Symptoms and stages of kidney failure and methods of prevention and treatment

The primary function of the kidneys is to get rid of excess water an body waste through urine, and purify the blood before it returns to the heart, in addition to many other important functions. Therefore, any malfunction or disorder in kidney function greatly affects human health. Perhaps one of the most important and dangerous kidney diseases is kidney failure. What is meant by it, what are the symptoms of kidney failure, and how to diagnose it? This is what we will learn in this article, Dalily Medical.

What is kidney failure

Kidney failure is a disorder resulting from dysfunction of the kidneys, as a normal, healthy kidney acts as a vital filter for the body, maintains the balance of body fluids, chemicals and blood acidity, and produces hormones that control the production of red blood cells and bone growth. Kidney failure leads to the accumulation of waste products in the body's various tissues, and affects all age groups, especially the elderly.

Is dialysis painful?

Dialysis is not painful, but some patients experience dizziness, nausea, or cramps during the dialysis process, due to the change in the body's fluid and salt content during the dialysis process.

When does the patient stop dialysis?

Stopping dialysis depends on the patient's condition and which kidney disease he has. In some cases, when kidney failure is a temporary problem, dialysis can be stopped when the kidneys recover and return to normal function. However, in many cases, kidney failure is chronic, which makes the individual need a kidney transplant. Since it is not always possible to perform a kidney transplant immediately, dialysis may be needed until a suitable donor kidney is available. In this case, dialysis can be stopped after the patient has undergone a kidney transplant.

What is a dialysis catheter?

A dialysis catheter is a catheter tube that is placed in one of the main veins. Its internal end reaches inside the vein, while its external end ends at the surface of the skin and forms a channel that connects the blood circulation to the skin. The most prominent types of dialysis catheters are the following:

Temporary dialysis catheter.

Permanent dialysis catheter.

**What is a temporary dialysis catheter?**

A temporary dialysis catheter is a catheter used for a short period of time, often placed in the upper neck. This catheter is used in emergency situations requiring dialysis, and is usually removed after a short period of time. The reason for rapid removal is due to the increased risk of infection over time, in addition to the fact that this type of catheter cannot be securely fixed under the skin, which can lead to its separation from the body and the emergence of problems.

**What is a permanent dialysis catheter?**

A permanent dialysis catheter is similar to a temporary catheter, but it is inserted under the skin, which helps to secure it and reduces the risk of contamination and infection. It also prevents the catheter from separating from the body, providing a reliable means of dialysis. Permanent catheters differ from temporary catheters in that they are inserted with the help of interventional radiology, which increases the cost of this procedure.

**Dialysis rate in dialysis patients**

The doctor usually sets a schedule for dialysis sessions, with sessions usually starting at four hours, three times a week. If you are a patient undergoing dialysis sessions at home, you can increase the number of sessions to four or seven per week, but with a reduction in the duration of each session, which helps to expel toxins from the body continuously.

Can a dialysis patient have children?

The issue of dialysis patients having children in Egypt is a sensitive topic, but the truth is that a dialysis patient can have children, although his fertility rate decreases, which affects the chances of pregnancy. In the first years of dialysis treatment, the chances of pregnancy are about 1%.

If a woman is a dialysis patient and is planning to get pregnant, she will need more dialysis sessions than the normal rate to avoid any complications that may affect her health or the health of the fetus.

What are the appropriate cases for each type of dialysis?

The patient is usually given the choice of the type of dialysis, as both techniques are generally effective, but each has advantages and disadvantages. For example:

- **Blood analysis**: If the patient chooses this type of treatment, he needs to do it three times a week, but it requires going to the hospital, and the sessions take a long time.

- **Peritoneal analysis**: This type of treatment can be easily done at home, even while sleeping, but the downside is that it requires the procedure to be done daily.

**Alternatives to dialysis**

Dialysis is a vital treatment for kidney failure, but there are alternative options that should be considered. Among these options, a kidney transplant is one of the solutions, as it provides patients with the opportunity to live a more normal life.

