How to Prevent Kidney Failure

Kidney failure is a life-threatening condition and there are a number of simple measures that help to protect our kidneys.  To understand how we can protect ourselves from kidney failure, it is important to first know what it is.

What is kidney failure?

Kidney failure is a condition in which the kidneys are no longer able to perform their assigned function of filtering waste products from the blood. When the functioning efficiency of the kidneys is less than 10% of normal, it is called as kidney failure.

It is a medical emergency that requires immediate medical attention and medical interventions. When there is kidney failure, the individual will need either dialysis or kidney transplantation to remove the waste products from the blood, failing which, the build-up of these toxins in the blood can cause life-threatening situations.

Are there different types of kidney failure?

Kidney failure can occur either suddenly or slowly progress over time. The following are the different types of kidney failure that are seen

• Acute Kidney Failure or Acute Kidney Injury: This is kidney failure that occurs suddenly. It is caused either by a reduced flow of blood to the kidneys, an internal problem with the kidneys, or any condition that causes an obstruction to the outflow of urine from the kidney

• Chronic Kidney Failure: This is kidney failure that occurs gradually and this type of kidney failure usually does not show any symptoms in the early stages of the disease.

• Acute Chronic Kidney Failure:  This sudden (acute) kidney failure can occur in the presence of chronic kidney failure and kidney disease.

What causes kidney failure?

Kidney failure can result from underlying medical conditions that affect the kidneys. They can also be caused by genetic factors and environmental factors. Different factors can result in either chronic kidney failure or acute kidney failure. The causes of Acute Kidney Failure can include

Low volume of circulating blood

There are many conditions that can cause a drop in the volume of blood. A drop in circulating blood volume can then result in a decreased blood supply to the kidneys resulting in their malfunctioning. Some conditions that can result in a drop in blood volume include

• Dehydration: Dehydration is from lack of intake of enough water and fluids, excessive sweating, excessive dry weather

• Use of certain medications – such as diuretics

• Burns
• Severe blood loss from trauma or major surgical procedures
• Medical conditions such as pancreatitis

Heart Disease

The heart and the kidneys are closely associated, and a condition that affects one is seen to invariably have a deleterious effect on the other. Conditions that affect the heart such as a heart attack, heart failure, heart valve disease, and low blood pressure can negatively affect the circulating blood volume or cause a reduced blood supply to the kidneys.

Infections – severe infections such as sepsis and even infections of the kidneys can result in acute kidney failure

Medications and Toxins – a number of drugs and medications can cause an acute failure of the kidneys including regularly used medications such as NSAIDs, antacids, contrast agents used for imaging tests, chemotherapy drugs, etc. Alcohol abuse, vitamin C overdose, and heavy metal poisoning can also cause kidney tissue damage and failure.

Blockage of blood supply to the kidneys – clots in the blood vessels or narrowing of the blood vessels supplying the kidneys can reduce blood flow and cause kidney tissue damage.

Kidney disease – such as glomerulonephritis can also cause acute kidney failure

Urine outflow obstruction – anything that causes an obstruction to the outflow of urine from the kidneys can cause a build-up of toxins within the kidney tissues and cause tissue damage. Some common conditions that are responsible for this include stones in the kidneys or ureters, tumors of the kidneys, scarring due to surgeries, enlargement of the prostate gland, prostate cancer, etc.

The causes of Chronic Kidney Failure include

• Poorly controlled and managed long-term diabetes mellitus
• Poorly controlled and managed high blood pressure
• Some kidney diseases such as polycystic kidney disease
• Long-term use of medications such as painkillers including paracetamol
• Some viral infections – such as those with the Hantavirus
• Some diseases affecting the immune system such as lupus

Who is at risk of developing kidney failure?

