitamin D treatment. You may also need to change your diet and take some medicines with your food.

Diet with less protein can help with several symptoms

Eating a diet with less protein can relieve the symptoms of kidney failure. Many of the residual products that accumulate in the body come from the body’s breakdown of protein from food. If you eat foods with less protein, less residual products are formed.

To change your diet, you need the help of a dietician to make sure you get enough nutrition. Do not change the diet yourself.

Fitness training is good

Fitness training can sometimes help lower blood pressure. A good condition also helps you cope with dialysis treatment better.

A very severe kidney failure often causes the muscle strength to decrease, so it is good to start building up the condition well in advance. 

dialysis Treatment

When the kidney function is severely impaired you may get symptoms that cannot be treated with drugs or by changing the diet. Then you need dialysis treatment or a kidney transplant. There are two forms of dialysis treatment, blood dialysis and pouch dialysis also called peritoneal dialysis.

Blood dialysis – hemodialysis

In blood dialysis, the blood is purified in a dialysis machine. The blood is discharged from the body, passes a filter and is then returned. As the blood passes through the filter, residual products and fluid that the body does not need to be filtered. Meanwhile, you can sit in a special chair or lie in a bed.

Most people get their treatment at a dialysis department, but some get their treatment at home.  

Bag Dialysis – Peritoneal Dialysis

In bag dialysis , it is your own peritoneum used as a dialysis filter. You have dialysis fluid in your stomach and replace it yourself several times a day with an inoperative silicone tube. Bag dialysis is also called peritoneal dialysis.

Most people who have bag dialysis take care of their treatment themselves. 

Kidney Transplant

A transplanted kidney replaces your kidneys that no longer work. The new kidney is operated into the groin and the old kidneys remain. You can get a kidney from a living person or someone who has recently passed away. It may take time to recover after a kidney transplant, but most people do very well after some time. 

What happens in the body?

The kidneys purify the blood from various substances that the body does not need. The substances are called residual products. For example, there may be substances that form when the body’s cells work or when cells die and are replaced by others. There may also be substances formed from the food you eat.

The kidneys also ensure that water is drained away that the body does not need. The water and substances are led away with the urine.

In the case of kidney failure, the kidneys do not work properly. This means that the body does not dispose of residual products and water in sufficient quantity, but they remain in the body.

What happens when substances that the body is going to dispose of remain?

In severe kidney failure it is common to have elevated levels of hydrogen ions and phosphate in the blood. The elevated level affects the calcium content of the blood and the skeletal circulation. You can become osteoporosis and get deposits of lime and phosphate in other parts of the body than in the skeleton. Having high levels of phosphate also increases the risk of cardiovascular disease.

You may get elevated levels of drugs in the blood

You may get elevated levels of medicines in your blood if you have impaired kidney function. Always tell your doctor that you have impaired kidney function if you are to receive a new drug.

This applies especially to medicines in diabetes such as metformin. This also applies to some heart medications such as so-called ACE inhibitors and some types of antibiotics. Talk to your doctor if you are taking any of these medicines and have impaired kidney function.

When the function deteriorates, more substances can accumulate in the body

When the function deteriorates further, more substances can accumulate in the body. It can be, for example, uremic poisons, potassium and water.

High levels of uremic poisons, among other things, make you tired, nauseous and itchy. High levels of potassium can be harmful to the heart. An increased amount of water in the lungs and lung sac can make you difficult to breathe. 

The kidneys also affect other functions of the body

In the kidneys, the hormone erythropoietin is formed which controls how many red blood cells to be produced in the body. In kidney failure, the kidneys are unable to produce enough erythopoietin. This leads to a low blood count and anemia.

Vitamin D is mainly formed in the skin and then activated in the kidneys. Activated vitamin D is important for the metabolism of the skeleton and the calcium balance in the body. Most people with kidney failure do not produce and activate enough vitamin D.

Some are at greater risk of renal failure

Kidney function is slowly deteriorating with age in everyone. However, aging does not automatically lead to kidney failure that needs to be treated.

You who have diabetes or high blood pressure have an increased risk of renal failure. Therefore, it is good to be careful with treatment and to check the kidney function. You who have diabetes may do it more regularly according to special care programs.  

Can I prevent kidney failure?

You can’t prevent all types of kidney failure, but there are some things you can do to reduce the risk of getting chronic kidney failure if you have diabetes or high blood pressure.

Avoid certain medicines if you get stomach upset

You can get acute kidney failure if you get stomach upset and dehydrated and at the same time use some medicines for high blood pressure or anti-inflammatory drugs. If you get stomach upset, do not take any of these medicines.

Consult your doctor if you need to use anti-inflammatory painkillers, so-called NSAIDs or cox inhibitors while you are sick and dehydrated. Examples of such drugs are Diclofenac, Ipren, Ibumetin and Naproxen. These drugs may increase the risk of acute renal failure.

Only eat mushrooms that you know for sure are edible

Some fungi that grow can cause kidney damage. Only eat mushrooms that you know for sure are edible. The most poisonous fungus that causes kidney damage is topical poison spindle.

Read more about poisonous fungi at the Poison Information Center.

Be careful about treatment and check if you have high blood pressure or diabetes

It is important to be careful about the treatment and that you go on your checks if you have high blood pressure or diabetes.

High blood pressure can eventually damage the blood vessels of the kidneys and reduce the blood flow to the kidneys. It can be a cause of chronic kidney failure. Therefore, it is important that you are careful about the treatment.

Diabetes means you have elevated blood sugar levels. It can affect the small blood vessels in the kidneys so that the function of the kidneys is impaired. It is important that you are carefully treated as it can prevent you from getting kidney failure.

Consult your doctor if you need to use medicines containing enalapril, candesartan or metformin. They can affect the risk of acute kidney failure.

Stop smoking if you smoke

You should also avoid smoking, as smoking damages blood vessels. 

How does kidney failure affect life?

Chronic kidney failure means a big change. You may need to take several medications every day and go for regular checkups at a kidney medical center. In the long term, you may need dialysis or a kidney transplant.

It is common to think a lot about one’s illness, both on physical, mental and social issues.

Discuss with your doctor how you perceive it to be living with a chronic illness. Often, there are also curators who are connected to the renal medicine clinics that you can talk to.

In conversation with the curator, you can discuss how you feel about the disease, think about whether life will change and how the disease can affect your life.

Starting with dialysis can be a painful experience. At dialysis clinics, there is often also a curator to talk to about your thoughts.

You can also contact a patient association for tips and advice. There you can also get in touch with others with whom you can share your experiences.

Renal failure can affect sex life

It is common for you to have decreased sex drive if you have severe kidney failure. For example, you may be tired or be affected by your illness in other ways. Men can also have problems getting and keeping the position.

Talk to a doctor or nurse if you feel that the disease is affecting your sex life. They are used to such questions and can advise.

Pregnancy and kidney failure

Usually, the ability to have children is not affected much if you have mild kidney failure. However, it is affected if you have severe kidney failure. In very severe renal failure, the period may decrease or cease. It is unusual to become pregnant with severe kidney failure.

Getting pregnant with severe kidney failure involves risks, both for the pregnant woman and for the fetus. Talk to your doctor if you have severe kidney failure and want to get pregnant. Then you will know what conditions you have.

After a kidney transplant , fertility improves.

More information

kidney Association

The Kidney Association  is a patient association for people with kidney disease and their relatives. The association consists of 14 regional associations across the country which organize various activities and meetings for its members. NjurFUNK is the Njurförbandets member magazine which publishes four issues a year.

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