However, finding a suitable donor and performing the transplant can take a long time. Therefore, some people may choose conservative treatment, which focuses on relieving symptoms and slowing the progression of kidney disease through lifestyle changes and the use of medications.

**Is dialysis a lifelong process?**

The need for dialysis varies from person to person. In some cases, kidney failure may be temporary, allowing dialysis to be stopped when the kidneys regain their function. However, for many patients, dialysis is a lifelong treatment. If a kidney transplant is not an option or desired, dialysis remains the primary treatment for kidney failure.

**Does dialysis cause death?**

Dialysis is a lifesaver for people with kidney failure, replacing the damaged kidneys and helping to remove toxins and waste from the body. Despite being a vital treatment, dialysis does carry some risks and challenges. Although dialysis itself is not

Directly related to death, studies indicate that the risk of death in dialysis patients increases due to other factors, such as:

- Heart disease.

- Infections.

- Sudden drop in blood circulation.

- Complications of chronic kidney disease.

Dialysis patients are exposed to sudden risks, such as heart attacks or strokes, which increase the risk of death.

Dialysis represents a glimmer of hope for patients with kidney failure, as it helps them continue to live a relatively normal life. With the continuous progress in the field of kidney treatments, techniques are becoming more effective and have fewer side effects, allowing patients to improve their quality of life. In addition to dialysis, psychological factors play an important role in the treatment journey, as psychological support from family and friends helps the patient adapt to his new health condition and face challenges with a positive spirit.

Types of dialysis

There are two types of dialysis, as how dialysis is performed and the duration of dialysis differs in each of these types:

Dialysis through blood During dialysis through blood, blood is drawn from the body and passes through a machine that filters out toxic substances and returns the blood to the body. This type of dialysis is usually performed in a dialysis unit located in a private center or hospital, where there are special devices that do the work of the kidneys in terms of purifying the blood from toxins. Patients usually undergo a dialysis session through the blood 3 times a week, and each dialysis takes about 4 hours.

Before treatment, patients weigh themselves to know the amount of fluid accumulated in the body from the previous dialysis, and dialysis is performed through the area designated for dialysis in the body that has been prepared in advance, and blood is drawn by a needle and purified in the device and returned to the connection again, and this process is repeated several times. During this period, the patient is closely monitored and his vital signs are taken continuously to ensure that no problems occur.

Dialysis through the peritoneal membrane in the abdomen, where during this type of dialysis, the blood is filtered while it is inside the body by injecting a special fluid into the abdomen, and this fluid absorbs the toxic substances, then this fluid is drained from the body. The patient's role is effective in this way, and it is done in the comfort of home. The medical staff installs a cannula connected to the abdominal cavity, through which the dialysis process is carried out. The patient empties a bag containing a special fluid into the abdominal cavity and the bag is tied to clothing until the next wash. The duration of peritoneal dialysis in the abdomen usually reaches 30 minutes, then the fluid is emptied into the bag again. The process is repeated 4 or 5 times a day. As an alternative to this treatment, some patients use a special machine that is installed during the night, in which 4 or 5 bags are used at once, where the machine changes the fluid while the patient sleeps.

Temporary dialysis The patient may need dialysis once, or dialysis may be temporary, where the patient performs dialysis until the normal kidney repairs itself. Temporary dialysis is suitable for patients who suffer from acute kidney failure for one reason or another, and the kidneys usually recover after a period of time, as well as patients who suffer from poisoning due to the consumption of drugs or toxic substances, accident and injury patients, or patients who suffer from heart failure.

When does a patient need dialysis?

A kidney patient needs to undergo dialysis when the kidneys are unable to perform the purification process, and toxins begin to accumulate in the body. The most important of these toxins are urea and creatine in the blood, which are measured in the laboratory. Doctors also measure the extent of blood purification from creatine by examining urine. One of the reasons that cause a problem in the functioning of the kidneys is kidney failure, which may be either acute or chronic. When toxins exceed a certain limit or when the purification rate falls below a certain limit, the body needs dialysis. This happens when the kidney function rate falls below 10-15% of the normal level. It is worth noting that dialysis does not perform all the functions of the kidneys, but only gets rid of toxins.

