Kidney failure

{{Short description|Disease where the kidneys fail to adequately filter waste products from the blood}} {{pp-vandalism|small=yes}} {{More citations needed|date=May 2024}} {{cs1 config|name-list-style=vanc}}  {{Infobox medical condition | name = Kidney failure | synonyms = Renal failure, end-stage renal disease (ESRD), stage 5 chronic kidney disease<ref name=Che2005/> | image = Hemodialysismachine.jpg | caption = A hemodialysis machine which is used to replace the function of the kidneys | field = Nephrology | symptoms = Leg swelling, feeling tired, reduced urination, foamy urine, loss of appetite, confusion<ref name=NIH2017/> | complications = '''Acute''': Uremia, high blood potassium, volume overload<ref name=Blak2010/> '''Chronic''': Heart disease, high blood pressure, anemia<ref name=Li2012/><ref name=MP2017/> | onset = | duration = | types = Acute kidney failure, chronic kidney failure<ref name=Hop2017/> | causes = '''Acute''': {{hlist|Low blood pressure|blockage of the urinary tract|certain medications|muscle breakdown|hemolytic uremic syndrome}}<ref name=Hop2017/> '''Chronic''': {{hlist|Diabetes|high blood pressure|nephrotic syndrome|polycystic kidney disease}}<ref name=Hop2017/> | risks = | diagnosis = '''Acute''': {{hlist|Decreased urine production|increased serum creatinine<ref name=Blak2010/>}} '''Chronic''': {{hlist|Glomerular filtration rate (GFR)|< 15<ref name=Che2005/>}} | differential = | prevention = | treatment = '''Acute''': Depends on the cause<ref name=Clat2010/> '''Chronic''': Hemodialysis, peritoneal dialysis, kidney transplant<ref name=NIH2017/> | medication = | prognosis = | frequency = '''Acute''': 3 per 1,000 per year<ref name=Fer2018Acute/> '''Chronic''': 1 per 1,000 (US)<ref name=Che2005/> | deaths = }}

'''Kidney failure''', also known as '''renal failure''' or '''end-stage renal disease''' ('''ESRD'''), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels.<ref name=NIH2017>{{cite web|title=Kidney Failure|url=https://www.niddk.nih.gov/health-information/Kidney-disease/kidney-failure|website=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=11 November 2017}}</ref> Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible.<ref name=Hop2017>{{cite web|title=What is renal failure?|url=https://www.hopkinsmedicine.org/healthlibrary/conditions/kidney_and_urinary_system_disorders/end_stage_renal_disease_esrd_85,P01474|website=Johns Hopkins Medicine|access-date=18 December 2017|language=en|archive-url=https://web.archive.org/web/20170618054600/http://www.hopkinsmedicine.org/healthlibrary/conditions/kidney_and_urinary_system_disorders/end_stage_renal_disease_esrd_85,P01474/|archive-date=18 June 2017}}</ref> Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion.<ref name=NIH2017/> Complications of acute and chronic failure include uremia, hyperkalemia, and volume overload.<ref name="Blak2010" /> Complications of chronic failure also include heart disease, high blood pressure, and anaemia.<ref name=Li2012>{{cite journal | vauthors = Liao MT, Sung CC, Hung KC, Wu CC, Lo L, Lu KC | title = Insulin resistance in patients with chronic kidney disease | journal = Journal of Biomedicine & Biotechnology | volume = 2012 | article-number = 691369 | year = 2012 | pmid = 22919275 | pmc = 3420350 | doi = 10.1155/2012/691369 | doi-access = free }}</ref><ref name=MP2017>{{cite web|title=Kidney Failure|url=https://medlineplus.gov/kidneyfailure.html|website=MedlinePlus|access-date=11 November 2017|language=en}}</ref>

Causes of acute kidney failure include low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome.<ref name=Hop2017/> Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease.<ref name=Hop2017/> Diagnosis of acute failure is often based on a combination of factors such as decreased urine production or increased serum creatinine.<ref name=Blak2010>{{cite book| vauthors = Blakeley S |title=Renal Failure and Replacement Therapies|date=2010|publisher=Springer Science & Business Media|isbn=978-1-84628-937-8|page=19|url=https://books.google.com/books?id=G1-9oN0I4lAC&pg=PA19|language=en}}</ref> Diagnosis of chronic failure is based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy.<ref name=Che2005>{{cite book| vauthors = Cheung AK |title=Primer on Kidney Diseases|date=2005|publisher=Elsevier Health Sciences|isbn=1-4160-2312-7|page=457|url=https://books.google.com/books?id=BUE9-mY4FkoC&pg=PA457|language=en}}</ref> It is also equivalent to stage 5 chronic kidney disease.<ref name=Che2005/>

