RENAL FAILURE, CHRONIC (Uremia)

General Information

DEFINITION--Inability of the kidneys to eliminate the body's waste products. Kidneys normally help rid the body of waste products, and when they fail, the waste products build up and cause symptoms that vary in severity. Chronic kidney failure usually develops gradually.

BODY PARTS INVOLVED--Kidneys, which eventually affect all body systems.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS--

None or few symptoms until 60% to 75% of kidney filtration fails. Then, 1 or more of the following:

• Listlessness, mental confusion and drowsiness; high blood pressure.
• Shortness of breath or bad breath.
• Inflamed, bleeding gums and mouth ulcers.
• Abdominal pain; itching skin.
• Numbness, tingling and burning in the legs and feet; muscle cramps.
• Decreased sex drive.
• Cessation of menstruation; unusual bleeding.
• Anemia, with paleness and fatigue.
• Muscle and bone pain. Bones break easily.

CAUSES

• Collagen diseases, such as systemic lupus erythematosus.
• Chronic glomerulonephritis.
• Chronic urinary-tract infections.
• Congenital kidney abnormalities, such as polycystic kidney disease.
• Kidney damage due to diabetes mellitus.
• Urinary-tract obstruction.
• Overdose of many drugs and chemicals, especially phenacetin or streptomycin.
• Blood-vessel diseases, such as hardening of the arteries in or leading to the kidney.

RISK INCREASES WITH-Any of the conditions listed in Causes.

HOW TO PREVENT--Obtain medical treatment for underlying diseases that lead to uremia before uremia results.

What To Expect

DIAGNOSTIC MEASURES--

• Laboratory blood and urine studies of kidney function.
• X-rays of abdomen, kidneys, ureters and bladder to detect kidney stones, ECG (See Glossary).
• Kidney biopsy (See Glossary).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Treatment will be determined by cause.
• Surgery, if the cause can be corrected by surgery.
• Emergency hospitalization for fluid and electrolyte therapy and kidney dialysis (sometimes).
• Dialysis (artificial methods of removing waste products from the blood) may be required until the kidneys recover their function.

POSSIBLE COMPLICATIONS

• Pericarditis.
• Myocarditis.
• Pneumonia.
• Pancreatitis.
• Hormone deficiencies.
• Fluid and electrolyte imbalance.
• Gastrointestinal ulcers.

PROBABLE OUTCOME--Kidney transplants can sometimes cure younger patients. Otherwise, kidney failure is a condition that worsens gradually, although a near-normal lifespan is possible if the condition stabilizes. Kidney dialysis treatment can improve and prolong life for several years.

How To Treat

GENERAL MEASURES--

• Weigh daily and keep a record.
• Measure the fluids you drink and the urine you pass each day. Keep a record, and take it with you to doctor visits. You should pass about 2500cc or more of urine a day. If you pass less, decrease fluid intake so intake does not exceed output by more than 800cc a day. For example, if you pass 2000cc in 24 hours, don't drink more than 2800cc in the next 24 hours.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Diuretics to reduce fluid accumulation.
• Iron and folic-acid supplements for anemia.
• Stool softeners to prevent constipation.
• Digitalis for congestive heart failure.

ACTIVITY--You must reduce activity. Don't become overheated or fatigued. Sleep more at night, and take rests during the day. If you are confined to bed, flex your legs often to reduce the chance of blood clots in leg veins.

DIET--Eat a low-salt, low-potassium, low-protein diet with added fiber. Eat frequent small, high-calorie meals.

Call Your Doctor If

The following occurs during treatment: Fever, vomiting or diarrhea. Urine output of less than 2000cc. Severe headache or convulsion.