Types of dialysis catheters

Before performing dialysis, the patient needs to undergo a minor surgical procedure to create a connection to the bloodstream, and this is done in one of the following ways:

Arteriovenous fistula: Also known as an arteriovenous fistula, where the artery is connected to the vein under the skin of the arm (the arm that you do not usually use for writing). The connection takes about 6 weeks to heal and can be used for several years.

Arteriovenous implantation: A plastic connection is implanted under the skin to connect the artery to the vein. It takes only two weeks to heal, but it cannot be used for a long time like a fistula, and it is more likely to become infected.

Central venous catheter: It is a plastic tube that is connected to a vein in the neck, upper chest, or near the pubic area. The dialysis process is started directly through it and does not take time to heal, but it is used for a short period only due to its complications.

**What are the stages of kidney failure?**

The stages of kidney failure are divided into five stages:

- **Stage 1:** It is characterized by a normal or high glomerular filtration rate (GFR) where the GFR is greater than 90 ml/min.

- **Stage 2:** It is considered mild chronic kidney disease (CKD) with a GFR ranging between 60-89 ml/min.

- **Stage 3A:** It indicates moderate kidney damage, where the glomerular filtration rate is between 45-59 ml/min.

- **Stage 3b:** is considered moderate CKD with a GFR of 30-44 ml/min.

- **Stage 4:** is considered severe CKD, with a GFR of 15-29 ml/min.

- **Stage 5:** represents the end stage of chronic kidney disease (CKD) with a GFR of less than 15 ml/min.

**Diagnostic Tests for Chronic Kidney Disease**

- **Check

Blood:** Used to determine if waste is being filtered properly. If urea and creatinine levels are consistently high, this may indicate end-stage kidney disease.

- **Urine test:** Helps detect the presence of blood or protein in the urine.

- **Kidney scan:** Includes tests such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound, to determine if there is a blockage in the flow of urine. These tests can reveal the size and shape of the kidneys, as the kidneys may be smaller and have an uneven shape in advanced stages of the disease.

- **Kidney biopsy:** Used to determine how well the kidneys are filtering waste.

- **Chest X-ray:** May be ordered to evaluate the condition of the kidneys.

- **Glomerular filtration rate (GFR):** This is a test that measures how well the kidneys are filtering waste, comparing the levels of waste in the patient's blood and urine. GFR shows the number of milliliters of waste that the kidneys can filter per minute, where healthy kidneys can filter more than 90 ml per minute.

**Types of kidney failure**

1. **Acute renal failure**: It is a sudden failure in kidney function that occurs over a short period of time. The patient may need temporary dialysis, and in many cases the patient can recover completely, or there may be a partial recovery leading to the development of the condition into chronic renal failure. It rarely develops into final renal failure.

2. **Chronic renal failure**: It is a continuous failure in kidney function as a result of long-term acute renal failure. It is divided into five stages based on the rate at which the kidneys filter harmful substances such as creatinine in the blood.

3. **End stage renal failure**: It is a severe and chronic failure in kidney function, which requires obtaining kidney replacement therapy to ensure the patient's survival.

**Causes of kidney failure**

It is difficult to list all the causes of kidney failure, as the causes differ between acute and chronic renal failure. So, we will review the causes of each of them separately:

**Causes of acute kidney failure**: Acute kidney failure results from a variety of health problems that may suddenly affect blood flow to the kidneys, cause severe damage to kidney tissue, or lead to blockage in the urinary tract. Common causes include:

- **Poor blood flow**: Some diseases and emergency health problems may lead to a decrease in blood supply to the kidneys, causing severe failure in their functions if not treated quickly. These causes include:

- Low blood pressure.

- Severe bleeding.

- Severe diarrhea.

- Heart attack.

- Heart failure.

- Liver failure.

- Hypersensitivity.

- Burns and injuries.

- Excessive use of non-steroidal anti-inflammatory drugs.