Treatment of acute failure depends on the underlying cause.<ref name=Clat2010>{{cite book| vauthors = Clatworthy M |title=Nephrology: Clinical Cases Uncovered|date=2010|publisher=John Wiley & Sons|isbn=978-1-4051-8990-3|page=28|url=https://books.google.com/books?id=55VOagYjaVkC&pg=PA28|language=en}}</ref> Treatment of chronic failure may include hemodialysis, peritoneal dialysis, or a kidney transplant.<ref name=NIH2017/> Hemodialysis uses a machine to filter the blood outside the body.<ref name=NIH2017/> In peritoneal dialysis specific fluid is placed into the abdominal cavity and then drained, with this process being repeated multiple times per day.<ref name=NIH2017/> Kidney transplantation involves surgically placing a kidney from someone else and then taking immunosuppressant medication to prevent rejection.<ref name=NIH2017/> Other recommended measures from chronic disease include staying active and specific dietary changes.<ref name=NIH2017/> Depression is also common among patients with kidney failure, and is associated with poor outcomes including higher risk of kidney function decline, hospitalization, and death. A recent PCORI-funded study of patients with kidney failure receiving outpatient hemodialysis found similar effectiveness between nonpharmacological and pharmacological treatments for depression.<ref>{{cite journal | vauthors = Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, Dember LM, Diaz-Linhart Y, Dubovsky A, Greene T, Grote N, Kutner N, Trivedi MH, Quinn DK, Ver Halen N, Weisbord SD, Young BA, Kimmel PL, Hedayati SS | display-authors = 6 | title = Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial | journal = Annals of Internal Medicine | volume = 170 | issue = 6 | pages = 369–379 | date = March 2019 | pmid = 30802897 | doi = 10.7326/M18-2229 | s2cid = 67876948 }}</ref>

In the United States, acute failure affects about 3 per 1,000 people a year.<ref name=Fer2018Acute>{{cite book| vauthors = Ferri FF |title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=978-0-323-52957-0|page=37|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA37|language=en}}</ref> Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly developing the condition each year.<ref name=Che2005/><ref name=Fer2018ESKD>{{cite book| vauthors = Ferri FF |title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=978-0-323-52957-0|page=294|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA294|language=en}}</ref> In Canada, the lifetime risk of kidney failure or end-stage renal disease (ESRD) was estimated to be 2.66% for men and 1.76% for women.<ref name=CanadaESRDLTR>{{cite journal | vauthors = Turin TC, Tonelli M, Manns BJ, Ahmed SB, Ravani P, James MT, Hemmelgarn BR | title = Lifetime risk of ESRD | journal = J Am Soc Nephrol | volume = 23 | issue = 9 | pages = 1569–1578 | date = September 2012 | pmid = 22904351 | pmc = 3431421 | doi = 10.1681/ASN.2012020164 }}</ref> Acute failure is often reversible while chronic failure often is not.<ref name=Hop2017/> With appropriate treatment many with chronic disease can continue working.<ref name=NIH2017/>

== Classification == {{See also|Hepatorenal syndrome}}

Kidney failure can be divided into two categories: acute kidney failure or chronic kidney failure. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney failure from chronic kidney failure include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.<ref>niddk.nih.gov, [Anemia in Chronic Kidney Disease](https://www.niddk.nih.gov/health-information/kidney-disease/anemia)</ref>

