What is kidney failure?
75% of all kidney failure is caused by the destruction of the tubules.A sudden loss of kidney function (acute renal failure) can be immediately life-threatening, while chronic kidney failure is a more gradual and progressive deterioration. Chronic kidney failure is the progressive loss of kidney cells and is a feature of long-term disorders including kidney disease, diabetes, high blood pressure, and inherited kidney disorders such as polycystic kidneys. Treatment for kidney failure includes dealing with the underlying cause of the condition as well as supporting production of vitamin D and red blood cells. If the kidneys fail completely, dialysis and a kidney transplant may be necessary.
What do kidneys do?
3600 pints of blood are received by the kidney every 24 hours. Our kidneys are part of the renal system which includes the kidneys, ureters, bladder, and urethra. The kidneys keep the body’s fluid and chemical composition in balance, clean the blood and regulate pH (acid level). The main job of the kidneys is to clean waste from the blood. Kidneys filters all of our blood every 25 minutes. The kidneys also play a role in the renin-angiotensin system, which regulates blood pressure, and in the metabolism of vitamin D, and they secrete erythropoietin to stimulate the production of red blood cells. When the kidneys fail, they can no longer do their job. Kidney failure can effect every system in our body.
The kidneys are located at the very back of your abdominal wall, near the 12th rib. They are on either side of your spine about an inch away. The kidneys are very selective filters for your blood. They remove extra water, electrolytes, and other waste from the blood which leave your body as urine.
Urine is made of water, urea, electrolytes, and other waste products. The exact contents of urine vary depending on how much fluid and salt you take in, your environment and your health.
- 94% water
- 3.5% urea
- 1% sodium*
- .5% chloride*
- .25% potassium*
- .25% phosphate*
- .25% sulfate
- .15% creatinine
- .1% uric acid
Electrolytes become ions in solution and can conduct electricity; they are needed for the normal function of organs and cells. Many processes in the body, especially in the brain, nervous system, and muscles, use electrical signals to communicate. Having electrolyte levels too high or too low can cause cells, muscles and organs not to work as they should and can even cause death.
Understanding kidney anatomy and function may help you better understand the disease and why it is important for you to follow a renal diet, have dialysis treatments or take medicines.
What causes kidney failure?
Kidney failure can be caused by:
- uncontrolled high blood pressure
- uncontrolled diabetes (high blood sugar)
- kidney infections, kidney stones, infected kidneys, gout
- systemic lupus erythematosus
- taking certain over-the-counter drugs for a long time
- acute tubular necrosis
- injury to the kidneys
These are some of the main causes. Ask your doctor (nephrologist) if one of these or something else caused your kidney failure.
Why does kidney failure make you feel bad?
When your kidneys fail, fluid waste and salts build up in your blood stream. Your blood pressure can get very high, and your body won’t make enough red blood cells. Your feet and legs can swell and feel uncomfortable. Together, these can make you feel sick. You may notice:
- a bad taste in your mouth, bad breath
- feeling sick to your stomach (nauseated)
- feeling tired and rundown
- pain in your back, just below your ribs (where your kidneys are)
- shortness of breath
- skipped heartbeats
- swelling in your feet and ankles, or hands and wrists
- swelling or puffiness around your eyes
- you don’t urinate as often as usual; you have dark urine, bloody urine, and/or burning when you urinate
- you have to urinate more often than usual, especially at night
It is common for you to feel bad all over until you start treatment.
When will I feel better?
You’ll start feeling better when your body gets rid of the extra fluid, waste and salts. Your failed kidneys can’t be fixed, but you can have treatments to do the job of your kidneys. Treatment for kidney failure has to be done for the rest of your life; you cannot live without the treatments or a new kidney.