- **Direct kidney damage**: The kidneys are exposed to direct damage that affects their functions as a result of the following health problems:

- Sepsis.

- Scleroderma.

- Tubular necrosis.

- Glomerulonephritis.

- Multiple myeloma.

- Interstitial nephritis.

- Vasculitis.

**Thrombotic microangiopathy**

Urine is transported from the kidney through the ureter to the bladder, and then continues through the urethra to the outside of the body. However, a blockage in the urethra may obstruct the flow of urine, causing symptoms of kidney failure. Conditions that can lead to this blockage include:

- Kidney stones

- Bladder cancer

- Prostate enlargement

- Prostate cancer

- Cervical cancer

- Blood clots in the urethra

**Second: Causes of chronic kidney failure**

Statistics indicate that more than two-thirds of chronic kidney failure cases are caused by diabetes or chronic high blood pressure, as symptoms of kidney failure are expected to appear when these two diseases worsen. In addition, there are some other causes that may contribute to the occurrence of chronic kidney failure, such as:

- Glomerulonephritis

- Polycystic kidney disease

- Congenital kidney and urinary tract abnormalities

Autoimmune diseases, such as lupus nephritis, can affect kidney health.

Urinary tract obstruction can also occur as a result of kidney stones or some tumors.

Does acute kidney failure cause pain?

The experience of pain in cases of acute kidney failure varies from one patient to another, depending on the cause of kidney failure and the complications associated with it. Among the possible areas of pain in cases of kidney failure are:

- Chest pain.

- Lower back pain.

- Pain in the flank, which may extend to the groin area.

- Pain during urination, which is more associated with urinary tract infections or stones.

**Complications of Kidney Failure**

There are several complications associated with kidney failure, the most prominent of which are:

- **Fluid retention**: The kidneys' ability to get rid of excess fluids is affected, leading to edema in the extremities and lungs, in addition to high blood pressure.

- **Heart rhythm disturbance**: The secretion of potassium from the body decreases, causing its levels in the blood to rise rapidly, which may lead to severe disturbances in the heart rhythm that may be life-threatening.

- **Bone fractures**: The kidneys play a role in regulating the levels of phosphorus and calcium in the blood, which are two essential elements for building bones. When the levels of these minerals are affected, the bones weaken and become more susceptible to fractures.

- **Anemia**: Anemia occurs as a result of a decrease in the level of the hormone erythropoietin, which is secreted by the kidneys, which stimulates the bone marrow to produce red blood cells.

- **Central nervous system injury**: The accumulation of toxic substances in the body negatively affects the functional performance of the central nervous system, causing difficulty concentrating, personality changes, and seizures.

**Symptoms of Kidney Failure**

Symptoms of kidney failure appear late in its early stages, as 90% of people do not realize it.

People who suffer from kidney failure in the early stages. Common symptoms include:

- Feeling short of breath for no apparent reason.

- Decreased urine output than usual.

- Noticing swelling in the legs and ankles due to fluid retention.

- Feeling sleepy and excessively tired.

- Continuous nausea for long periods.

- Feeling confused with chest pain.

- Exposure to coma, heart attacks and strokes.

**Early symptoms of kidney failure**

It is difficult to identify the symptoms of kidney failure in its early stages, but the color of urine and the changes that occur in it can be used as a means of predicting the health condition of the body, as follows:

- **Foamy urine**: The appearance of many bubbles in the urine may indicate the presence of protein, which is a sign of kidney problems.

- **Orange urine**: It is a sign of dehydration, but it is not an indicator of kidney disease.

- **Red or pink urine**: The presence of drops of blood may change the color of the urine, which requires an urgent urine test.

**Symptoms of kidney failure in women**

The symptoms of chronic kidney failure remain unclear for long periods, due to the body's ability to adapt to decreased kidney function. Blood and urine tests are the known way to detect kidney failure.

Here are the most prominent symptoms of kidney failure in women:

- Feeling increasingly tired.

- Loss of appetite and desire to eat.

- Decreased concentration.