=== Acute kidney failure === {{Main|Acute kidney injury}}

Acute kidney injury (AKI), previously called acute renal failure (ARF),<ref>{{cite journal | vauthors = Moore EM, Bellomo R, Nichol AD | title = The meaning of acute kidney injury and its relevance to intensive care and anaesthesia | journal = Anaesthesia and Intensive Care | volume = 40 | issue = 6 | pages = 929–48 | date = November 2012 | pmid = 23194202 | doi = 10.1177/0310057X1204000604 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Ricci Z, Ronco C | title = New insights in acute kidney failure in the critically ill | journal = Swiss Medical Weekly | volume = 142 | pages = w13662 | year = 2012 | issue = 3334 | pmid = 22923149 | doi = 10.4414/smw.2012.13662 | doi-access = free }}</ref> is a rapidly progressive loss of renal function,<ref name="Adam">{{cite encyclopedia |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/ | archive-url = https://web.archive.org/web/20140117220151/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/ | archive-date = 17 January 2014 |title=Acute kidney failure | encyclopedia = A.D.A.M. Medical Encyclopedia |year=2012 |publisher=U.S. National Library of Medicine |access-date=1 January 2013}}</ref> generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,<ref>{{cite journal | vauthors = Klahr S, Miller SB | title = Acute oliguria | journal = The New England Journal of Medicine | volume = 338 | issue = 10 | pages = 671–5 | date = March 1998 | pmid = 9486997 | doi = 10.1056/NEJM199803053381007 }}</ref> less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as ''prerenal'', ''intrinsic'', and ''postrenal''. Many people diagnosed with paraquat intoxication experience AKI, sometimes requiring hemodialysis.<ref>{{cite journal | title=Predictors of acute kidney injury after paraquat intoxication | journal=Oncotarget | date=2017 | volume=8 | issue=31 | pages=51345–51354 | doi=10.18632/oncotarget.17975 | pmid=28881652 | pmc=5584253 | vauthors = Weng CH, Chen HH, Hu CC, Huang WH, Hsu CW, Fu JF, Lin WR, Wang IK, Yen TH }}</ref>

===Chronic kidney failure=== {{Main|Chronic kidney disease}}

thumb|Illustration of a kidney from a person with chronic renal failure

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms.<ref>{{cite encyclopedia |url=https://www.medlineplus.gov/ency/article/000471.htm |title=Chronic kidney disease |year=2011 |encyclopedia=A.D.A.M. Medical Encyclopedia |publisher= Medline Plus, National Institutes of Health |access-date=1 January 2013}}</ref> CKD can be the long term consequence of irreversible acute disease or part of a disease progression.{{citation needed|date=August 2022}} CKD is divided into 5 different stages (1–5) according to the estimated glomerular filtration rate (eGFR). In CKD1, eGFR is normal and in CKD5 eGFR has decreased to less than 15 ml/min.<ref>{{Cite web |date=2021-11-22 |title=Stages of kidney disease |url=https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease |access-date=2023-03-09 |website=www.kidneyfund.org |language=en}}</ref>

=== Acute-on-chronic kidney failure === Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the person to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the person has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.{{citation needed|date=August 2022}}

== Signs and symptoms == Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When the kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.<ref name="grinsted">{{cite web | vauthors = Grinsted P | title = Kidney failure (renal failure with uremia, or azotaemia) | work = Netdoctor | date = 2005-03-02 | url = http://www.netdoctor.co.uk/diseases/facts/kidneyfailure.htm | access-date = 2009-05-26 | archive-date = 2015-10-15 | archive-url = https://web.archive.org/web/20151015111748/http://www.netdoctor.co.uk/diseases/facts/kidneyfailure.htm }}</ref>