While it is possible that kidney failure can affect anybody, the risks of developing this condition are higher in some people. The risk factors for kidney failure include

• Elderly age group – Individuals over the age of 60 years are more likely to develop kidney failure than younger adults. This has to do with many factors including the presence of other medical conditions that develop with age and the effects of aging on the functioning of the various organs of the body.
• Severe medical conditions that require intensive care and hospitalization – Individuals with severe medical conditions are more likely to develop kidney failure either acute or chronic due to many factors including the increased load placed on the kidney from medications, investigations, and procedures.
• Diabetes – A chronic medical condition which when present has the tendency to affect multiple organs and organ systems due to the high levels of circulating blood sugars, and the damage that is subsequently cause to the small blood vessels and nerves.
• High blood pressure – Uncontrolled high blood pressure over time results in the narrowing of the blood vessels that reduces the blood flow to many organs including the kidneys.
• Heart Disease – Individuals with conditions that affect the heart such as heart attack, heart failure, or severe heart valve disease generally have a reduction in proper and efficient blood supply to the various other organs of the body including the kidneys. This predisposes them to an increased risk of developing kidney failure
• Kidney and Liver Disease – Individuals with pre-existing kidney and liver diseases are also at a very high risk of developing kidney failure when compared to those that have healthy kidneys and liver.
• Peripheral Artery Disease (PAD) – Individuals with peripheral artery disease are at a higher risk of developing kidney failure, as PAD can lead to a narrowing of the blood vessels supplying blood to the kidneys.
• Chemotherapy – Individuals undergoing chemotherapy for the treatment of cancer, are also at an increased risk of developing kidney failure due to the highly toxic nature of these medications that have the potential to damage kidney tissues.

What are the symptoms of kidney failure?

Kidney failure that develops slowly may not present with any symptoms in the initial stages, whereas the symptoms tend to come on suddenly in the case of acute kidney failure. Some of the symptoms of kidney failure include

• Nausea and vomiting
• Loss of appetite and weight loss
• Tiredness
• Increased frequency of urination and increased urination at night
• Either low urine output or excessive urine output
• Blood in urine
• Frothy urine
• Itching
• Muscle cramps
• Back pain
• Swelling of the hands, legs, ankles, feet, and face
• Shortness of breath
• Abnormal heart rhythms
• Low blood pressure
• Muscle paralysis
• Dizziness
• Seizures
• Loss of concentration and memory loss
• Disturbed sleep

How is kidney failure diagnosed?

The diagnosis of kidney failure is done based on the clinical symptoms and medical history of the individual. Additionally certain investigations are also done to confirm the diagnosis. These investigations include

• Measurement of urine output - The amount of urine passed in 24 hours is measured. The urine output may be lower or higher than the standard urine output in normal kidney function.  
• Complete Urine Examination - A complete examination of the urine including cells, albumin/protein, sugars, blood etc is done
• Blood tests and Renal Function tests- to measure the levels of levels of urea, nitrogen, Creatinine and eGFR. The eGFR test is an important test that is an estimated measure of the glomerular filtration rate and it gives an overall picture about the functioning capacity and efficiency of the kidneys at the time of the test.
• Imaging tests - Ultrasound and CT scan of the abdomen may be required
• Kidney Biopsy - Biopsy to obtain a sample of kidney tissue may be required in some cases to identify the type and extent of kidney damage or the underlying disease present.

Can kidney failure be treated once it develops?

Kidney failure can be treated once it develops, however, the type of treatment that helps or that is require depends both on the underlying cause of the failure as well as on the severity of failure. Individuals with chronic kidney failure however, cannot expect a restoration of kidney function, but treatment helps to slow the progress of the condition, and retain the existing function of the kidneys.

The aim of treatment in kidney failure is to restore kidney function and prevent further damage to the kidneys.

Treatment of kidney failure can include

• Medical Management –
  • Stopping any drugs or medications that are causing kidney damage
  • Antibiotics – if there is an infection of the kidneys or if there is sepsis
  • Fluid Replacement
  • Electrolyte replacement – to manage potassium and calcium levels
• Interventions –
  • Dialysis – is done to remove the excess fluid, toxins, or potassium from the body. Dialysis may be done continuously until kidney function improves or it may be done intermittently.
  • Catheter placement – if there is an obstruction to the outflow of urine, a catheter is placed to remove the urine from the kidneys or urinary bladder
  • Surgical procedures – to remove any obstruction such as stones, tumors, narrowing of blood vessels, etc.
  • Kidney Transplantation – it is the final and last resort when other management methods have failed to restore kidney function.