- Feeling insomnia and difficulty sleeping normally.

- Frequent muscle cramps, especially at night.

- Swollen eyes and swollen feet.

- Increased number of times to urinate at night.

- Dry skin and frequent itching.

**Symptoms of kidney failure in children**

Children can suffer from two types of kidney failure: acute and chronic. Chronic kidney failure is more common among children, as it is often hereditary and transmitted from parents, while acute kidney failure occurs suddenly.

Symptoms of kidney failure in children include the following:

- Fluid retention in the body.

- Low energy levels in the child.

- Reducing the amount of urine below the normal rate.

- Paleness of the face due to iron deficiency and anemia.

- Stopping normal growth.

- Feeling a headache.

- The desire to vomit.

- Urinary tract infection.

- High temperature and fever.

- Increased involuntary urination.

- Bloody diarrhea.

**Symptoms of kidney failure in diabetics**

Symptoms of kidney failure in diabetics are divided into two categories: early symptoms and late symptoms. Below we review each category:

**Early symptoms:**

- Increased albumin excretion in the urine is one of the most prominent early signs of kidney failure in diabetics, so it is recommended to conduct a periodic albumin test at least once a year.

- Ankle swelling.

- Weight gain.

- Frequent urination, especially at night.

- High blood pressure.

**Late symptoms:**

- Loss of appetite.

- Feeling constantly tired.

- The desire to scratch the skin.

- Feeling nauseous and vomiting.

- High creatinine levels in the blood.

- Muscle cramps, especially in the legs.

- Significant anemia.

- Increased protein levels in the urine.

- No need for insulin.

Treatment of kidney failure

The treatment options for kidney failure depend on its type, whether acute or chronic, as well as the stage it has reached, the causes that led to it, and the complications that the patient may be exposed to. Therefore, we divide the treatment of kidney failure as follows:

First: Treatment of acute kidney failure Treatment of acute cases of kidney failure requires hospitalization; to remain under medical care for the entire duration of treatment, and the sooner the patient receives medical care; the greater the chance of recovery, and doctors aim to prevent the worsening of kidney failure, and help the kidney to regain its normal functions again, and among the proposed treatment options:

Treatment of the causes of kidney failure: Doctors conduct the necessary diagnostic tests to determine the cause of acute kidney failure, and then the medical team determines an appropriate treatment plan to treat the problem or alleviate it as much as possible.

Preventing complications of kidney failure: Doctors aim to provide the kidneys with the appropriate environment to recover, and in light of this, some precautionary measures are taken to avoid worsening kidney failure, or exposing the patient to unwanted complications, and what the patient may need then:

Treatment of symptoms of kidney failure.

Restoring fluid balance in the body.

Some patients may need to take diuretics.

Some medications to regulate potassium and calcium levels in the blood.

Dialysis; to rid the body of toxins until the kidneys regain their health.

Second: Treatment of chronic kidney failure

Treatment of kidney failure in chronic cases aims to improve the patient's health condition, and slow down or prevent the worsening of the disease as much as possible, and some treatment procedures may differ depending on the cause of kidney failure, and chronic kidney failure is treated as follows:

Treatment of the causes of kidney failure: Acute kidney failure is often caused by diabetes or high blood pressure, and a treatment plan should be developed to alleviate the disease causing kidney failure, which reduces the severity of kidney failure symptoms.

Preventing worsening kidney failure: Doctors try to keep the glomerular reflux rate (GFR) as safe as possible, as well as the level of albumin in the urine. In light of this, the patient needs to follow a special diet, along with taking some medications such as:

Diuretics.

Anemia medications.

High blood pressure medications.

Cholesterol-lowering medications.

Nutritional supplements, such as calcium and vitamin D.

Dialysis: In advanced stages of kidney failure, dialysis becomes an urgent necessity to get rid of toxins, as the kidneys become completely unable to perform this function.

Kidney transplantation: This is a surgical procedure that aims to provide the patient with a healthy kidney to replace the damaged kidney, and is a suitable option for those whose kidney function has decreased toOnly 20%.