Chronic Kidney Failure is also known as Chronic Kidney Disease (CKD), which is characterised by a gradual decrease in kidney function with time. This synonymously means that with time, they will not work as well as they should. So if you want to know what renal failure is and its symptoms and treatment, continue reading this piece.

Kidneys are about the size of a computer mouse and filter blood every 30 minutes. Inside your body, they work to remove wastes, excess fluids and toxins to control blood pressure and stimulate the production of red blood cells. Additionally, it also helps to regulate blood chemicals and keeps bone healthy, which is essential for healthy well-being.

As mentioned, during chronic kidney failure, the kidney is incapable of working efficiently, and the excess waste and fluid remain in the body, which causes complexities in the body. A few of the complexities might include stroke, heart diseases, anaemia etc.

The symptoms of chronic renal failure can progress slowly and will develop over time. However, in usual cases, the symptoms of chronic kidney failure depend on their severity. They include –

• Vomiting
• Nausea
• Sleep problems
• Change in urinating habits
• Weakness and fatigue
• Itchy and dry skin
• High blood pressure (hypertension) that is difficult to control
• Muscle cramps
• Chest pain, if fluid builds up around the lining of the heart
• Swelling of ankles and feet
• Loss of appetite
• Reduced mental sharpness
• Shortness of breath, if fluid builds up in the lungs

Although one of the most common causes of chronic renal failure is diabetes, multiple causes lead to CKD. A few of those causes are –

• Type 1 and Type 2 diabetes
• High Cholesterol
• Glomerulonephritis
• High blood pressure/Hypertension
• Interstitial nephritis
• Inherited kidney diseases or polycystic kidney disease
• Vesicoureteral reflux
• Prolonged obstruction of the urinary tract (Example: kidney stones, enlarged prostate etc.)
• Pyelonephritis
• Continuous use of certain medications (Example: NSAIDs and lithium)

It is important to consult a doctor if you are witnessing any of the symptoms of Chronic Kidney Disease. However, you are at a higher risk of developing a CKD if you have or indulge in -

• Obesity
• Family history of CKD
• Heart disease
• Frequent use of medications that can damage the kidneys
• High blood pressure
• Diabetes
• Smoking
• Abnormal kidney structure
• Older age

The stages of chronic kidney disease are divided into two broader categories, viz., early stage kidney disease (Stages 1 to 3) and late stage kidney disease (Stages 4 to 5). The respective stage are –

• Stage 1: Normal or High GFR (GFR > 90 mL/min)
• Stage 2: Mild CKD (GFR = 60-89 mL/min)
• Stage 3 A: Moderate CKD (GFR = 45-59 mL/min)
• Stage 3 B: Moderate CKD (GFR = 30-44 mL/min)
• Stage 4: Severe CKD (GFR = 15-29 mL/min)
• Stage 5: End Stage CKD (GFR <15 mL/min)

Chronic Kidney Failure or Chronic Kidney Disease is mainly diagnosed through urine and blood tests. These tests detect the imbalances between the chemicals which cause a gradual loss in kidney function. Nevertheless, depending on the condition of a patient, biopsies and imaging tests can further follow these tests to find the exact reason for kidney dysfunction. However, the diagnosis of kidney failure can be differentiated into different categories.

1. Labs and Tests

The screening process begins in labs that diagnose different markers like glomerular filtration rate (GFR), serum creatinine (SCr), blood urea nitrogen (BUN) and urinary albumin.

• Glomerular Filtration Rate (GFR)

This is an estimate of how well your kidneys are functioning. More precisely, it calculates how much blood is passing through the tiny filters of your kidney (glomeruli) each minute. For calculations, labs use an algorithm that considers various parameters, viz. gender, ethnicity, age, SCr value, weight and height.

The GFR references are –

1. 90 to 120 mL per minute: Normal
2. Below 60 mL/minute: Chronic Kidney Disease
3. Less than 15 mL/minute: End-Stage Renal Disease (ESRD)

However, these values can vary with lab, as each uses a different calculation formula.

