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Kidney failure
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{{Short description|Disease where the kidneys fail to adequately filter waste products from the blood}} {{pp-vandalism|small=yes}} {{More citations needed|date=May 2024}} {{cs1 config|name-list-style=vanc}} <!-- This article is meant to be a disambig-like article. Detailed explanations should go into the 'Acute renal injury' and 'Chronic renal disease' articles. --><!-- Definition and symptoms --> {{Infobox medical condition | name = Kidney failure | synonyms = Renal failure, end-stage renal disease (ESRD), stage 5 chronic kidney disease<ref name=Che2005/> | image = Hemodialysismachine.jpg | caption = A [[hemodialysis]] machine which is used to replace the function of the kidneys | field = [[Nephrology]] | symptoms = [[pedal edema|Leg swelling]], feeling tired, loss of appetite, confusion<ref name=NIH2017/> | complications = '''Acute''': [[Uremia]], [[high blood potassium]], [[volume overload]]<ref name=Blak2010/><br>'''Chronic''': [[Cardiovascular disease|Heart disease]], high blood pressure, [[anemia]]<ref name=Li2012/><ref name=MP2017/> | onset = | duration = | types = [[Acute kidney failure]], [[chronic kidney failure]]<ref name=Hop2017/> | causes = '''Acute''': {{hlist|[[Low blood pressure]]|blockage of the [[urinary tract]]|certain medications|[[rhabdomyolysis|muscle breakdown]]|[[hemolytic uremic syndrome]]}}<ref name=Hop2017/><br>'''Chronic''': {{hlist|[[diabetic nephropathy|Diabetes]]|[[high blood pressure]]|[[nephrotic syndrome]]|[[polycystic kidney disease]]}}<ref name=Hop2017/> | risks = | diagnosis = '''Acute''': {{hlist|[[Oliguria|Decreased urine production]]|increased [[serum creatinine]]<ref name=Blak2010/>}}<br />'''Chronic''': {{hlist|[[Renal function|Glomerular filtration rate]] (GFR)|< 15<ref name=Che2005/>}} | differential = | prevention = | treatment = '''Acute''': Depends on the cause<ref name=Clat2010/><br />'''Chronic''': [[Hemodialysis]], [[peritoneal dialysis]], [[kidney transplant]]<ref name=NIH2017/> | medication = | prognosis = | frequency = '''Acute''': 3 per 1,000 per year<ref name=Fer2018Acute/><br>'''Chronic''': 1 per 1,000 (US)<ref name=Che2005/> | deaths = }} '''Kidney failure''', also known as '''renal failure''' or '''end-stage renal disease''' ('''ESRD'''), is a medical condition in which the [[kidney]]s can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels.<ref name=NIH2017>{{cite web|title=Kidney Failure|url=https://www.niddk.nih.gov/health-information/Kidney-disease/kidney-failure|website=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=11 November 2017}}</ref> Kidney failure is classified as either [[acute kidney failure]], which develops rapidly and may resolve; and [[chronic kidney failure]], which develops slowly and can often be irreversible.<ref name=Hop2017>{{cite web|title=What is renal failure?|url=https://www.hopkinsmedicine.org/healthlibrary/conditions/kidney_and_urinary_system_disorders/end_stage_renal_disease_esrd_85,P01474|website=Johns Hopkins Medicine|access-date=18 December 2017|language=en|archive-url=https://web.archive.org/web/20170618054600/http://www.hopkinsmedicine.org/healthlibrary/conditions/kidney_and_urinary_system_disorders/end_stage_renal_disease_esrd_85,P01474/|archive-date=18 June 2017}}</ref> Symptoms may include [[edema|leg swelling]], feeling tired, [[vomiting]], loss of appetite, and [[confusion]].<ref name=NIH2017/> Complications of acute and chronic failure include [[uremia]], [[hyperkalemia]], and [[volume overload]].<ref name="Blak2010" /> Complications of chronic failure also include [[heart disease]], [[high blood pressure]], and [[anaemia]].<ref name=Li2012>{{cite journal | vauthors = Liao MT, Sung CC, Hung KC, Wu CC, Lo L, Lu KC | title = Insulin resistance in patients with chronic kidney disease | journal = Journal of Biomedicine & Biotechnology | volume = 2012 | pages = 691369 | year = 2012 | pmid = 22919275 | pmc = 3420350 | doi = 10.1155/2012/691369 | doi-access = free }}</ref><ref name=MP2017>{{cite web|title=Kidney Failure|url=https://medlineplus.gov/kidneyfailure.html|website=MedlinePlus|access-date=11 November 2017|language=en}}</ref> <!-- Cause and diagnosis --> Causes of acute kidney failure include [[low blood pressure]], blockage of the [[urinary tract]], certain medications, [[muscle breakdown]], and [[hemolytic uremic syndrome]].