renal failure

من طرف ghonem الخميس نوفمبر 12, 2009 10:41 pm

renal failure

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Featured kidney failure patient discussions on symptoms experienced at onset of disease

"I lost my right kidney to cancer in 2007. Now I am told my left kidney is failing. My kidney failure symptoms were constant light- to-moderate pain at first, then profuse sweating, very weak, and shortness of breath."
"When my kidney stopped functioning, I was having abdominal pains, so my doctor suspected it was something wrong with my gall bladder. An ultrasound found kidney stones. A subsequent CT scan showed an extremely enlarged kidney, and the doctors recommended removal. In hindsight, I was fatigued and had incessant itching on small spots on my hands (with no apparent rash). Without the abdominal pain, I may not have discovered the kidney failure until infection or sepsis set in."
"When I had kidney failure, I had puffy eyes, my eyelids were twitching on their own, and I was urinating constantly around menstruation time or leading up to my period. I was also retaining loads of water and gaining weight around that time. I felt weak, my knees began to hurt, I had lower back discomfort, and I was extremely cold when entering places with air conditioning. I was dizzy sometimes, especially at night when lying down. My hair was breaking constantly, I was sleepy constantly, and I had no energy."Read All Comments on Kidney Failure »

Patient Discussions are not a substitute for professional medical advice, or treatment.
See the disclaimer at the bottom of the comments page.

What are the kidneys?

The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste products, but also by balancing levels of electrolytes in the body, controlling blood pressure, and stimulating the production of red blood cells.
The kidneys are located in the abdomen toward the back, normally one of each side of the spine. They get their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the renal veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)
The kidneys have the ability to monitor the amount of body fluid, the concentrations of electrolytes like sodium and potassium, and the acid-base balance of the body. They filter waste products of body metabolism, like urea from protein metabolism and uric acid from DNA breakdown. Two waste products in the blood can be measured: blood urea nitrogen (BUN) and creatinine (Cr).
When blood flows to the kidney, sensors within the kidney decide how much water to excrete as urine, along with what concentration of electrolytes. For example, if a person is dehydrated from exercise or from an illness, the kidneys will hold onto as much water as possible and the urine becomes very concentrated. When adequate water is present in the body, the urine is much more dilute, and the urine becomes clear. This system is controlled by renin, a hormone produced in the kidney that is part of the fluid and blood pressure regulation systems of the body.
Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels rise and the body starts to manufacture more red blood cells.
After the kidneys filter blood, the urine is excreted through the ureter, a thin tube that connects it to the bladder. It is then stored in the bladder awaiting urination, when the bladder sends the urine out of the body through the urethra.

What causes kidney failure?

Kidney failure can occur from an acute situation or from chronic problems.
In acute renal failure, kidney function is lost rapidly and can occur from a variety of insults to the body. The list of causes is often categorized based on where the injury has occurred.
Prerenal causes (pre=before + renal=kidney) causes are due to decreased blood supply to the kidney. Examples of prerenal causes are:

Hypovolemia (low blood volume) due to blood loss
Dehydration from loss of body fluid (vomiting, diarrhea, sweating, fever )
Poor intake of fluids
Medication, for example, diuretics ("water pills") may cause excessive water loss.
Loss of blood supply to the kidney due to obstruction of the renal artery or vein.

Renal causes (damage directly to the kidney itself) include:

Sepsis: The body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually does not occur with urinary tract infections.
Medications: Some medications are toxic to the kidney, including nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen. Others are antibiotics like aminoglycosides [gentamicin (Garamycin), tobramycin], lithium (Eskalith, Lithobid), iodine-containing medications such as those injected for radiology dye studies.
Rhabdomyolysis: This is a situation in which there is significant muscle breakdown in the body, and the degeneration products of muscle fibers clog the filtering system of the kidneys. Often occurring because of trauma and crush injuries, it can also be caused by some medications used to treat high cholesterol.
Multiple Myeloma
Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys. Many diseases can cause this inflammation including systemic lupus erythematosus, Wegener's granulomatosis, and Goodpasture syndrome.

Post renal causes (post=after + renal= kidney) are due to factors that affect outflow of the urine:

Obstruction of the bladder or the ureters can cause back pressure when there is no place for the urine to go as the kidneys continue to work. When the pressure increases enough, the kidneys shut down.
Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying.
Tumors in the abdomen that surround and obstruct the ureters.
Kidney stones

Chronic renal failure develops over months and years. The most common causes of chronic renal failure are related to:

Poorly controlled diabetes
Poorly controlled high blood pressure
Chronic glomerulonephritis

Less common causes:

Polycystic Kidney Disease
Reflux nephropathy
Kidney stones
.prostate disease
What are the symptoms of kidney failure?

In the beginning, kidney failure may be asymptomatic (not producing any symptoms). As kidney function decreases, the symptoms are related to the inability to regulate water and electrolyte balances, to clear waste products from the body, and to promote red blood cell production. Lethargy, weakness, shortness of breath, and generalized swelling may occur. Unrecognized or untreated, life-threatening circumstances can develop.
Metabolic acidosis, or increased acidity of the body due to the inability to manufacture bicarbonate, will alter enzyme and oxygen metabolism, causing organ failure.
Inability to excrete potassium and rising potassium levels in the serum (hyperkalemia) is associated with fatal heart rhythm disturbances (arrhythmias).
Rising urea levels in the blood (uremia) can affect the function of a variety of organs ranging from the brain (encephalopathy) with alteration of thinking, to inflammation of the heart lining (pericarditis), to decreased muscle function because of low calcium levels (hypocalcemia).
Generalized weakness can be due to anemia, a decreased red blood cell count, because lower levels of erythropoietin do not adequately stimulate the bone marrow. A decrease in red cells equals a decrease in oxygen-carrying capacity of the blood, resulting in decreased oxygen delivery to cells for them to do work; therefore, the body tires quickly. As well, with less oxygen, cells more readily use anaerobic metabolism (an=without + aerobic=oxygen) leading to increased amounts of acid production that cannot be addressed by the already failing kidneys.
As waste products build in the blood, loss of appetite, lethargy, and fatigue become apparent. This will progress to the point where mental function will decrease and coma may occur.
Because the kidneys cannot address the rising acid load in the body, breathing becomes more rapid as the lungs try to buffer the acidity by blowing off carbon dioxide. Blood pressure may rise because of the excess fluid, and this fluid can be deposited in the lungs, causing congestive heart failure.

من طرف loza الجمعة نوفمبر 13, 2009 4:29 pm

Very important information

thanxxxxxxxxxxxxxx

**snow white** .... تاريخ التسجيل : 12/10/2009

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من طرف ghonem الإثنين نوفمبر 16, 2009 8:52 pm

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renal failure

renal failure

رد: renal failure

رد: renal failure

رد: renal failure