Symptoms of kidney failure include the following:<ref name="grinsted"/><ref>{{cite book | vauthors = Stein A | title = Understanding Treatment Options For Renal Therapy | publisher = Baxter International Inc. | date = 2007-07-01 | location = Deerfield, Illinois | page = 6 | url = http://www.renalinfo.com/ | isbn = 978-1-85959-070-6 | access-date = 2010-07-12 | archive-date = 2019-01-30 | archive-url = https://web.archive.org/web/20190130063734/http://www.renalinfo.com/ }}</ref><ref name="PD">{{cite book | title = The PD Companion | publisher = Baxter International Inc. | date = 2008-05-01 | location = Deerfield, Illinois | pages = 14–15 | url = http://www.renalinfo.com/uk | id = 08/1046R | access-date = 2010-07-12 | archive-url = https://web.archive.org/web/20100625040151/http://www.renalinfo.com/uk/ | archive-date = 2010-06-25 }}</ref><ref name="lifeoptions">{{cite web | last = Amgen Inc. | author-link = Amgen | title = 10 Symptoms of Kidney Disease | year = 2009 | url = https://www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4 | access-date = 2009-05-26}}</ref> * High levels of urea in the blood, which can result in: ** Vomiting or diarrhea (or both) that may lead to dehydration ** Nausea ** Weight loss ** Nocturnal urination (nocturia) ** More frequent urination, or in greater amounts than usual, with pale urine ** Less frequent urination, or in smaller amounts than usual, with dark coloured urine ** Blood in the urine ** Pressure, or difficulty urinating ** Unusual amounts of urination, usually in large quantities * A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause: ** Itching ** Bone damage ** Nonunion in broken bones ** Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia) * A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause: ** Abnormal heart rhythms ** Muscle paralysis<ref>{{cite web | work = MedicineNet, Inc. | title = Hyperkalemia | date = 2008-07-03 | url = https://www.medicinenet.com/hyperkalemia/page4.htm | access-date = 2009-05-26}}</ref> * Failure of kidneys to remove excess fluid may cause: ** Swelling of the hands, legs, ankles, feet, or face ** Shortness of breath due to extra fluid on the lungs (may also be caused by anemia) * Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause: ** Pain in the back or side * Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in: ** Feeling tired or weak ** Memory problems ** Difficulty concentrating ** Dizziness ** Low blood pressure * Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,<ref name="proteinuria">{{cite web | vauthors = Hebert LA, Charleston J, Miller E | title = Proteinuria | year = 2009 | url = http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ | access-date = 2011-03-24 | archive-url = https://web.archive.org/web/20110505073832/http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ | archive-date = 2011-05-05 }}</ref> after which symptoms include: ** Foamy or bubbly urine ** Swelling in the hands, feet, abdomen, and face * Other symptoms include: ** Appetite loss, which may include a bad taste in the mouth ** Difficulty sleeping ** Darkening of the skin ** Excess protein in the blood ** With high doses of penicillin, people with kidney failure may experience seizures<ref>{{cite book| vauthors = Katzung BG |title=Basic and Clinical Pharmacology |edition=10th |year=2007|publisher=McGraw Hill Medical|location=New York, NY|isbn=978-0-07-145153-6|page=733}}</ref>

== Causes ==

=== Acute kidney injury === {{Main|Acute kidney injury}}

Acute kidney injury (previously known as acute renal failure) – or AKI – usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.{{citation needed|date=April 2022}}

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, along with bee stings<ref>{{cite journal | vauthors = Silva GB, Vasconcelos AG, Rocha AM, Vasconcelos VR, Barros J, Fujishima JS, Ferreira NB, Barros EJ, Daher EF | display-authors = 6 | title = Acute kidney injury complicating bee stings - a review | journal = Revista do Instituto de Medicina Tropical de Sao Paulo | volume = 59 | article-number = e25 | date = June 2017 | pmid = 28591253 | pmc = 5459532 | doi = 10.1590/S1678-9946201759025 }}</ref> may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the person with AKI to resume a normal life. People with acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.<ref>{{cite web |url=http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#7 |title=The Kidneys and How They Work |author=National Kidney and Urologic Diseases Information Clearinghouse |year=2012 |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |access-date=1 January 2013 |archive-url=https://web.archive.org/web/20150502081848/http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#7 |archive-date=2 May 2015 }}</ref>

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.{{citation needed|date=April 2023}}

=== Chronic kidney failure === {{Main|Chronic kidney disease}}

Chronic kidney failure has numerous causes. The most common causes of chronic failure are diabetes mellitus and long-term, uncontrolled hypertension.<ref>{{cite journal | vauthors = Kes P, Basić-Jukić N, Ljutić D, Brunetta-Gavranić B | title = [The role of arterial hypertension in development of chronic renal failure] | language = hr | journal = Acta Medica Croatica | volume = 65 | issue = Suppl 3 | pages = 78–84 | date = October 2011 | pmid = 23120821 | url = http://www.amzh.hr/amc/pdf/amc_2011%20vol%2065%20supplement%203.pdf | trans-title = The role of arterial hypertension in the development of chronic renal failure | archive-url = https://web.archive.org/web/20130719135947/http://www.amzh.hr/amc/pdf/amc_2011%20vol%2065%20supplement%203.pdf | archive-date = 2013-07-19 }}</ref> Polycystic kidney disease is another well-known cause of chronic failure. The majority of people affected with polycystic kidney disease have a family history of the disease. Systemic lupus erythematosus (SLE) is also a known cause of chronic kidney failure. Other genetic illnesses cause kidney failure, as well.{{citation needed|date=August 2022}}

