Kidney Failure or Damage: Causes, Symptoms and Treatments

Kidneys are among other important organs that help keep blood clean. They are red-bean shape organs that are situated beneath the rib cage near to the middle of the back.

The urine result shows you a simple test for albuminuria or albumin in the urine that determines the extent of the damage of your kidney. While a urine test is useful to indicate kidney failure, the staging of nephropathy (or kidney disease) can be based upon the level of kidney function.

Albumin is one of the proteins that can be easily filtered through the kidney into the urine due to its smaller molecular size. At the initial stage of kidney disease, small amounts of albumin can be seen in the urine. The presence of albumin in the urine which is also known as microalbuminuria can persist either for months or years. For diabetics, microalbuminuria can be a predictive marker but this situation is normally reversible with tight control on blood pressure and blood sugar.

When larger amounts of albumin presents in the urine, the condition changes from microalbuminuria to proteinuria (or macroalbuminuria). The occurrence of macroalbuminuria creates a health concern as kidney damage progresses causing end-stage renal disease (ESRD) or commonly called kidney failure.

Overview of Urinary Albumin Excretion (UACR) Test

In the urinary albumin excretion (UACR) test, a small urine sample is required to carry out the examination for the presence of albumin in the urine. Varying volume in urine will certainly affect the albumin concentration, and hence creatinine (Cr) is also measured along with UACR test. And the final result of this test will be calculated based upon the ration of albumin to creatine.

Normal: UACR < 30 μg/ mg Cr

Microalbuminuria: UACR < 30-299 μg/ mg Cr

Macroalbuminuria: UACR > 300 μg/ mg Cr

Chronic Kidney Disease (CKD)

When renal tissue loses its function, the glomerular filtration rate (GFR) may sustain at normal or increased levels due to the remaining tissue increasing its performance to adapt towards the situation. As urine creatinine ( a compound used as an energy source in muscles which is a breakdown or waste product of creatinine, and it is mainly excreted out of the body via the kidney) level increases, the kidney function may drop to 50% of normal GFR along with a loss of 75% of renal tissue.

In most cases, CKD is defined as either kidney damage or GFR of less than 60mL/min/1.73m2 for 3 months. The severity of CKD can be grouped into 5 stages as follow:

Stage 1: kidney damage with normal or relatively high GFR or slightly diminished kidney function; ≥ 90 GFR (mL/min/1.73m2)

Stage 2: mild reduction in GFR with kidney damage; 60-89 GFR (mL/min/1.73m2)

Stage 3: moderate reduction in GFR; 30-59 GFR (mL/min/1.73m2)

Stage 4: severe reduction in GFR; 15-29 GFR (mL/min/1.73m2)

Stage 5: established kidney failure; < 15 GFR (mL/min/1.73m2)

What are the Symptoms of Kidney Failure?

Initially, CKD sufferers may not experience any symptoms except for increased blood creatinine and proteinuria. This is followed by a decline of the ability to concentrate urine early and later a decrease of ability to excrete acid, potassium and phosphate.

You can observe the early warning signs as below:

• Urine appears frothy or foamy;
• Blood in urine or bloody urine (also called haematuria);
• Edema around the eyes (especially in the morning), thighs, wrists, face, ankles or abdomen;
• Less frequent urinating- with coffee- or dark colored urine
• Mid-back pain especially near the kidneys or just beneath the ribs;
• Problem with urinating- with abnormal discharge or burning sensation;
• Urinating in large quantity or more frequent than usual particularly during the nighttime (also called nocturia)

The progress of kidney disease may also affect other body functions and systems including nerve damage, reduced phosphate excretion (also called hyperphosphatemia) which is linked to increased calcium excretion (hypocalcemia due to vitamin D deficiency), hyperparathyroidism, hypertension, accumulation of potassium in the blood (also called hyperkalemia), and other cardiovascular related diseases.

What is Kidney Disease Management?

If you are diagnosed for CKD, here is some appropriate disease management steps you need to adopt in your life:

Controlling blood pressure: By limiting salt intake, losing weight, exercising regularly and refraining from tobacco and alcohol, you can help lower your blood pressure.

Controlling blood sugar: If you are diabetic, controlling blood sugar is an essential step to help reduce the risk of microalbuminuria. In case that you are already diagnosed with microalbuminuria, tight control of blood sugar may help cut the risk of progressing to albuminuria by 50%.

Diet control: If you have had some kidney problems, you should go on very strict low-protein ; and low salt (sodium) , phosphates, potassium and other electrolytes diet and also restrict fluid intake. If you are trying to lose weight, you need to get enough calories. A “phosphate binder” is recommended if dietary steps to cut off phosphates are not enough.

As in the case of diabetic nephropathy, doctors may prefer to prescribe an angiotensin II receptor blockers (or ARBs like valsartan and losartan) and antihypertensive drugs (also called angiotensin-converting enzyme inhibitors or ACEIs like enalapril and captopril).

Certain medications may be good for keeping your blood pressure lower, but not all are equally good for people living with kidney disease. Therefore, it is advisable for you to consult a doctor prior to taking these medications. Also, you need to avoid pain medications which contain combinations with caffeine, paracetamol, naproxen, ketoprofen or ibuprofen.

What are the Treatments for Kidney Failure?

You must see a nephrologist (or a kidney disease specialist) immediately to discuss about the renal (kidney) transplant or renal replacement therapy as like dialysis, if you are already progressed to stage 4 of CKD or your GFR falls below 30Ml /min/1.73m2. Your nephrologist will start you on one of these treatments if they observe that you are at stage 5 of CKD or your GFR drops below 15.

In comparison to dialysis, renal (kidney) transplantation will increase the survival rate of patients who are at stage 5 of CKD significantly. If a kidney is donated by a living relative, it is always the most successful transplantation. Alternatively, living unrelated kidney or a cadaver kidney (from a person who has just died) may be used as a recommended option for this transplantation.

Of all, dialysis is the most commonly introduced treatment. This way, it helps clean blood with an artificial kidney. Generally, there are two types of dialysis, namely peritoneal dialysis and haemodialysis.

In peritoneal dialysis (PD), peritoneum (or membrane inside the abdomen) is utilized to filter the blood which requires large quantities of fluid called dialysate to be introduced through a permanent soft catheter inserted via a surgery procedure into the abdomen. Each dwell (exchange) time will take 4-5 fours, or 30-45 minutes depending upon the type of PD being used, and this procedure is undergone 4-5 times in a day.

In Haemodialysis, blood is withdrawn from the body from an "access" and is sent to the dialysis machine for cleaning prior to returning the clean blood to the body. It is either performed at dialysis unit or in a clinic or even at home with each lasting 3-4 hours. As for conventional haemodialysis, it needs to be done twice or three times a week.

You might also like my related articles:

• Are you a candidate for stroke?
• Are you at risk for atherogenic dyslipidaemia?
• Understanding heart disease
• Alzheimer's disease; causes, symptoms. treatments and preventative options
• Heart health: surprising facts on stroke everyone must know
• How to battle with kidney failure
• The high cost you could pay for ignoring your kidney health
• More dialysis-free years with practical diet modification
• How to adopt good nutrition to delay CKD progrss

You can read more of my content here.

As always, stay well and healthy!