Comprehensive Guide to Kidney Failure Treatment

Kidney failure, or renal failure, happens when the kidneys can no longer filter waste & excess fluids from the bloodstream. These organs are essential for maintaining the body's equilibrium by managing fluid levels, electrolytes, and the removal of waste. 

When kidney function declines, toxins and fluids accumulate, causing various severe health complications. Kidney failure can be acute (developing suddenly) or chronic (gradually worsening over time). Acute kidney failure often results from injury, dehydration, or infections.

In contrast, chronic kidney disease (CKD) is typically caused by long-term conditions like diabetes, high blood pressure, or certain genetic disorders. Without timely treatment, kidney failure can lead to life-threatening complications such as fluid retention, heart failure, and toxin buildup.

Types of Kidney Failure and Their Symptoms

Kidney failure is broadly categorized into acute kidney failure and chronic kidney disease (CKD), each with distinct causes, progression, and symptoms. Understanding these types is key to recognizing the disease early and seeking timely medical care.

1. Acute Kidney Failure (AKF)

Acute kidney failure occurs suddenly & is often reversible with prompt treatment. It develops within a few hours to days and is usually caused by an event that disrupts kidney function, such as an injury or a severe illness. Acute kidney failure can progress to chronic kidney disease if left untreated for too long.

Causes of Acute Kidney Failure

• Severe dehydration: Insufficient fluid levels in the body can cause reduced flow of blood to the kidneys
• Acute infections: Sepsis or a severe infection can cause a rapid decline in kidney function
• Obstruction: Blockages in the urinary tract (like kidney stones) can prevent urine from draining properly
• Certain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, or chemotherapy can harm the kidneys
• Trauma or surgery: Physical injuries, especially to the kidneys, or major surgery can lead to acute kidney failure

Symptoms of Acute Kidney Failure

The symptoms may vary in severity, but common signs include:

• Reduced urine output: A significant decrease in urine produced or complete cessation of urine output (anuria)
• Swelling: Fluid retention may cause swelling in the ankles, legs, or around the eyes
• Fatigue: Feeling unusually tired or weak, the kidneys cannot remove waste and excess fluids
• Shortness of breath: Fluid that builds up in the lungs can cause breathing difficulties
• Confusion: A buildup of waste products like urea and creatinine can affect mental clarity, leading to confusion or disorientation
• Chest pain or pressure: This can be caused by fluid buildup in the lungs or heart, a potentially life-threatening symptom
  

2. Chronic Kidney Disease (CKD)

Chronic kidney disease is a slow and irreversible decline in kidney function. It develops over several months or even years, often due to long-term conditions like high blood pressure or diabetes. 

This disease is classified into five stages, with stage 1 representing mild kidney dysfunction and stage 5 representing end-stage renal disease (ESRD), where the kidneys have lost nearly all function.

Causes of Chronic Kidney Disease

• Diabetes
• High blood pressure (hypertension)
• Glomerulonephritis
• Polycystic kidney disease (PKD)
• Prolonged use of certain medications
• Heart disease

Symptoms of Chronic Kidney Disease

In the early stages, CKD often presents few or no symptoms, so regular check-ups and blood tests are crucial for detection. 

As the disease progresses, the symptoms become more noticeable and severe. Symptoms include:

• Fatigue
• Swelling in the feet, ankles, legs, or hands
• Urinary changes like urine may also appear foamy, indicating excess protein
• Shortness of breath
• Loss of appetite
• Itchy skin
• Confusion or difficulty concentrating
• High blood pressure

3. End-Stage Renal Disease (ESRD)

End-stage renal disease is the end stage of chronic kidney disease. Here the kidneys function at less than 15% of their standard capacity. At this stage, kidney failure becomes life-threatening, and individuals require either dialysis or a kidney transplant to survive.

