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Kidney Failure
Kidney Failure
Dr. Pham Hoang Trung

The kidneys are two pea-shaped bodies that are about the size of a fist, located on either side of the spine just below the lowest rib. Each kidney weighs about a quarter of a pound (about 110 grams) and contains about 1 million structural and functionalunit callednephron. The kidneys filtrate about 200 liters of blood a day and produce about 2 liters of urine. The main function of the kidneys is to filterwaste products and excess water from the blood to make urine and retain nutrients in the blood. Thanks to the kidneys, we can eat a variety of foods, drink lots of medicine without being toxic to the body because the kidneys filter harmful waste products from food, medicine through urine. This residue cannot accumulate in humans to a concentration that can be harmful to the body. The kidneys also play an important role in regulating the concentration of many minerals such as calcium, sodium (salt) and potassium present in the blood. The kidneys also help regulate blood pressure and secretion of endocrine factors (hormone) involved in the production of red blood cells.

Renal failure happens when the kidneys loss of a partial or complete ability to filter outexcess water and waste products from the blood. Toxic wastes normally be eliminated out from the body, but when kidney failure they are accumulated in the body, thereby potentially endangering the body. In addition, kidney failure can lead to several other conditions such as anemia, high blood pressure, acidosis (increased acidity in body fluids), dyslipidemia and bone disease due reduced production of hormones from the kidneys. Kidney failure can be distinguished from acute or chronic renal failure.


Acute renal failure usually progresses rapidly within a few days or weeks. Acute renal failure does not cause permanent damage. If treated promptly and properly, the kidneys will recover completely.

In some cases, acute kidney failure, if left untreated promptly and properly, can progress to chronic kidney disease.

Chronic kidney failure occurs when patient lost kidney function gradually and often permanently. This process is gradual, usually from several months to several years. Chronic kidney disease is divided into 5 stages, from mild to severe. Chronic renal failure (stage 5) means chronic kidney disease in the terminal stage, when the kidneys almost or completely lose filtering function and the patient requires dialysis or needs a kidney transplant to survive.

Kidney function is measured by the Glomerular Filtration Rate (GFR). The average GFR is above 60, which is good. If lower than 60 we have problem with the kidneys. Chronic kidney failure at stage 5 is the final stage of renal failure, the GFR is only less than 15 (instead of over 60 is normal). At this point, patient often mustundergo dialysis.

In addition, kidney function is also assessed by the amount of creatinine, a waste in the blood. If the kidneys are good, with normal filtration, creatinine is 1.2. Creatinine will slowly rise (more than 1.2) in the blood when the patient begins to suffer from kidney failure.


Because the kidneys carry out many functions in the body, kidney disease can affect the body in many different ways. Symptoms vary and many organs are affected. Specially, most patients do not have a decrease in urine output, even if chronic kidney disease progresses to a severe stage.

The kidneys are an excellent organ for their ability to work with endurance. Therefore, chronic kidney disease may progress silently without any symptoms for a long time until the function of the kidney becomes minimal, by which time the patient will have following symptoms:

– Feeling frequent urination, especially in the evening.
– Swelling of the legs and recognized puffiness around the eyes due to body fluid retention.
– High blood pressure
– Fatigue,weakness (due to anemia or by the accumulation of waste products in the body not being filtered out).
– Loss of appetite, nausea, vomiting.
– Itchy skin, easy bruising and pale skin color (due to anemia).
– Shortness of breath due to accumulation of water in the lungs.
– Headache, legs or arms numbness (peripheral neuropathy), sleepingproblem, personality changes (due to brain accumulation of waste products and toxic urea) and unusual feelings of their legs like itching, crawling... to urge to move legs (restless legs syndrome), typically in the evenings.
– Chest pain due to pericarditis.
– Easilybleeding because bleeding does not stop (due to difficulty of blood clotting).
– Painful feeling in bone and easy to get bone fracture.
– Reduce libido and impotence.


Although chronic kidney disease sometimes as a result of the disease comes directly from the kidney, but the main cause that leads to kidney failure is due to patients who have had diabetes and high blood pressure.