• Serum Creatinine

The Serum Creatinine test is intended to measure the amount of creatinine in the blood. This is exerted through urine and, as it is excreted at a steady rate from muscle metabolism, is a reliable measure of kidney function.

Normal measurements of SCr are –

1. 0.7 to 1.2 mg/dL in men
2. 0.5 to 1.0 mg/dL in women

• Blood Urine Nitrogen

BUN or Blood Urea Nitrogen measures the amount of waste product that is present in the blood. This urea nitrogen is generated when the liver breaks down the protein to create serum creatinine which is excreted at a constant rate. Moreover, a BUN test can also detect the underlying cause of kidney failure.

Normal measurements of BUN are –

1. 8 to 24 mg/dL for men
2. 6 to 21 mg/dL for women

• Urine Volume

This is the amount of urine your kidney produces over a period of time. The urine volume is measured in millilitres per kilogram of your body weight per hour. This is primarily used to diagnose AKI, and Oliguria is connected more widely with acute kidney injury than CKD.

2. Imaging

Besides the lab tests, imaging is also important to identify and evaluate any damage in the kidneys. A few of those are – 

• X-Rays

This is primarily used to access the size and shape of the kidney.

• Ultrasound

Ultrasound is one of the most preferred imaging modes to measure the kidney's appearance and size. Apart from it, ultrasound is also used to locate lesions, tumours and blockages in the kidney.

• Magnetic Resonance Imaging

Magnetic Resonance Imaging or MRI produces high-contrast images of the kidney without radiation. Although the use of MRI is as same as a CT scan but to perform it, gadolinium contrast dye is required, which can cause nephrogenic systemic fibrosis (NSF) in people with poor kidney functions.

• Computed Tomography

CT scan produces cross-sectional images of the kidneys and is used to detect lesions, cancer, kidney stones and obstructions in the kidney. This is primarily used for people for whom ultrasound cannot produce clear images.

3. Kidney Biopsy

A kidney biopsy is executed to take a sample of kidney tissue and examine it under a microscope. However, this can either be open or percutaneous, depending on the patient and the doctor. A kidney biopsy can be indicated in situations like –

• Hematuria
• Kidney disease with no clear cause
• Renal tumours
• Kidney trauma
• Nephrotic syndrome
• Kidney failure

4. Staging

Staging is done to understand your kidney's functionality and determine the appropriate course of the treatment. However, for CKD, this is solely dependent on the GFR results, and then a treatment course is chalked out.

5. Differential Diagnoses

This helps in the search for diagnostic clues for both AKI and CKD, and the parameters include –

• Serum Creatinine
• Medical History
• Urine output
• Kidney Size
• Creatinine Levels in Fingernail clippings

It is important to understand that there is no cure for CKD, but treatments can make the symptoms ease and can halt from getting worse. Moreover, the treatment depends on the stage of your CKD, and the main treatments are –

• Change in lifestyle
• Medication to control associated problems such as high cholesterol and high blood pressure
• Dialysis is generally used for advanced stages of CKD.
• A kidney transplant is used for advanced stages of CKD.

They are discussed in detail in the sections below.

1. Lifestyle Changes

Lifestyle changes can help patients considerably in the early stage of CKD. A few of the recommended changes are –

1. Quit smoking.
2. Eat a healthy and balanced diet.
3. Exercise regularly, at least 150 minutes a week.
4. Decrease the salt intake to 6 gm per day (or 1 teaspoon).
5. Control the alcohol intake and don’t exceed the recommended limit.
6. Try to lose weight if you are obese.
7. Avoid consuming over-the-counter NSAIDs, like ibuprofen, apart from when prescribed by a doctor or a medical professional.