Symptoms of ESRD

• Complete loss of appetite and nausea
• Severe fluid retention leads to swelling throughout the body
• Severe fatigue and weakness make everyday tasks nearly impossible
• Very high blood pressure that cannot be controlled by medications
• Persistent shortness of breath due to fluid buildup in the lungs
• Heart complications, including arrhythmias, as the kidneys no longer regulate electrolytes properly
• Difficulty sleeping or restless legs due to a buildup of toxins in the blood
• Itchy skin that does not improve with moisturizing

At this stage, the focus is on managing symptoms and providing life-sustaining treatments like dialysis. A kidney transplant is often the best option for patients with ESRD who are otherwise healthy enough for surgery.

Stages of Kidney Failure: Understanding the Progression

Kidney failure progresses in five stages based on the level of kidney function, measured by the glomerular filtration rate (GFR). The GFR is a blood test that estimates how well the kidneys filter waste & excess fluids. 

As kidney function declines, the GFR decreases, and symptoms of kidney disease become more pronounced. Early-stage kidney disease often has few symptoms, which is why regular testing is vital for those at risk. 

Understanding these stages of kidney failure can help individuals manage their health better and seek appropriate treatments before kidney function deteriorates too much.

Stage 1: Damage in Kidney with Normal or High GFR (GFR ≥ 90)

In this initial stage, the kidneys are damaged but functioning normally or nearly usually. There may be no noticeable symptoms, and kidney function is generally detected through blood or urine tests showing protein in the urine or other signs of kidney damage.

Key Features

• GFR of 90 or higher
• Mild kidney damage or early signs of kidney disease
• Presence of protein in the urine or abnormalities in imaging tests
  

What You Can Do

• Your focus should be on managing risk factors, such as diabetes & high blood pressure, to prevent further damage
• Follow a kidney-friendly diet, stay hydrated, and exercise regularly to support kidney function
• Regular check-ups and urine tests to monitor kidney health

Stage 2: Damage in Kidney with Mild Decrease in GFR (GFR 60–89)

In stage 2, kidney function has decreased mildly, but the kidneys can still carry out their primary functions. Symptoms are often subtle or nonexistent at this point. However, tests may show an elevated level of waste products in the blood or slight damage to the kidney tissue.

Key Features

• GFR between 60 and 89
• Mild decrease in kidney function
• Increased waste products in the blood
• Proteinuria may persist or worsen
  

What You Can Do

• Control underlying health conditions, particularly hypertension or diabetes, which can contribute to kidney damage
• Your doctor may recommend you some lifestyle changes, such as a low-sodium diet, avoiding smoking, and keeping blood sugar levels within target ranges
• Regular kidney function tests to track changes in GFR
  

Stage 3: Moderate Kidney Damage (GFR 30–59)

At this stage, kidney function is moderately reduced. Symptoms like fatigue, swelling in the legs & ankles, and back pain may become noticeable. Waste products like creatinine and urea begin to accumulate in the bloodstream. Based on the degree of kidney impairment, this stage is often divided into Stage 3a (GFR 45-59) and Stage 3b (GFR 30-44).

Key Features

• GFR between 30 and 59
• Moderate kidney dysfunction with more noticeable symptoms
• Increased complications, such as high blood pressure, anemia, and bone health issues
  

What You Can Do

• Medications may be prescribed to control high blood pressure, lower protein in the urine, and manage other symptoms, such as anemia
• Close blood pressure and blood sugar monitoring are essential to prevent further damage
• Consider seeing a nephrologist (kidney specialist) for further evaluation and management

Stage 4: Severe Kidney Damage (GFR 15–29)

Stage 4 kidney disease is a severe reduction in kidney function, and the kidneys are no longer able to filter waste and fluids effectively. Symptoms are more pronounced, and individuals may experience significant fatigue, swelling, and other complications like itchy skin and shortness of breath. 

This stage is often when people begin to prepare for possible dialysis or a kidney transplant.

