Kidney Failure

Kidney, or renal, failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function.

There are two types of renal failure: acute and chronic.

Acute renal failure: has an abrupt onset and is potentially reversible.

Chronic failure: progresses slowly over at least three months and can lead to permanent renal failure.

The causes, symptoms, treatments, and outcomes of acute and chronic renal failure are different.

Causes of Acute and Chronic Renal Failure

• Acute renal failure may be caused by the following:
• Heart attack
• Rhabdomyolysis, or kidney damage that can occur from muscle breakdown
• Decreased blood flow to the kidneys for a period of time; this may occur from blood loss or shock
• An obstruction or blockage along the urinary tract
• Hemolytic uremic syndrome, usually caused by an E. coli infection
• Ingestion of certain medications that may cause toxicity to the kidneys
• Glomerulonephritis

• Chronic renal failure may be caused by the following:
• Diabetes
• Hypertension, or chronic high blood pressure
• Lupus
• A prolonged urinary tract obstruction or blockage
• Alport syndrome
• Nephrotic syndrome and tissue swelling
• Polycystic kidney disease
• Cystinosis
• Interstitial nephritis or pyelonephritis

Diagnostic Procedures

In addition to a physical exam and complete medical history, diagnostic procedures for renal failure may include the following:

• Blood tests to determine blood cell counts, electrolyte levels, and kidney function
• Urine tests
• Renal ultrasound, also called sonography; a noninvasive test in which a transducer is passed over the kidney producing sound waves that bounce off the kidney, transmitting a picture of the organ on a video screen. The test is use to determine the size and shape of the kidney and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
• Kidney biopsy, in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present
• Computed tomography scan (also called a CT or CAT scan), a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images, both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Treatment

Specific treatment for renal failure may include hospitalization; intravenous fluids to replace depleted blood volume; diuretic therapy or medications to increase urine output; close monitoring of important electrolytes such as potassium, sodium, and calcium; medications to control blood pressure; and specific diet requirements.

Some people may develop severe electrolyte disturbances and toxic levels of certain waste products that are normally eliminated by the kidneys. Fluid overload also may develop. In these cases, dialysis may be needed.

Treatment of chronic renal failure depends on the degree of kidney function that remains. Treatment may include medications to help with growth, prevent bone density loss, and/or to treat anaemia; diuretic therapy or medications to increase urine output; specific diet restrictions; dialysis; and kidney transplantation.

Dialysis

Dialysis is a procedure that is performed routinely on persons who suffer from acute or chronic renal failure. The process involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used for individuals who have been exposed to or ingested toxic substances to prevent renal failure from occurring. There are two types of dialysis that may be performed on your child: peritoneal or hemodialysis.

• Peritoneal dialysis. Peritoneal dialysis is performed by surgically placing a special, soft, hollow tube into your child's lower abdomen near the navel. After the tube is placed, a special solution called dialysate is instilled into the peritoneal cavity. The peritoneal cavity is the space in the abdomen that houses the organs and is lined by two special membrane layers called the peritoneum. The dialysate is left in the abdomen for a designated period of time which will be determined by your child's doctor. The dialysate fluid absorbs the waste products and toxins through the peritoneum. The fluid is then drained from the abdomen, measured, and discarded. There are two different types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD):

• CAPD does not require a machine. Exchanges, often referred to as "passes," can be done three to five times a day, during waking hours.
• CCPD requires the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even while your child is asleep.

• Hemodialysis. Hemodialysis is performed in a dialysis center or hospital by trained health care professionals. A special type of access, called an arteriovenous (AV) fistula, is placed surgically, usually, in your child's arm. This involves joining an artery and a vein together. An external, central, intravenous (IV) catheter may also be inserted, but is less common for long term dialysis. After access has been established, your child will be connected to a large hemodialysis machine which drains your child's blood, bathes it in a special dialysate solution which removes waste substances and fluid, then returns it to your child's bloodstream. Hemodialysis is usually performed several times a week and lasts for four to five hours. Because of the length of time hemodialysis takes, it may be helpful to bring games or reading materials for your child to occupy him or her during this procedure.