2. Medicine

There are no particular medications for chronic kidney failure, but some are usually prescribed for the causes to prevent any complications. However, you should only take medications if a doctor or medical professional advises. A few of the medications for the causes include –

• High Blood Pressure

Control of blood pressure works well for kidneys. Individuals must aim to keep their blood pressure below 140/90mmHg or 130/80mmHg if they have diabetes. Although various types of medicine are available, primarily angiotensin converting enzyme (ACE) inhibitors are used for the treatment. A few of the examples include enalapril, ramipril, and lisinopril. However, ACE inhibitors also have side effects, including headaches, weakness and tiredness, dizziness and a persistent dry cough.

• High Cholesterol

Individuals with CKD are at a higher risk of cardiovascular diseases such as stroke and heart attack. Doctors may prescribe statins that can reduce the risk of cardiovascular diseases, such as simvastatin and atorvastatin. However, some of these medications' side effects are muscle and joint pain, constipation or diarrhoea, feeling sick and headaches.

• Water Retention

If you have kidney disease, then you might have swelled hands, ankles and feet. This happens because your kidneys are not as effective in removing fluids. Hence, reducing the intake of salt and fluid is recommended. However, you can replace those with yoghurts and soups to help reduce swelling. Nevertheless, you might be prescribed diuretics, such as furosemide. But, the major side effect of taking this is the reduction of sodium and potassium levels in the blood.

• Glomerulonephritis

Glomerulonephritis is seen when your body's immune system mistakenly attacks the kidney and causes inflammation of the filters in the kidney. To control it, doctors can prescribe steroids that can reduce the activity of your immune system, such as cyclophosphamide.

• Bone Problems

If the kidneys don't work well, it can cause the build of phosphate within the body, which is an important component of the bones. So, if the phosphate level increases too much, it can disrupt the calcium balance of the bones, leading to its thinning. Hence, you might need to reduce the intake of dairy products, red meats etc. Doctors can prescribe phosphate blinders to keep your lowering phosphate levels in check. Along with it, some patients might also have lower levels of Vitamin D, which is also an important component for bones. So, a medical professional can prescribe supplements such as colecalciferol or ergocalciferol to trigger Vitamin D levels.

• Anaemia

People in the advanced stages of CKD can develop anaemia, which is the lack of red blood cells within the body. A few symptoms of anaemia include lack of energy, tiredness, heart palpitations, and shortness of breath. However, if you have anaemia, doctors might inject you with erythropoietin. Also, if you have iron deficiency, supplements can be recommended.

3. Dialysis

Although rare, for a few patients, the kidneys might stop working. Under these circumstances, doctors can proceed with the treatments with dialysis. There are primarily two types of dialysis –

• Haemodialysis

This is the process of diverting the blood into an external machine that purifies it and finally is returned it to the body.

• Peritoneal Dialysis

This is a process where dialysis fluid is pumped inside the body to draw out the waste products from the blood as they pass through the vessels lining your tummy.

4. Kidney Transplant

A kidney transplant is an alternative to dialysis with severely reduced kidney functionality. Moreover, this is one of the most effective treatments, and it involves major surgery and taking medications such as immunosuppressants. Although it is possible to live with one kidney, a donor's kidney comes from recently deceased donors, and if there is a shortage of donors, you might have to wait for months. Most importantly, the survival rates for a kidney transplant are significant. About 90% of these kidneys function even after 5 years of transplant, and some are useful after 10 years and more.

Chronic Kidney Failure cannot be prevented completely, but you can take some necessary steps to reduce the chances of getting this condition. However, if you have any symptoms of CKD, it is advised to consult a doctor to get yourself checked about the severity of the problem. A few of the ways of prevention that might help include –

• Using the kidney risk calculator
• Avoid taking medicines that are harmful to kidneys
• Exercise regularly
• Reduce smoking and consuming alcohol
• Take a balanced diet

Hence, apart from providing details on what is renal failure? It is also important to understand the symptoms, treatments and prevention for chronic kidney failure to deal with this problem. Nevertheless, it should be noted that early detection can prevent the progression of this disease. Moreover, about 37 million people in the US (15%) have chronic kidney disease, which is a significant number.