Kidney failure is hard on your body and spirit and it affects every part of your life. It’s normal to feel scared about the future. You may feel angry, sad, and depressed as you learn of all the changes kidney failure brings and as you begin coping with these changes. You may feel that it just too much to deal with all at once. Once you start treatment, work out your new routine and get a better understanding of what you must do going forward, you will gain confidence—the scary and hopeless feelings won’t be as strong. Family and friends will be learning along with you, and they can offer help and support you so all of you can get on with your lives.
What can I expect long term?
Your long term choices for treatment are dialysis or a kidney transplant. Until you get a transplant, you will probably be on dialysis. Long term treatment for kidney failure can be broken down into 3 main parts that you must do for the rest of your life. These treatments take over the jobs your kidneys used to do.
- Dialysis – artifical kidney that cleans and filters your blood.
- Medicine – to help control blood pressure and rid your body of salt and fluid
- A Special Renal Diet – limits the amount of fluids and certain substances you can eat or drink
Your doctor will guide you in setting diet restrictions and prescribe medicines that are best for you based on your overall health and your kidney failure.
Dialysis cleans and filters your blood. There are 2 kinds of dialysis, peritoneal dialysis and hemodialysis. Peritoneal dialysis cleans your blood while its still in your body. Hemodialysis (shown in the image) cleans your blood by running your blood through an artificial kidney machine.
There is a lot to know about both peritoneal dialysis and hemodialysis. Once you find out which type of dialysis you will be on, learn as much as you can about it so you can better plan your days that you aren’t on dialysis.
A kidney transplant may be a choice for you—that is, putting a kidney from someone else inside your body. With a new kidney, you won’t need dialysis treatments any longer, but you still have to take extra care of yourself.
There may be someone in your family member who can donate a kidney, or you can be put on a waiting list until a kidney can be found. People on a kidney transplant waiting list are tested to be sure that the new kidney is a good match. There aren’t enough kidneys to go around, therefore strict rules have been set up to decide who gets a transplant. Waiting lists usually don’t include people who have cancer, AIDS or heart disease, have a drug or alcohol problem. You also may not be considered if you haven’t been sticking to your renal diet, taking your medicines or other treatments.
After a kidney transplant you can eat a less restrictive diet than when you were on dialysis. But you still have to limit salt and take medicines. You also need your blood and urine tested often to monitor how your new kidney is working.
Sometimes the body rejects the new kidney even though the tests show the kidney is a good match for you. Rejection can start after a month, or even years after the transplant. You may be able to get another kidney; if not you will have to go back on dialysis.
“It’s just too much to think about right now.”
It is normal not to be able to think straight when you first find out you have kidney failure. Chances are your mind isn’t clear due to the waste in your body and the shock of learning that you have a serious illness.
Keep in mind, you don’t have to decide on long-term treatment right away. You’re already getting short-term treatment in the hospital or at the dialysis clinic. Soon you’ll be able to think more clearly, but right now you need a supportive family and friends. Don’ be afraid to ask them for help or let them know what they can do.
So which treatment is best? That depends on:
- illnesses you have had in the past (such as heart disease or diabetes)
- your overall health and how sick you are right now
- your age
- your habits or lifestyle (do you live alone, do you work, do you have support)
Some choices are easy to make; if you don’t have family that can donate a kidney or you aren’t eligible for the kidney transplant list, then dialysis is your obvious choice. Talk with your doctor; he can help you choose which treatment is best for your situation.
Some people choose not to have treatment because they have other serious illnesses such as cancer or severe heart disease. They feel treatment prolongs death rather than extends life. Choosing not to have treatment is one that only you can make. If you’re thinking about refusing treatment, talk with your family, nurse, people at your church and doctors. The choice you make must be right for you.
How does kidney failure change your life?
At first, you’ll feel as if life as you knew it is over and your everything you do has changed. But keep in mind, thousands of new kidney failure patients learn to cope, live and work with kidney failure every yer. Once you get used to the changes, get a support system together, you’ll work out a routine you can handle.