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney failure.<ref>{{cite journal | vauthors = Perneger TV, Whelton PK, Klag MJ | title = Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs | journal = The New England Journal of Medicine | volume = 331 | issue = 25 | pages = 1675–9 | date = December 1994 | pmid = 7969358 | doi = 10.1056/NEJM199412223312502 | doi-access = free }}</ref> Some infectious disease agents, such as hantavirus, can attack the kidneys, causing kidney failure.<ref>{{cite web |year=2012 |title=Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome) |url=https://www.uptodate.com/contents/renal-involvement-with-hantavirus-infection-hemorrhagic-fever-with-renal-syndrome |access-date=1 January 2013 |publisher=UpToDate |vauthors=Appel GB, Mustonen J}}</ref>

Long term lithium treatment is known to cause chronic kidney disease after 10-20 years of treatment in 1-5% of people.<ref>{{Cite journal |last1=Malhi |first1=Gin S |last2=Tanious |first2=Michelle |last3=Das |first3=Pritha |last4=Berk |first4=Michael |date=2012-03-01 |title=The science and practice of lithium therapy |url=https://doi.org/10.1177/0004867412437346 |journal=Australian & New Zealand Journal of Psychiatry |language=EN |volume=46 |issue=3 |pages=192–211 |doi=10.1177/0004867412437346 |pmid=22391277 |issn=0004-8674|url-access=subscription }}</ref><ref>{{Cite journal |last1=Tondo |first1=Leonardo |last2=Alda |first2=Martin |last3=Bauer |first3=Michael |last4=Bergink |first4=Veerle |last5=Grof |first5=Paul |last6=Hajek |first6=Tomas |last7=Lewitka |first7=Ute |last8=Licht |first8=Rasmus W. |last9=Manchia |first9=Mirko |last10=Müller-Oerlinghausen |first10=Bruno |last11=Nielsen |first11=René E. |last12=Selo |first12=Marylou |last13=Simhandl |first13=Christian |last14=Baldessarini |first14=Ross J. |last15=for the International Group for Studies of Lithium (IGSLi) |date=2019-07-22 |title=Clinical use of lithium salts: guide for users and prescribers |journal=International Journal of Bipolar Disorders |language=en |volume=7 |issue=1 |pages=16 |doi=10.1186/s40345-019-0151-2 |doi-access=free |issn=2194-7511 |pmc=6643006 |pmid=31328245}}</ref> End stage renal failure due to lithium occurs in 0.53% of people versus 0.2% in the general population.<ref>{{Cite journal |last1=Presne |first1=Claire |last2=Fakhouri |first2=Fadi |last3=Noël |first3=Laure-Hélène |last4=Stengel |first4=Bénédicte |last5=Even |first5=Christian |last6=Kreis |first6=Henri |last7=Mignon |first7=Françoise |last8=Grünfeld |first8=Jean-Pierre |date=Aug 2003 |title=Lithium-induced nephropathy: Rate of progression and prognostic factors |url=https://linkinghub.elsevier.com/retrieve/pii/S0085253815493652 |journal=Kidney International |volume=64 |issue=2 |pages=585–592 |doi=10.1046/j.1523-1755.2003.00096.x |pmid=12846754 |issn=0085-2538}}</ref><ref>{{Cite journal |last1=Tondo |first1=Leonardo |last2=Abramowicz |first2=Maria |last3=Alda |first3=Martin |last4=Bauer |first4=Michael |last5=Bocchetta |first5=Alberto |last6=Bolzani |first6=Lorenza |last7=Calkin |first7=Cynthia V. |last8=Chillotti |first8=Caterina |last9=Hidalgo-Mazzei |first9=Diego |last10=Manchia |first10=Mirko |last11=Müller-Oerlinghausen |first11=Bruno |last12=Murru |first12=Andrea |last13=Perugi |first13=Giulio |last14=Pinna |first14=Marco |last15=Quaranta |first15=Giuseppe |date=2017-08-01 |title=Long-term lithium treatment in bipolar disorder: effects on glomerular filtration rate and other metabolic parameters |journal=International Journal of Bipolar Disorders |language=en |volume=5 |issue=1 |pages=27 |doi=10.1186/s40345-017-0096-2 |doi-access=free |issn=2194-7511 |pmc=5537163 |pmid=28480485}}</ref><ref name=":2">{{Cite journal |last1=Barroilhet |first1=S. A. |last2=Ghaemi |first2=S. N. |date=2020 |title=When and how to use lithium |url=https://www.researchgate.net/publication/342111738 |journal=Acta Psychiatrica Scandinavica |language=en |volume=142 |issue=3 |pages=161–172 |doi=10.1111/acps.13202 |pmid=32526812 |issn=1600-0447}}</ref> Dosing lithium more than once per day is associated with more kidney damage.<ref>{{Cite journal |last1=Carter |first1=Lorie |last2=Zolezzi |first2=Monica |last3=Lewczyk |first3=Andrea |date=2013-10-01 |title=An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection |url=https://doi.org/10.1177/070674371305801009 |journal=The Canadian Journal of Psychiatry |language=EN |volume=58 |issue=10 |pages=595–600 |doi=10.1177/070674371305801009 |pmid=24165107 |issn=0706-7437}}</ref> Kidney harm can be mitigated by dosing lithium once per day at night and keeping the dose as low as possible.<ref>{{Cite web |last=MD |first=Chris Aiken |date=2026-01-19 |title=6 Ways to Protect the Kidneys While Prescribing Lithium {{!}} Psychiatric Times |url=https://www.psychiatrictimes.com/view/6-ways-protect-kidneys-while-prescribing-lithium |access-date=2026-01-19 |website=www.psychiatrictimes.com |language=en}}</ref> Dosing lithium once per day allows for long periods where the kidney is exposed to low levels of lithium, which minimizes kidney harm.<ref name=":2" />