– Diabetes type 1 and type 2 that causes kidney disease due to diabetes(diabetic nephropathy) is the first rankedreason of kidney disease in the United States.
– High blood pressure, if not well controlled, can cause kidney damage over a long time.
– Glomerulonephritis is inflammation and damage to the kidney's filtering system and can cause kidney failure. Post-infection and lupus are one of the causes of glomerulonephritis.
– Polycystic kidney disease is an example of a genetic cause of chronic kidney disease; In this case both kidneys have multiple cysts (water sacs).
– Pain killer drugs as acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil) if taken regularly for prolonged periods of time can cause damage to the kidneys. Certain other medicines can also harm the kidneys.
– Blocking and hardening of the arteries leading to the kidneys can cause ischemia for the glomeruli and thereby cause gradually kidney damage.
– Impeding the flow of urine due to urinary tract stones, swelling of the prostate gland, narrowing of the urinary tract or cancer of the urinary tract can also cause kidney disease.
– The other causes of chronic kidney disease include HIV, sickle cell disease, heroin addictive, amyloidosis, kidney stones, chronic infection of kidneys and some cancers.

Therefore, you need to checkkidney function more frequently if you are suffering from the following diseases because these diseases are more at risk of developing chronic kidney disease.

* Diabetes

Because long-term high blood sugar levels cause damage to millions of filtering units (glomeruli) of the kidney, this can lead to kidney failure.
High blood sugar in diabetics also narrows the blood vessels that enter the kidneys. This keeps the blood from reaching the kidneys leading to kidney failure.

* High blood pressure

High blood pressure for a long time is more likely to develop arteriosclerosis, which prevents blood from reaching the kidneys, resulting in kidney failure.

* High cholesterol

High cholesterol would narrow the arteries diameter due to fatty plaques being formed, which in turn attach to the inside wall of the artery; if this case occurs in renal arteries, the blood is prevented to flow to kidneys to nourish them, which can cause kidney failure.

* Heart disease

For example, coronary artery disease causes the heart not to pump blood strong enough to circulate blood to the kidney, which can easily lead to kidney failure.

* Kidney disease

As glomerulonephritis or kidney infections for prolonged periods of time also easily lead to kidney failure.

* Amyloidosis

This disease is caused by the body making abnormal proteins, which are abundant in the kidney, causing kidney damage, which in turn leads to kidney failure.

* Sickle cell anemia

This disease is caused by sickle-shaped red blood cells that cause anemia in the kidneys leading to kidney failure.

* Systemic lupus erythematosus

This disease is caused by an autoimmune disease, in which the body immune system attacks its own kidney cells which in turn causes kidney inflammation, eventually leading to kidney failure.

* Fibromuscular dysplasia

These diseases narrow blood vessels, including blood vessels leading to the kidneys, which causes the kidneys not having enough blood to nourish kidney cells, thereby leading to kidney failure.

* Vesicoureteral reflux

In this disease, urine flows from the bladder back to the kidneys, making the kidneys more susceptible to infections; without treatment for long time will lead to kidney failure.

* Patients taking regularlyanti-inflammatory drugs for pain

Since the anti-inflammatory drugs when taken regularly will cause constriction of blood vessels into the glomeruli, thereby reducing filtration function, leading to kidney failure.

* People with genetic factors for kidney disease

If someone in the family who has had kidney disease, they are genetically at risk of kidney disease.

* Liver diseases

Severe liver disease as liver cirrhosis constricts the blood vessels into the kidneys, from which there is not enough blood to nourish the kidneys, leading kidney failure(hepatorenal syndrome).

Actually, the liver and kidneys have a relationship interrelated because the liver and kidneys are two vital organs of the body to purify the blood. The liver function is to filter harmful substances from the outside into the body; These toxic substances can be present in food, medicine... coming in from the digestive tract, these toxic substances can come from polluted air when we breathe in, and from contacting with toxic chemicals throughskin to enter into the bloodstream. In general, the liver has a duty to prevent, filter and neutralize toxic substances that enter the bloodstream, which are at risk of causing allergic reactions such as rash, itching, hives, and acne, etc.…  But as I said above, kidney function is to filter the toxic and waste products outof the bloodstream.

Therefore, there is a theory that if the liver disease is as severe as in cirrhosis, the liver is unable to filter out the toxic substances in the blood, then the kidneys must work harder to filter out the toxic substances that the liver is supposed to do it. This causes the kidneys to overwork, leading to kidney failure.


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