Renal failure
Renal failure, also known as kidney failure, renal insufficiency, or end-stage renal disease (ESRD), is a serious medical condition characterized by a significant decline in kidney function. This deterioration prevents the kidneys from effectively removing waste materials from the body, leading to the accumulation of toxic metabolic wastes in the bloodstream. Renal failure can be classified into three main causes: prerenal, which involves issues such as reduced blood flow due to hypertension or heart failure; intrinsic renal causes, related to infections or drug toxicity; and postrenal causes, stemming from obstructions that hinder urine flow. Symptoms can include electrolyte imbalances, cardiovascular complications, pulmonary edema, chronic fatigue, and increased susceptibility to infections.
Treatment options for renal failure primarily include hemodialysis, which filters the blood to remove waste, and kidney transplantation, the latter being the most effective solution but often limited by donor availability. As of early 2023, many individuals are on waiting lists for kidney transplants. Ongoing research aims to develop artificial kidneys to replicate their natural function, with promising advances in bioengineering and genetically modified organ transplantation. Understanding renal failure is crucial for managing overall health and seeking timely medical intervention.
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Subject Terms
Renal failure
ALSO KNOWN AS: Kidney failure, renal insufficiency, end-stage renal disease (ESRD)
ANATOMY OR SYSTEM AFFECTED: Heart, immune system, kidneys
DEFINITION: A breakdown of kidney function that prevents the removal of waste materials from the body
CAUSES: Obstruction of renal artery (from hypertension, liver disease, congestive heart failure), infection, certain drugs, obstruction of urine flow from kidney
SYMPTOMS: Accumulation of toxic metabolic wastes in bloodstream, electrolyte imbalance, cardiovascular problems, pulmonary edema, gastrointestinal symptoms, chronic fatigue, infections
DURATION: Acute or chronic and progressive
TREATMENTS: Hemodialysis, kidney transplantation
Causes and Symptoms
Renal failure, also called kidney failure, renal insufficiency, or end-stage renal disease (ESRD), can be defined as a decline in kidney function sufficient to result in the retention of metabolic waste material in the body. The loss of the ability of the to excrete waste material is often progressive, culminating in complete renal failure in untreated cases. Although kidney disease can occur at any age, most cases occur in adults, frequently as a of diabetes and/or hypertension.
There are three major causes of renal failure. The first, prerenal, results from of the renal artery because of causes such as hypertension. The decreased blood flow to the kidney causes tissue destruction and loss of renal function. Prerenal causes may also be linked to liver disease and congestive heart failure. The second major cause of renal failure is a direct breakdown of kidney function as a result of inflammatory processes associated with infection. Certain drugs may also have toxic effects on kidney function. The third major cause of renal failure is postrenal, which refers to obstructions that block the flow of urine from the kidney.
The body cannot survive without at least one functioning kidney. As a consequence of renal failure, toxic metabolic wastes accumulate in the bloodstream, such as nitrogen produced in the metabolism of proteins. Renal failure also results in disturbances of electrolyte balance, associated with high levels of sodium, potassium, and other salts. Other complications include compromised function, pulmonary edema, symptoms, chronic fatigue, and infections.
Treatment and Therapy
Acute renal failure can be treated effectively with hemodialysis and/or kidney transplantation. The machine has made it possible to extend the lives of many patients. This external device filters the blood as it traverses fluid-bathed semipermeable filters that remove metabolic wastes while permitting the retention of essential blood components. Blood leaves the body and returns postfiltration through a fistula or access joint inserted under the skin to link arterial and venous blood flow. Dialysis must be carried out on a regular basis and requires several hours.
The best treatment for renal failure is a kidney transplant. Sadly, there are not enough donor kidneys to meet the need; patients may wait for years before transplantation occurs. The Organ Procurement and Transplantation Network reports that as of January 2023 almost 89,000 transplant candidates were on the waiting list to receive a kidney donation in the United States. Research continues on an artificial kidney that would replicate the delicate filtering functions of the kidney’s glomeruli. A study published in the journal Nature Medicine in April 2013 reported that scientists have been able to bioengineer working kidneys in rats. While the kidneys lacked the full function of normal kidneys and much more work needs to be done, the milestone represents a promising step towards the goal of creating fully functional artificial kidneys from the cells of patients in need of a transplant. In 2024, a Massachusetts man successfully received a genetically modified pig kidney. He was discharged less than three weeks after surgery.
Bibliography
Aronoff, George. Kidney Failure: The Facts. New York: Oxford UP, 1996. Print.
HealthDay. “‘Bioengineered’ Kidneys Show Promise in Rat Study.” MedlinePlus. US Natl. Lib. of Medicine, NIH, April 15, 2013. Web. 2013.
Martinez-Hernandez, Sandra Luz, et al. "Novel Approaches in Chronic Renal Failure without Renal Replacement Therapy: A Review." Biomedicines, vol. 11, no. 10, 2023. DOI: 10.3390/biomedicines11102828. Accessed 8 Apr. 2024.
MedlinePlus. “Kidney Failure.” MedlinePlus. US Natl. Lib. of Medicine, NIH, 8 Dec. 2016, medlineplus.gov/kidneyfailure.html. Web. 8 Aug. 2023.
Mitch, William E., and Saulo Klahr, eds. Handbook of Nutrition and the Kidney. 6th ed. Philadelphia: Lippincott, 2010. Print.
Molitoris, Bruce A., and William Finn, eds. Acute Renal Failure. Philadelphia: Saunders, 2001. Print.
“Organ Donation Statistics.” Organ Procurement and Transplantation Network. HRSA, US Dept. of Health and Human Services, Mar. 2023, www.organdonor.gov/learn/organ-donation-statistics. Web. Accessed 8 Aug. 2023.
Ramada, David Loureiro, et al. "Portable, Wearable and Implantable Artificial Kidney Systems: Needs, Opportunities and Challenges." Nature Reviews Nephrology, vol. 19, 2023, doi.org/10.1038/s41581-023-00726-9. Accessed 8 Aug. 2023.
Savitsky, Diane. “Kidney Failure.” Health Library. EBSCO Information Services, 10 Oct. 2013. Web. 6 May. 2016.
Shafiq, Saman, and Karen Weintraub. "'New Beginning': First Man to Successfully Receive Pig Kidney Transplant Gets Discharged from Hospital." USA Today, 5 Apr. 2024, www.usatoday.com/story/news/health/2024/04/05/pig-kidney-transplant-rick-slayman/73214776007/. Accessed 8 Apr. 2024.
Skorecki, Karl. et al., eds. Brenner and Rector’s The Kidney. 10th ed. Philadelphia: Elsevier, 2016. Print.