=== Genetic predisposition === The ''APOL1'' gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies.<ref>{{cite journal | vauthors = Bostrom MA, Freedman BI | title = The spectrum of MYH9-associated nephropathy | journal = Clinical Journal of the American Society of Nephrology | volume = 5 | issue = 6 | pages = 1107–13 | date = June 2010 | pmid = 20299374 | pmc = 4890964 | doi = 10.2215/CJN.08721209 }}</ref> Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.<ref>{{cite journal | vauthors = Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, Bowden DW, Langefeld CD, Oleksyk TK, Uscinski Knob AL, Bernhardy AJ, Hicks PJ, Nelson GW, Vanhollebeke B, Winkler CA, Kopp JB, Pays E, Pollak MR | display-authors = 6 | title = Association of trypanolytic ApoL1 variants with kidney disease in African Americans | journal = Science | volume = 329 | issue = 5993 | pages = 841–5 | date = August 2010 | pmid = 20647424 | pmc = 2980843 | doi = 10.1126/science.1193032 | bibcode = 2010Sci...329..841G }}</ref><ref>{{cite journal | vauthors = Tzur S, Rosset S, Shemer R, Yudkovsky G, Selig S, Tarekegn A, Bekele E, Bradman N, Wasser WG, Behar DM, Skorecki K | display-authors = 6 | title = Missense mutations in the APOL1 gene are highly associated with end stage kidney disease risk previously attributed to the MYH9 gene | journal = Human Genetics | volume = 128 | issue = 3 | pages = 345–50 | date = September 2010 | pmid = 20635188 | pmc = 2921485 | doi = 10.1007/s00439-010-0861-0 }}</ref>

== Diagnostic approach ==

=== Measurement for CKD === ;Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using the person's GFR, or glomerular filtration rate.

* '''Stage 1 CKD''' is mildly diminished renal function, with few overt symptoms. * '''Stages 2 and 3''' need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. * '''People with stage 4 and 5''' kidney failure usually require preparation towards active treatment in order to survive. * '''Stage 5 CKD''' is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.<ref>Kidney Transplantation as Primary Therapy for End-Stage Renal Disease: A National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) Conference](https://pmc.ncbi.nlm.nih.gov/articles/PMC2390948/)</ref>

;Glomerular filtration rate A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function.<ref>Fadem, Stephen Z., M.D., [http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm FACP, FASN. Calculators for HealthCare Professionals. National Kidney Foundation. 13 Oct 2008] {{Webarchive|url=https://web.archive.org/web/20140727183526/http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |date=27 July 2014 }}</ref> The National Kidney Foundation offers an easy-to-use on-line GFR calculator<ref>{{cite web |url=http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |title=GFR calculator |publisher=Kidney.org |access-date=2011-09-25 |archive-date=2014-07-27 |archive-url=https://web.archive.org/web/20140727183526/http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm }}</ref> for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator.)