You and someone close to you (family or friend) must learn all about your medicines—what it’s for, what it looks like, when to take it, and how much to take, what are the side effects and what to do if there is a problem. It is helpful to keep track of your medicines by writing them down. This is also helpful if some of your medicines are temporary (antibiotics) or may be changed later (blood pressure medicine). If you have a visiting nurse, they will want to know that you are taking your medicines as you should and a written record is an easy way for the nurse to follow.
Because your kidneys can no longer get rid of electrolytes, salts and fluids, you must follow a special diet to limit these nutrients. Your doctor will tell you which nutrients you must limit and how much you can have each day. The dietitian will help you understand your new diet, which foods to limit, and how to monitor and measure the amount of fluids you get every day. Take the food list to the grocey store. Read food labels and ingredients labels to find out how much of these nutrients are in the foods you choose. Some foods have to be measured and others must be cooked a certain way. Learn a variety of ways to make the foods you can eat so it won’t seem as if your diet is so limited. You also have to limit the amount of fluids you eat and drink every day.
This is an example of a special renal diet for people with kidney failure and sample menus. These are low sodium guidelines for 2 gram sodium diet and a one page list of the sodium content of foods for 2000 mg sodium diet.
Monitoring Your Weight
It’s a good idea to watch your weight every day. A weight gain likley means you have had too much salt or fluid. The dialysis clinic will weigh you each time you have a treatment.
Monitoring Your Blood pressure
Check your blood pressure twice a day, especially if you have high blood pressure or are now on blood pressure medicine. Blood pressure monitors are inexpensive and can be purchased at most drug stores. Be sure to take your blood pressure the right way so that you get an accurate reading.
Exercise is important. You need to be strong enough to do activities of daily living—walking around your home, taking a shower, getting dressed, etc. Exercise can also help you feel good mentally. Talk with your doctor about an exercise plan he can recommend for you. Ask if physical therapy would be helpful.
You should wear some type of identification at all times that lets others know you have kidney failure if for some reason you can’t tell them yourself. There are necklaces, charms and bracelets that will identify you as having kidney failure. This is especially important if you plan to travel.
Driving and Travel
If you’re on hemodialysis, at first you’ll need someone to take you to and from the clinic for treatment. It takes a a few visits to figure out how you will feel after each treatment. At some point, you may be able to drive yourself. As you get used to having dialysis and eating the right foods, you may feel like traveling. There are dialysis clinics all over the U.S. Your clinic can help you find one in the city where you want to go and can help you make arrangements for you to have treatment once you get there.
It’s normal for people with kidney failure to get depressed. Depression means more than being sad for a a few days. Depression is an illness and has its own warning signs. You and those who care for you should learn the warning signs so you can get help if you need it.
- feeling tired all the time, feeling like you have no energy
- changes in your weight or appetite
- feeling guilty for needing help
- feeling restless or worrying
- feeling sad, discouraged or hopeless
- feeling sick all the time
- feeling worthless because you need help
- losing interest in things you used to like and want to do
- you’re sleeping too much
- you have trouble remembering things, concentrating or making decisions, especially about your care
- you have trouble sleeping
- you’re having thoughts of suicide or wish you were dead
You and your family need a lot of support when you are first diagnosed. It is helpful to talk with each other, but you each need someone else you to talk with. Social workers at the hospital or dialysis clinic, nurses at the hospital or home health nurses, doctors, church members, neighbors, and friends can all help.
It is not good when families give up all of their outside interest to care for a loved one with kidney failure. Family members need to care for themselves and their family, too. They need to eat well, take breaks from being a caregiver, keep up some of their outside activities and get plenty of rest.
Living with kidney failure and the treatment of it is not easy for you or your family. But, working together, you can find ways to live well and manage all of the changes living with kidney failure brings. Take advantage of all of the help and support you can get. Use charts, worksheets, and any other tools that make it easier for you to keep up with treatment. These will make your life easier until you can get into a routine that becomes second nature to you. Keeping records and monitoring your health will come in handy if someone new helps care for you or your doctor wants to know how you have been doing.