Editing Kidney failure

{{Short description|Disease where the kidneys fail to adequately filter waste products from the blood}}
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<!-- 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 = 369–379 | 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 = 1569–1578 | 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/>

== Classification ==
{{See also|Hepatorenal syndrome}}

Kidney failure can be divided into two categories: [[acute kidney failure]] or [[chronic kidney failure]]. The type of renal failure is differentiated by the trend in the serum [[Creatinine#Diagnostic use|creatinine]]; other factors that may help differentiate acute kidney failure from chronic kidney failure include [[anemia]] and the kidney size on [[sonography]] as chronic kidney disease generally leads to anemia and small kidney size.<ref>niddk.nih.gov, [Anemia in Chronic Kidney Disease](https://www.niddk.nih.gov/health-information/kidney-disease/anemia)</ref>

=== Acute kidney failure ===
{{Main|Acute kidney injury}}

[[Acute kidney injury]] (AKI), previously called acute renal failure (ARF),<ref>{{cite journal | vauthors = Moore EM, Bellomo R, Nichol AD | title = The meaning of acute kidney injury and its relevance to intensive care and anaesthesia | journal = Anaesthesia and Intensive Care | volume = 40 | issue = 6 | pages = 929–48 | date = November 2012 | pmid = 23194202 | doi = 10.1177/0310057X1204000604 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Ricci Z, Ronco C | title = New insights in acute kidney failure in the critically ill | journal = [[Swiss Medical Weekly]] | volume = 142 | pages = w13662 | year = 2012 | pmid = 22923149 | doi = 10.4414/smw.2012.13662 | doi-access = free }}</ref> is a rapidly progressive loss of [[renal function]],<ref name="Adam">{{cite encyclopedia |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/ | archive-url = https://web.archive.org/web/20140117220151/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/ | archive-date = 17 January 2014 |title=Acute kidney failure | encyclopedia = A.D.A.M. Medical Encyclopedia |year=2012 |publisher=U.S. National Library of Medicine |access-date=1 January 2013}}</ref> generally characterized by [[oliguria]] (decreased [[urine]] production, quantified as less than 400&nbsp;[[millilitres|mL]] per day in adults,<ref>{{cite journal | vauthors = Klahr S, Miller SB | title = Acute oliguria | journal = The New England Journal of Medicine | volume = 338 | issue = 10 | pages = 671–5 | date = March 1998 | pmid = 9486997 | doi = 10.1056/NEJM199803053381007 }}</ref> less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and [[Water-electrolyte imbalance|fluid and electrolyte imbalance]]. AKI can result from a variety of causes, generally classified as ''prerenal'', ''intrinsic'', and ''postrenal''. Many people diagnosed with [[paraquat|paraquat intoxication]]  experience AKI, sometimes requiring [[hemodialysis]].<ref>Predictors of acute kidney injury after paraquat intoxication, [National Library of Medicine - National Institutes of Health](https://pmc.ncbi.nlm.nih.gov/articles/PMC5584253/)</ref>  The underlying cause must be identified and treated to arrest the progress, and [[Kidney dialysis|dialysis]] may be necessary to bridge the time gap required for treating these fundamental causes.{{citation needed|date=April 2023}}

===Chronic kidney failure===
{{Main|Chronic kidney disease}}
[[File:CKD - Chronic kidney disease.jpg|thumb|Illustration of a kidney from a person with chronic renal failure]]

[[Chronic kidney disease]] (CKD) can also develop slowly and, initially, show few symptoms.<ref>{{cite encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/000471.htm |title=Chronic kidney disease |year=2011 |encyclopedia=A.D.A.M. Medical Encyclopedia |publisher=  Medline Plus, National Institutes of Health |access-date=1 January 2013}}</ref> CKD can be the long term consequence of irreversible acute disease or part of a disease progression.{{citation needed|date=August 2022}} CKD is divided into 5 different stages (1–5) according to the estimated glomerular filtration rate (eGFR). In CKD1 eGFR is normal and in CKD5 eGFR has decreased to less than 15&nbsp;ml/min.<ref>{{Cite web |date=2021-11-22 |title=Stages of kidney disease |url=https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease |access-date=2023-03-09 |website=www.kidneyfund.org |language=en}}</ref>

=== Acute-on-chronic kidney failure ===
Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the person to baseline kidney function, typically measured by serum [[creatinine]]. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the person has not been monitored by a [[physician]] and no baseline (i.e., past) blood work is available for comparison.{{citation needed|date=August 2022}}