Key Features

• GFR between 15 and 29
• Severe decline in kidney function
• Notable symptoms include swelling, fatigue, shortness of breath, and nausea
  

What You Can Do

• At this stage, a nephrologist will likely recommend more frequent monitoring and may discuss treatment options such as dialysis or kidney transplant
• Medications may be prescribed to manage fluid retention, high blood pressure, and electrolyte imbalances
• Lifestyle changes, such as limiting salt intake, reducing protein consumption, and managing underlying conditions, will be crucial in slowing progression

Stage 5: End-Stage Renal Disease (GFR < 15)

Stage 5 or end-stage renal disease (ESRD) or kidney failure, is the final and end stage of kidney disease. Here the kidneys have lost almost all of their function. The kidneys can no longer remove waste or excess fluids from the body, leading to life-threatening complications. Dialysis or a kidney transplant is necessary to sustain life.

Key Features

• GFR below 15
• Severe kidney failure with almost no function
• Life-threatening symptoms such as severe fatigue, fluid overload, heart problems, and toxic buildup in the blood

What You Can Do

• Dialysis is a procedure that replaces the kidneys' filtering function. There are two types: hemodialysis (filtering blood outside the body) and peritoneal dialysis (using the abdominal lining to filter blood).
• Kidney transplant: If suitable, this is the best long-term solution. A kidney transplant involves replacing the failed kidneys with a healthy donor kidney.
• Symptom management: Managing symptoms like fluid retention, high blood pressure, anemia, and electrolyte imbalances is key to improving quality of life

Diagnosis of Kidney Failure

Diagnosing kidney failure typically involves a combination of blood tests, urine tests, imaging, and physical examination to assess the degree of kidney dysfunction and identify the underlying cause.

Blood Tests (Serum Creatinine and GFR)

A key blood test used to assess kidney function is the serum creatinine test, which measures the level of creatinine (a waste product) in the blood. Elevated creatinine levels suggest that the kidneys are not effectively filtering waste. 

From the serum creatinine result, doctors calculate the glomerular filtration rate (GFR), a measure of kidney function. A GFR below 60 for three months or maybe more indicates kidney disease. In advanced kidney failure (Stage 5), the GFR drops below 15, indicating end-stage renal disease (ESRD).

Urine Tests

Urine tests check for abnormalities—protein in the urine (Proteinuria) & hematuria (blood in the urine). Proteinuria is a mojor sign of kidney damage, and persistent protein in the urine can indicate the progression of kidney disease. 

Urine albumin-to-creatinine ratio (UACR) is often used to detect early kidney damage. A high UACR suggests an increased risk of kidney failure.

Imaging Tests (Ultrasound, CT Scan, MRI)

Imaging tests like ultrasound or CT scans visualize the size and structure of the kidneys. They can help detect conditions like kidney stones, cysts, or tumors present in the urinary tract that could impair kidney function. 

A renal ultrasound is noninvasive and commonly used to identify kidney damage or abnormalities in the urinary system.

Kidney Biopsy

In some cases, doctors may recommend a kidney biopsy if the cause of kidney damage is unclear. During a biopsy, a small sample of your kidney tissue is removed & examined under a microscope to identify signs of glomerulonephritis, infection, or other conditions that could be causing kidney dysfunction. 

This test is typically performed if the kidney disease is progressing quickly or if the exact type of kidney disease needs to be determined.

Physical Examination

A physical exam includes measuring blood pressure, checking for swelling in the legs, ankles, or around the eyes, and listening for heart or lung abnormalities. High blood pressure is both a cause and a consequence of kidney disease, so it is closely monitored.

The doctor will also assess for symptoms like fatigue, shortness of breath, or nausea, which could indicate worsening kidney function.

Other Tests and Assessments

Depending on the suspected underlying cause of kidney failure, further tests may be required, such as

• Blood tests for electrolyte imbalances (sodium, potassium, calcium, etc.)
• Tests for autoimmune diseases (if glomerulonephritis is suspected)
• Infectious disease screening (for kidney infections or hepatitis)

Treatment of Kidney Failure

1. Lifestyle Changes and Medications (Stage 1–3)

In the early stages of kidney failure i.e., Stage 1 to Stage 3, the primary treatment involves lifestyle modifications and medications to prevent further damage.

