Failure of the kidneys to function efficiently for various reasons.

 

Causes of Kidney Failure

The kidneys filter about 180 litres/40 gallons of blood daily, extracting the waste products of metabolism, especially urea -a breakdown product from protein. Besides filtration, they also regulate blood pressure (via the renin/angiotensin system), blood volume, vitamin D and calcium balance and red blood cell production.

Filtration takes place at a delicate membrane layer, which is the usual site for chronic kidney disease. Damage to this membrane is caused mostly by inflammation of the filtration apparatus or blockage with protein complexes, from an immunological cause. High blood pressure damages circulation within the kidneys, while kidney disease itself leads to high blood pressure. The other common cause of kidney failure is diabetes, which damages the filtration surface and the blood flow. Less common but still serious causes of kidney failure are infections, large kidney stones, obstruction to urine flow, serious falls in blood pressure, certain drugs, tumours and congenital abnormalities of the kidneys.

Symptoms of Kidney Failure

These are rarely dramatic at the onset; you pass urine that is a little more dilute than usual, blood pressure creeps up. If things deteriorate you feel tired and nauseous as waste products accumulate within the blood. Blood pressure may reach high levels, there is anaemia and swelling of limbs. Eventually there is profound tiredness, nausea, itching, bone pain and ultimately confusion or convulsions.

Kidney failure is confirmed by blood tests showing raised levels of the breakdown products urea and creatinine, and specialized measures of the efficiency of the kidneys. Often a kidney biopsy is required to establish the cause. Abrupt kidney failure is usually the result of either low blood pressure, for example after haemorrhage in an accident or major surgery, or acute infection.

Treatment of Kidney Failure

Clearly, blood pressure, obstruction or diabetes must be controlled or eliminated. Special diets control a number of salts poorly handled in kidney failure, such as sodium, potassium, calcium and phosphate. A low-protein diet reduces the load on the kidneys and may slow progression of the disease.

Anaemia used to be unbeatable but can now be helped by injections of synthetic erythropoietin, which the kidneys normally produce to maintain red blood cell numbers.

Eventually the kidney patient may require kidney dialysis or a kidney transplant.

QUESTIONS

How common is kidney failure?

Chronic failure resistant to all but transplant affects about one person in ten thousand per year. Many more people have a more modest degree of kidney failure requiring dialysis or special diets.

Can it be avoided?

Most cases are unavoidable, the cause being some as yet unknown immune condition. However, good control of blood pressure and diabetes reduces the chances of kidney failure.

Complementary Treatment

Kidney failure is a medical emergency and needs to be treated in hospital. However, many complementary therapies can aid recuperation. Those listed under Stress could all help case the tension associated with being ill and in hospital. Sec Diabetes and Gastrointestinal Allergy for kidney disease linked to these conditions. Depending on the cause of the disease, traditional Chinese medicine (acupuncture, herbalism, tai chi/chi kung) may offer help, as may Ayurveda.

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