== Signs and symptoms ==
Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When the kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called [[azotemia]]. Very low levels of azotemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed [[uraemia]].<ref name="grinsted">{{cite web  | vauthors = Grinsted P  | title = Kidney failure (renal failure with uremia, or azotaemia)  | work = Netdoctor  | date = 2005-03-02  | url = http://www.netdoctor.co.uk/diseases/facts/kidneyfailure.htm  | access-date = 2009-05-26  | archive-date = 2015-10-15  | archive-url = https://web.archive.org/web/20151015111748/http://www.netdoctor.co.uk/diseases/facts/kidneyfailure.htm  | url-status = dead  }}</ref>

Symptoms of kidney failure include the following:<ref name="grinsted"/><ref>{{cite book  | vauthors = Stein A  | title = Understanding Treatment Options For Renal Therapy  | publisher = Baxter International Inc.  | date = 2007-07-01  | location = Deerfield, Illinois  | page = 6  | url = http://www.renalinfo.com/  | isbn = 978-1-85959-070-6  | access-date = 2010-07-12  | archive-date = 2019-01-30  | archive-url = https://web.archive.org/web/20190130063734/http://www.renalinfo.com/  | url-status = dead  }}</ref><ref name="PD">{{cite book  | title = The PD Companion  | publisher = Baxter International Inc.  | date = 2008-05-01  | location = Deerfield, Illinois  | pages = 14–15  | url = http://www.renalinfo.com/uk  | id = 08/1046R  | access-date = 2010-07-12  | archive-url = https://web.archive.org/web/20100625040151/http://www.renalinfo.com/uk/  | archive-date = 2010-06-25  | url-status = dead  }}</ref><ref name="lifeoptions">{{cite web  | last = Amgen Inc. | author-link = Amgen  | title = 10 Symptoms of Kidney Disease   | year = 2009  | url = https://www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4  | access-date = 2009-05-26}}</ref>
* High levels of [[urea]] in the blood, which can result in:
** [[Vomiting]] or [[diarrhea]] (or both) that may lead to [[dehydration]]
** [[Nausea]]
** Weight loss
** Nocturnal urination ([[nocturia]])
** More frequent urination, or in greater amounts than usual, with pale urine
** Less frequent urination, or in smaller amounts than usual, with dark coloured urine
** [[Blood in the urine]]
** Pressure, or difficulty urinating
** Unusual amounts of urination, usually in large quantities
* A buildup of [[phosphates]] in the blood that diseased kidneys cannot filter out may cause:
** Itching
** Bone damage
** [[Nonunion]] in broken bones
** [[Muscle cramps]] (caused by low levels of calcium which can be associated with [[hyperphosphatemia]])
* A buildup of [[potassium]] in the blood that diseased kidneys cannot filter out (called [[hyperkalemia]]) may cause:
** Abnormal heart rhythms
** Muscle paralysis<ref>{{cite web  | work = MedicineNet, Inc. | title = Hyperkalemia  | date = 2008-07-03  | url = https://www.medicinenet.com/hyperkalemia/page4.htm  | access-date = 2009-05-26}}</ref>
* Failure of kidneys to remove excess fluid may cause:
** Swelling of the hands, legs, ankles, feet, or face
** Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
* [[Polycystic kidney disease]], which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
** Pain in the back or side
* Healthy kidneys produce the hormone [[erythropoietin]] that stimulates the [[bone marrow]] to [[Haematopoiesis|make oxygen-carrying red blood cells]]. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less [[hemoglobin]], a condition known as [[anemia]]. This can result in:
** Feeling tired or weak
** Memory problems
** Difficulty concentrating
** [[Dizziness]]
** Low blood pressure
* Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,<ref name="proteinuria">{{cite web | vauthors = Hebert LA, Charleston J, Miller E | title = Proteinuria | year = 2009 | url = http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ | access-date = 2011-03-24 | archive-url = https://web.archive.org/web/20110505073832/http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ | archive-date = 2011-05-05 | url-status = dead }}</ref> after which symptoms include:
** Foamy or bubbly urine
** Swelling in the hands, feet, abdomen, and face
* Other symptoms include:
** Appetite loss, which may include a bad taste in the mouth
** [[Insomnia|Difficulty sleeping]]
** Darkening of the skin
** Excess protein in the blood
** With high doses of [[penicillin]], people with kidney failure may experience [[seizures]]<ref>{{cite book| vauthors = Katzung BG |title=Basic and Clinical Pharmacology |edition=10th |year=2007|publisher=McGraw Hill Medical|location=New York, NY|isbn=978-0-07-145153-6|page=733}}</ref>

== Causes ==

=== Acute kidney injury ===
{{Main|Acute kidney injury}}
Acute kidney injury (previously known as acute renal failure) – or AKI – usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.{{citation needed|date=April 2022}}