== Complications == Those with end stage renal failure who undergo haemodialysis have higher risk of spontaneous intra-abdominal bleeding than the general population (21.2%) and non-occlusive mesenteric ischemia (18.1%). Meanwhile, those undergoing peritoneal dialysis have a higher chance of developing peritonitis and gastrointestinal perforation. However, the rate of acute pancreatitis does not differ from the general population.<ref>{{cite journal | vauthors = Tonolini M, Ierardi AM, Carrafiello G | title = Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease | journal = Insights into Imaging | volume = 6 | issue = 6 | pages = 693–695 | date = December 2015 | pmid = 26472545 | pmc = 4656237 | doi = 10.1007/s13244-015-0439-4 }}</ref>

== Treatment ==

Treatment for kidney failure centers on renal replacement therapy, conservative management, and complication control, as no curative options exist for chronic cases.<ref name=":0">{{Citation |last1=Rout |first1=Preeti |title=End-Stage Renal Disease |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK499861/ |access-date=2025-12-10 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29763036 |last2=Aslam |first2=Ahsan}}</ref><ref name=":1">{{Cite journal |last1=Stevens |first1=Paul E. |last2=Ahmed |first2=Sofia B. |last3=Carrero |first3=Juan Jesus |last4=Foster |first4=Bethany |last5=Francis |first5=Anna |last6=Hall |first6=Rasheeda K. |last7=Herrington |first7=Will G. |last8=Hill |first8=Guy |last9=Inker |first9=Lesley A. |last10=Kazancıoğlu |first10=Rümeyza |last11=Lamb |first11=Edmund |last12=Lin |first12=Peter |last13=Madero |first13=Magdalena |last14=McIntyre |first14=Natasha |last15=Morrow |first15=Kelly |date=2024-04-01 |title=KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease |url=https://www.kidney-international.org/article/S0085-2538(23)00766-4/fulltext |journal=Kidney International |language=English |volume=105 |issue=4 |pages=S117–S314 |doi=10.1016/j.kint.2023.10.018 |issn=0085-2538 |pmid=38490803}}</ref> It requires multidisciplinary care and patient education for shared decision-making on RRT initiation.<ref name=":1" />

=== Renal replacement therapy === Renal replacement therapy (RRT) modalities include hemodialysis, peritoneal dialysis, and kidney transplantation, selected based on patient lifestyle, vascular access feasibility, and comorbidities.<ref name=":0" /><ref>{{Cite journal |last1=Levin |first1=Adeera |last2=Ahmed |first2=Sofia B. |last3=Carrero |first3=Juan Jesus |last4=Foster |first4=Bethany |last5=Francis |first5=Anna |last6=Hall |first6=Rasheeda K. |last7=Herrington |first7=Will G. |last8=Hill |first8=Guy |last9=Inker |first9=Lesley A. |last10=Kazancıoğlu |first10=Rümeyza |last11=Lamb |first11=Edmund |last12=Lin |first12=Peter |last13=Madero |first13=Magdalena |last14=McIntyre |first14=Natasha |last15=Morrow |first15=Kelly |date=2024-04-01 |title=Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns |url=https://www.kidney-international.org/article/S0085-2538(23)00764-0/fulltext |journal=Kidney International |language=English |volume=105 |issue=4 |pages=684–701 |doi=10.1016/j.kint.2023.10.016 |issn=0085-2538 |pmid=38519239|doi-access=free }}</ref> Hemodialysis provides extracorporeal filtration in which machines take over the kidney’s filtering function, clearing the blood of extra fluid, dissolved substances, and toxins.<ref>{{Citation |last1=Murdeshwar |first1=Himani N. |title=Hemodialysis |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK563296/ |access-date=2025-12-10 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=33085443 |last2=Agarwal |first2=Ankit |last3=Anjum |first3=Fatima}}</ref> Peritoneal dialysis offers home-based continuous therapy using the peritoneum.<ref>{{Cite web |title=Peritoneal Dialysis - NIDDK |url=https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis |access-date=2025-12-10 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref> Guideline recommends advance care planning at GFR 20-30 mL/min, noting equivalent survival across modalities when optimized, though hemodialysis risks infection and peritoneal dialysis risks peritonitis.<ref name=":1" /><ref>{{Cite journal |last1=Roumeliotis |first1=Stefanos |last2=Dounousi |first2=Evangelia |last3=Salmas |first3=Marios |last4=Eleftheriadis |first4=Theodoros |last5=Liakopoulos |first5=Vassilios |date=2020-05-14 |title=Unfavorable Effects of Peritoneal Dialysis Solutions on the Peritoneal Membrane: The Role of Oxidative Stress |journal=Biomolecules |language=en |volume=10 |issue=5 |pages=768 |doi=10.3390/biom10050768 |doi-access=free |issn=2218-273X |pmc=7277773 |pmid=32423139}}</ref>