What is the outlook for people with kidney failure?

The outlook for kidney failure depends majorly on what the underlying cause is, how early it is identified, and how well it is managed. Individuals with chronic kidney failure greatly benefit from early medical interventions. Acute kidney injury however, has a poorer outlook especially if it develops after surgical interventions. Permanent kidney damage is more likely in acute kidney failure resulting in the need for continued dialysis or even kidney transplantation, and an overall reduce quality of life.

What are the measures that can be taken to prevent kidney failure?

Lifestyle and our habits

Lifestyle and our habits make a huge difference in our well-being and health. It is therefore important that we pay attention to how we live and take necessary but simple steps to ensure that we not only stay healthy overall, but protect our vital organs such as our kidneys from severe damage and life-threatening complications. Some measures that will ensure that our kidneys stay healthy include

Regular monitoring and strict control of blood sugar levels:

This is especially important for those who are living with diabetes. Keeping blood sugars under control by taking the prescribed medications in a timely manner and following the lifestyle modifications advised by doctors will ensure that the long term complications of this chronic condition do not affect the kidneys.

Keeping high blood pressure under control:

Individuals with hypertension should regularly check their blood pressure levels and take prescribed medications without fail as well as follow the lifestyle modifications advised by medical specialists. Controlling high blood pressure is important to keep the kidneys healthy and prevent kidney failure.

Maintain an ideal body weight:

Shedding those extra pounds in a proper manner and keeping an ideal height-to-weight ratio is important to ensure that the risk of heart disease, hypertension, diabetes, and other chronic diseases is greatly reduced, which in turn reduces the risk of kidney failure.

Getting Regular Exercise:

Regular exercise keeps the entire body including the heart and cardiovascular system healthy. Regular exercise also helps to reduce any extra weight that can be one of the unwanted side effects of a sedentary lifestyle.

Avoiding self-medication and overuse of painkillers:

These seemingly harmless acts of taking or depending on painkillers can put a great amount of stress on the kidneys leading to complications and kidney failure.

Eat a healthy diet:

A diet rich in fruits and vegetables, whole grains, lean meat, low-fat dairy is important to keep the kidneys healthy. Avoiding a diet that is high in salt, red meat, trans-fats is also important to lower the risk of heart diseases and subsequent kidney disease.

Ensure Proper Hydration:

It is important to consume the required and right amounts of water and fluids to ensure that the kidneys are not put under a strain, and the blood supply to the kidneys is maintained as needed. It is also important to ensure that the right amount of electrolytes such as potassium, calcium, sodium, etc., are also being given to the body.

Avoid Alcohol Consumption:

Consuming alcohol results in dehydration and alcohol also directly damages kidney tissues especially when it is consumed in high doses. It is therefore advisable to avoid or moderate the consumption of alcohol to ensure healthy kidneys.

Avoid Smoking:

Smoking is a known cause of numerous health problems including heart disease, hypertension, diabetes, etc., all of which can result in kidney problems and kidney failure. It is therefore to start taking measures to completely stop smoking.

Reduce stress:

Stress influences the management of diabetes and high blood pressure. Keeping stress under control helps to keep high blood sugars and high blood pressure under control, and also promotes heart and kidney health.

Get Regular Medical Check-ups:

If there is a family history of kidney disease, if there is a previous history of kidney problems, or if there are other risk factors that increase the likelihood of kidney disease, then it is important to get regular medical check-ups with a nephrologist near you. Even in the absence of any such risk factors, adults over the age of 45-50 years will benefit from getting regular annual health check-ups that will assess their overall health, and indicate any potential problems if present.