Kidney Failure

Dr James Stim

1.)    What is kidney failure?

Kidney failure occurs when the kidneys do not do their job of filtering the blood in a normal manner. This results in build up of waste chemicals in the body as indicated by an increase in BUN and Creatinine in the blood. These chemicals are measured as part of routine chemistry blood tests and are markers of the retention of the many metabolic waste chemicals that the kidneys usually filter out of the blood. This process may be silent and may occur even though a normal amount of urine is produced. When the build up of waste chemicals is high enough it can result in a syndrome called uremia which is characterized by symptoms of nausea, vomiting, fatigue, sleepiness, and decreased mental alertness. This condition may occur when the kidney function is less than 15 % and artificial treatments to clean the blood (dialysis) may be necessary to correct the symptoms and to maintain life.

2.)    Does kidney failure always result in decreased urination?

No. Kidney failure may occur with normal urination or decreased urination depending upon the cause of the kidney failure and whether the person is dehydrated or not.

3.)    What are some common causes of kidney failure?

The most common causes of chronic kidney failure are diabetes mellitus and hypertension and over half the patients on dialysis now have these diseases as the cause of their kidney failure. Any patient with diabetes or hypertension should know what their blood Creatinine is and whether there has been any change over time. Other causes of kidney failure may include obstruction or blockage of urine along the urinary tract, toxicity from medications, severe dehydration or heat stroke, and effects of contrast IV dyes given with certain X ray procedures.

4.)    What is the best way to monitor for kidney failure?

Blood testing for BUN and Creatinine along with a urinalysis. A urinalysis may indicate whether there is loss of protein or other abnormalities in the urine.

5.)    Does a normal creatinine mean that there is no kidney failure?

No. In most cases normal creatinine means no significant decrease in kidney function. However, blood creatinine may not be very sensitive to early decreases in kidney function and there are new formulas based on age, sex, race, and creatinine level that can calculate kidney filtering function more accurately. A consultation with a nephrologists (kidney disease specialist) is considered standard especially when there is early kidney disease to help manage the treatment as well as consider further diagnostic testing for the cause of kidney disease. Additionally, dietary consultation and management is an important adjunct to seeing a nephrologist.

6.)    How would seeing a dietician help with kidney failure?

The kidneys regulate the levels of various minerals in the blood including potassium, sodium, calcium, magnesium, and phosphorus. When kidney function decreases the levels of these minerals may become abnormal and require dietary management to assist in keeping these minerals in line. A dietician specializing in kidney disease patients can provide the best information concerning the proper diet to be on for a kidney failure patient.

7.)    What other parts of my body may be affected by kidney failure?

Kidneys produce and influence the levels of several important hormones. Erythropoietin is produced by the kidneys and helps us produce red blood cells in our bone marrow. In most cases, kidney failure will result in some degree of anemia (low red blood cell count) which may cause fatigue. This can be correct by administering erythropoietin replacement by injections in the office resulting in improved well being and quality of life for kidney failure patients. Vitamin D is activated by the kidneys and kidney failure may cause a vitamin D deficiency state resulting in low calcium and bone thinning. Active Vitamin D may be administered to patients to correct this condition. Retention of phosphorus may cause an increase in parathyroid hormone from the parathyroid glands which can cause bone disease. Correction of phosphorus level with diet, Vitamin D, and phosphorus binders can correct this condition.

    Summary

Kidney failure is an increasingly common condition which may be silent in its early stages. Working with your primary care physicians, early diagnosis and management by nephrologists and their ancillary specialty staff can be effective in slowing and controlling the processes that result in further kidney damage and disease as well as its effects on other organ systems. The most common reasons for kidney failure are diabetes mellitus and hypertension. Kidney disease can be prevented by early detection and treatment of these diseases through early screening by blood and urine testing and appropriate follow up with health care providers in your community.

James Stim, MD



How to contact us

612 Roxbury Rd - Rockford, IL 61107 - phone 815-227-8300 - fax 815-227-8301