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, along with bee stings<ref>{{cite journal | vauthors = Silva GB, Vasconcelos AG, Rocha AM, Vasconcelos VR, Barros J, Fujishima JS, Ferreira NB, Barros EJ, Daher EF | display-authors = 6 | title = Acute kidney injury complicating bee stings - a review | journal = Revista do Instituto de Medicina Tropical de Sao Paulo | volume = 59 | pages = e25 | date = June 2017 | pmid = 28591253 | pmc = 5459532 | doi = 10.1590/S1678-9946201759025 }}</ref> may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the person with AKI to resume a normal life. People with acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.<ref>{{cite web |url=http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#7 |title=The Kidneys and How They Work |author=National Kidney and Urologic Diseases Information Clearinghouse |year=2012 |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |access-date=1 January 2013 |archive-url=https://web.archive.org/web/20150502081848/http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#7 |archive-date=2 May 2015 |url-status=dead }}</ref>

Among the accidental causes of renal failure is the [[crush syndrome]], when large amounts of [[toxin]]s are suddenly released in the [[blood circulation]] after a long compressed [[Limb (anatomy)|limb]] is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing [[Kidney Ischemia|ischemia]]. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a [[reperfusion injury]] that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably [[myoglobin]], [[potassium]], and [[phosphorus]] – that are the products of [[rhabdomyolysis]] (the breakdown of skeletal muscle damaged by [[ischemia|ischemic]] conditions). The specific action on the [[kidney]]s is not fully understood, but may be due in part to [[nephrotoxicity|nephrotoxic]] [[metabolite]]s of myoglobin.{{citation needed|date=April 2023}}

=== Chronic kidney failure ===
{{Main|Chronic kidney disease}}
Chronic kidney failure has numerous causes. The most common causes of chronic failure are [[diabetes mellitus]] and long-term, uncontrolled [[hypertension]].<ref>{{cite journal | vauthors = Kes P, Basić-Jukić N, Ljutić D, Brunetta-Gavranić B | title = [The role of arterial hypertension in development of chronic renal failure] | language = hr | journal = Acta Medica Croatica | volume = 65 | issue = Suppl 3 | pages = 78–84 | date = October 2011 | pmid = 23120821 | url = http://www.amzh.hr/amc/pdf/amc_2011%20vol%2065%20supplement%203.pdf | url-status = dead | trans-title = The role of arterial hypertension in the development of chronic renal failure | archive-url = https://web.archive.org/web/20130719135947/http://www.amzh.hr/amc/pdf/amc_2011%20vol%2065%20supplement%203.pdf | archive-date = 2013-07-19 }}</ref> [[Polycystic kidney disease]] is another well-known cause of chronic failure. The majority of people affected with polycystic kidney disease have a family history of the disease. Systemic lupus erythematosus (SLE) is also a known cause of chronic kidney failure. Other genetic illnesses cause kidney failure, as well.{{citation needed|date=August 2022}}

Overuse of common drugs such as [[ibuprofen]], and [[acetaminophen]] (paracetamol) can also cause chronic kidney failure.<ref>{{cite journal | vauthors = Perneger TV, Whelton PK, Klag MJ | title = Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs | journal = The New England Journal of Medicine | volume = 331 | issue = 25 | pages = 1675–9 | date = December 1994 | pmid = 7969358 | doi = 10.1056/NEJM199412223312502 | doi-access = free }}</ref>

Some infectious disease agents, such as [[hantavirus]], can attack the kidneys, causing kidney failure.<ref>{{cite web |url=https://www.uptodate.com/contents/renal-involvement-with-hantavirus-infection-hemorrhagic-fever-with-renal-syndrome |title=Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome) | vauthors = Appel GB, Mustonen J |year=2012 |publisher=[[UpToDate]] |access-date=1 January 2013}}</ref>

=== Genetic predisposition ===
The ''[[APOL1]]'' gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include [[HIV-associated nephropathy]] (HIVAN), primary nonmonogenic forms of [[focal segmental glomerulosclerosis]], and hypertension affiliated [[chronic kidney disease]] not attributed to other etiologies.<ref>{{cite journal | vauthors = Bostrom MA, Freedman BI | title = The spectrum of MYH9-associated nephropathy | journal = Clinical Journal of the American Society of Nephrology | volume = 5 | issue = 6 | pages = 1107–13 | date = June 2010 | pmid = 20299374 | pmc = 4890964 | doi = 10.2215/CJN.08721209 }}</ref> Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.<ref>{{cite journal | vauthors = Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, Bowden DW, Langefeld CD, Oleksyk TK, Uscinski Knob AL, Bernhardy AJ, Hicks PJ, Nelson GW, Vanhollebeke B, Winkler CA, Kopp JB, Pays E, Pollak MR | display-authors = 6 | title = Association of trypanolytic ApoL1 variants with kidney disease in African Americans | journal = Science | volume = 329 | issue = 5993 | pages = 841–5 | date = August 2010 | pmid = 20647424 | pmc = 2980843 | doi = 10.1126/science.1193032 | bibcode = 2010Sci...329..841G }}</ref><ref>{{cite journal | vauthors = Tzur S, Rosset S, Shemer R, Yudkovsky G, Selig S, Tarekegn A, Bekele E, Bradman N, Wasser WG, Behar DM, Skorecki K | display-authors = 6 | title = Missense mutations in the APOL1 gene are highly associated with end stage kidney disease risk previously attributed to the MYH9 gene | journal = Human Genetics | volume = 128 | issue = 3 | pages = 345–50 | date = September 2010 | pmid = 20635188 | pmc = 2921485 | doi = 10.1007/s00439-010-0861-0 }}</ref>