=== Diet === In non-diabetics and people with type 1 diabetes, a low protein diet is found to have a preventive effect on progression of chronic kidney disease. However, this effect does not apply to people with type 2 diabetes.<ref>{{cite journal | vauthors = Rughooputh MS, Zeng R, Yao Y | title = Protein Diet Restriction Slows Chronic Kidney Disease Progression in Non-Diabetic and in Type 1 Diabetic Patients, but Not in Type 2 Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials Using Glomerular Filtration Rate as a Surrogate | journal = PLOS ONE | volume = 10 | issue = 12 | article-number = e0145505 | date = 28 December 2015 | pmid = 26710078 | pmc = 4692386 | doi = 10.1371/journal.pone.0145505 | bibcode = 2015PLoSO..1045505R | doi-access = free }}</ref> A whole food, plant-based diet may help some people with kidney disease.<ref>{{cite journal | vauthors = Chauveau P, Combe C, Fouque D, Aparicio M | title = Vegetarianism: advantages and drawbacks in patients with chronic kidney diseases | journal = Journal of Renal Nutrition | volume = 23 | issue = 6 | pages = 399–405 | date = November 2013 | pmid = 24070587 | doi = 10.1053/j.jrn.2013.08.004 }}</ref> A high protein diet from either animal or plant sources appears to have negative effects on kidney function at least in the short term.<ref>{{cite journal | vauthors = Bernstein AM, Treyzon L, Li Z | title = Are high-protein, vegetable-based diets safe for kidney function? A review of the literature | journal = Journal of the American Dietetic Association | volume = 107 | issue = 4 | pages = 644–50 | date = April 2007 | pmid = 17383270 | doi = 10.1016/j.jada.2007.01.002 | s2cid = 39551628 }}</ref>

=== Slowing progression === People who receive earlier referrals to a nephrology specialist, meaning a longer time before they must start dialysis, have a shorter initial hospitalization and reduced risk of death after the start of dialysis.<ref>{{cite journal | vauthors = Smart NA, Dieberg G, Ladhani M, Titus T | title = Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease | journal = The Cochrane Database of Systematic Reviews | issue = 6 | article-number = CD007333 | date = June 2014 | pmid = 24938824 | doi = 10.1002/14651858.CD007333.pub2 }}</ref> Other methods of reducing disease progression include minimizing exposure to nephrotoxins such as NSAIDs and intravenous contrast.<ref>{{Cite book|url=http://accessmedicine.mhmedical.com/content.aspx?aid=1145435499|title=Current Medical Diagnosis & Treatment 2018| vauthors = Dirkx TC, Woodell T, Watnick S |date=2017|publisher=McGraw-Hill Education| veditors = Papadakis MA, McPhee SJ, Rabow MW |location=New York, NY}}</ref>

== References == {{Reflist}}

== External links == {{Medical condition classification and resources|DiseasesDB = 26060 |ICD10 = {{ICD10|N|17||n|17}}–{{ICD10|N|19||n|17}} |ICD9 = {{ICD9|584}}–{{ICD9|585}} |MedlinePlus = |eMedicineSubj = |eMedicineTopic = |MeshName = Renal+Failure |MeshNumber = C12.777.419.780.500 |}}

Category:Kidney diseases Category:Organ failure Category:Wikipedia medicine articles ready to translate