Key Approaches

• Dietary Modifications: A kidney-friendly diet is crucial to reduce kidney strain. This includes reducing salt intake, limiting protein consumption, and ensuring adequate hydration. Foods high in potassium and phosphorus may need to be limited in later stages.
• Blood Pressure Control: High blood pressure is a leading cause of kidney damage. Medications may be prescribed to control blood pressure and protect the kidneys
• Managing Blood Sugar: For individuals with diabetes, controlling blood sugar levels is critical to prevent further kidney damage. Medications, insulin therapy, and dietary changes can help maintain stable blood sugar levels.
• Cholesterol and Lipid Management: Statins may be prescribed to control cholesterol levels, often elevated in people with kidney disease

2. Dialysis (Stage 4–5)

When kidney function falls to Stage 4 or Stage 5 (severe kidney failure or end-stage renal disease), the kidneys can no longer filter waste or excess fluids adequately. Dialysis is a treatment that artificially performs these functions, removing waste products and maintaining fluid balance.

Types of Dialysis

• Hemodialysis: In this procedure, blood is removed from the body, cleaned through a machine (dialyzer), and returned to the body. This process is typically done in a hospital or dialysis center, though some people may undergo hemodialysis at home.
• Peritoneal Dialysis: This method involves placing a sterile solution (dialysate) into the abdomen through a catheter. The lining of the abdomen acts as a natural filter, removing waste and excess fluids. Peritoneal dialysis can be done at home. It is either done manually or using a machine.

Dialysis helps manage symptoms, but it does not cure kidney failure. Depending on the individual's condition, hemodialysis is typically required three times a week, or peritoneal dialysis daily.

3. Kidney Transplant (End-Stage Renal Disease)

For patients with end-stage renal disease (Stage 5), a kidney transplant is the most preferable long-term treatment. A kidney transplant involves replacing the failed kidneys with a healthy one from a living or deceased donor. 

This option can significantly improve the quality of life and restore kidney function, but it requires lifelong immunosuppressive medications to prevent the body from rejecting the new kidney.

Key Considerations

• Eligibility: Not everyone with kidney failure is a candidate for a transplant. A thorough evaluation, including health status, age, and other medical conditions, is required to determine eligibility.
• Waitlist: Kidney transplants often involve a long waitlist, as suitable donors may be limited. The wait can range from months to several years, depending on factors like blood type, tissue compatibility, and availability of organs.
• Post-transplant Care: After a kidney transplant, patients need regular follow-up care to monitor kidney function and prevent rejection. Immunosuppressive drugs may cause side effects such as increased risk of infection or certain cancers.

4. Managing Underlying Conditions

In addition to dialysis or kidney transplant, managing the underlying conditions that cause kidney failure is essential. This includes:

• Chronic Kidney Disease (CKD) Management: For patients with CKD, maintaining kidney function can involve medications, dietary adjustments, and lifestyle changes
• Managing Infections: If the kidney failure is due to an infection or glomerulonephritis (inflammation of the kidney’s filtering units), treatments may include antibiotics or immunosuppressive medications
• Kidney Stones: If kidney failure is caused by kidney stones, treatments might involve procedures like shock wave therapy or surgery to remove the rocks

5. Palliative Care

For individuals with end-stage kidney disease who won't be undergoing dialysis or transplant, palliative care may be offered to manage symptoms & improve quality of life. Palliative care focuses on providing comfort, controlling pain, and addressing emotional and psychological needs during the final stages of the disease.

6. Preventing Kidney Failure in High-Risk Individuals

Early detection & preventive care are essential for individuals at high risk of kidney failure, such as those with diabetes, high blood pressure, or a family history of kidney disease. Regular check-ups, blood tests (to monitor creatinine levels and GFR), and urine tests (to detect proteinuria) are vital for identifying kidney issues before they progress to failure. Early intervention through lifestyle changes, managing underlying conditions, & appropriate medication can greatly reduce the risk of developing kidney failure.

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to healthy kidneys. If you are looking for the best kidney specialist in Ahmedabad and Vadodara Race Course Road, Vadodara Bhayli, we've got you. With considerable years of experience, we have built a team of the best nephrologists in these regions to provide you with premium treatment and the best results. Safeguard your kidney health and contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier life.