<ref name=Hop2017/> Causes of chronic kidney failure include [[diabetic nephropathy|diabetes]], [[high blood pressure]], [[nephrotic syndrome]], and [[polycystic kidney disease]].<ref name=Hop2017/> Diagnosis of acute failure is often based on a combination of factors such as [[oliguria|decreased urine production]] or increased [[serum creatinine]].<ref name=Blak2010>{{cite book| vauthors = Blakeley S |title=Renal Failure and Replacement Therapies|date=2010|publisher=Springer Science & Business Media|isbn=9781846289378|page=19|url=https://books.google.com/books?id=G1-9oN0I4lAC&pg=PA19|language=en}}</ref> Diagnosis of chronic failure is based on a [[glomerular filtration rate]] (GFR) of less than 15 or the need for [[renal replacement therapy]].<ref name=Che2005>{{cite book| vauthors = Cheung AK |title=Primer on Kidney Diseases|date=2005|publisher=Elsevier Health Sciences|isbn=1416023127|page=457|url=https://books.google.com/books?id=BUE9-mY4FkoC&pg=PA457|language=en}}</ref> It is also equivalent to stage 5 [[chronic kidney disease]].<ref name=Che2005/> <!-- Treatment and prognosis --> Treatment of acute failure depends on the underlying cause.<ref name=Clat2010>{{cite book| vauthors = Clatworthy M |title=Nephrology: Clinical Cases Uncovered|date=2010|publisher=John Wiley & Sons|isbn=9781405189903|page=28|url=https://books.google.com/books?id=55VOagYjaVkC&pg=PA28|language=en}}</ref> Treatment of chronic failure may include [[hemodialysis]], [[peritoneal dialysis]], or a [[kidney transplant]].<ref name=NIH2017/> Hemodialysis uses a machine to filter the blood outside the body.<ref name=NIH2017/> In peritoneal dialysis specific fluid is placed into the [[abdominal cavity]] and then drained, with this process being repeated multiple times per day.<ref name=NIH2017/> Kidney transplantation involves surgically placing a kidney from someone else and then taking [[immunosuppressant]] medication to prevent [[organ rejection|rejection]].<ref name=NIH2017/> Other recommended measures from chronic disease include staying active and specific dietary changes.<ref name=NIH2017/> Depression is also common among patients with kidney failure, and is associated with poor outcomes including higher risk of kidney function decline, hospitalization, and death. A recent [[PCORI]]-funded study of patients with kidney failure receiving outpatient hemodialysis found similar effectiveness between nonpharmacological and pharmacological treatments for depression.<ref>{{cite journal | vauthors = Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, Dember LM, Diaz-Linhart Y, Dubovsky A, Greene T, Grote N, Kutner N, Trivedi MH, Quinn DK, Ver Halen N, Weisbord SD, Young BA, Kimmel PL, Hedayati SS | display-authors = 6 | title = Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial | journal = Annals of Internal Medicine | volume = 170 | issue = 6 | pages = 369β379 | date = March 2019 | pmid = 30802897 | doi = 10.7326/M18-2229 | s2cid = 67876948 }}</ref> <!-- Epidemiology and culture --> In the United States, acute failure affects about 3 per 1,000 people a year.<ref name=Fer2018Acute>{{cite book| vauthors = Ferri FF |title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=9780323529570|page=37|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA37|language=en}}</ref> Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly developing the condition each year.<ref name=Che2005/><ref name=Fer2018ESKD>{{cite book| vauthors = Ferri FF |title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=9780323529570|page=294|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA294|language=en}}</ref> In Canada, the lifetime risk of kidney failure or end-stage renal disease (ESRD) was estimated to be 2.66% for men and 1.76% for women.<ref name=CanadaESRDLTR>{{cite journal | vauthors = Turin TC, Tonelli M, Manns BJ, Ahmed SB, Ravani P, James MT, Hemmelgarn BR | title = Lifetime risk of ESRD | journal = J Am Soc Nephrol | volume = 23 | issue = 9 | pages = 1569β1578 | date = September 2012 | pmid = 22904351 | pmc = 3431421 | doi = 10.1681/ASN.2012020164 }}</ref> Acute failure is often reversible while chronic failure often is not.<ref name=Hop2017/> With appropriate treatment many with chronic disease can continue working.<ref name=NIH2017/>
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