== Diagnostic approach ==

=== Measurement for CKD ===
;Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using the person's GFR, or [[glomerular filtration rate]]. Stage&nbsp;1 CKD is mildly diminished renal function, with few overt symptoms. Stages&nbsp;2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. People with stage&nbsp;4 and 5 kidney failure usually require preparation towards active treatment in order to survive. [[Chronic kidney disease|Stage&nbsp;5 CKD]] is considered a severe illness and requires some form of renal replacement therapy ([[Kidney dialysis|dialysis]]) or [[Kidney transplantation|kidney transplant]] whenever feasible.<ref>Kidney Transplantation as Primary Therapy for End-Stage Renal Disease: A National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) Conference](https://pmc.ncbi.nlm.nih.gov/articles/PMC2390948/)</ref>

;

;Glomerular filtration rate
	
A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function.<ref>Fadem, Stephen Z., M.D., [http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm FACP, FASN. Calculators for HealthCare Professionals. National Kidney Foundation. 13 Oct 2008] {{Webarchive|url=https://web.archive.org/web/20140727183526/http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |date=27 July 2014 }}</ref> [[The National Kidney Foundation]] offers an easy to use on-line GFR calculator<ref>{{cite web |url=http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |title=GFR calculator |publisher=Kidney.org |access-date=2011-09-25 |archive-date=2014-07-27 |archive-url=https://web.archive.org/web/20140727183526/http://www.kidney.org/professionals/KDOQI/gfr_calculator.cfm |url-status=dead }}</ref> for anyone who is interested in knowing their glomerular filtration rate. (A serum [[creatinine]] level, a simple blood test, is needed to use the calculator.)

== Complications ==
Those with end stage renal failure who undergo haemodialysis have higher risk of spontaneous intra-abdominal bleeding than the general population (21.2%) and [[Intestinal ischemia|non-occlusive mesenteric ischemia]] (18.1%). Meanwhile, those undergoing [[peritoneal dialysis]] have a higher chance of developing [[peritonitis]] and [[gastrointestinal perforation]]. However, the rate of [[acute pancreatitis]] does not differ from the general population.<ref>{{cite journal | vauthors = Tonolini M, Ierardi AM, Carrafiello G | title = Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease | journal = Insights into Imaging | volume = 6 | issue = 6 | pages = 693–695 | date = December 2015 | pmid = 26472545 | pmc = 4656237 | doi = 10.1007/s13244-015-0439-4 }}</ref>

== Treatment ==

The treatment of acute kidney injury depends on the cause.<ref name=Clat2010/> The treatment of chronic kidney failure may include renal replacement therapy: [[hemodialysis]], [[peritoneal dialysis]], or [[kidney transplant]].<ref name=NIH2017/>

=== Diet ===
In non-diabetics and people with [[type 1 diabetes|type&nbsp;1 diabetes]], a low protein diet is found to have a preventive effect on progression of chronic kidney disease. However, this effect does not apply to people with [[type 2 diabetes|type&nbsp;2 diabetes]].<ref>{{cite journal | vauthors = Rughooputh MS, Zeng R, Yao Y | title = Protein Diet Restriction Slows Chronic Kidney Disease Progression in Non-Diabetic and in Type 1 Diabetic Patients, but Not in Type 2 Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials Using Glomerular Filtration Rate as a Surrogate | journal = PLOS ONE | volume = 10 | issue = 12 | pages = e0145505 | date = 28 December 2015 | pmid = 26710078 | pmc = 4692386 | doi = 10.1371/journal.pone.0145505 | bibcode = 2015PLoSO..1045505R | doi-access = free }}</ref> A whole food, [[plant-based diet]] may help some people with kidney disease.<ref>{{cite journal | vauthors = Chauveau P, Combe C, Fouque D, Aparicio M | title = Vegetarianism: advantages and drawbacks in patients with chronic kidney diseases | journal = Journal of Renal Nutrition | volume = 23 | issue = 6 | pages = 399–405 | date = November 2013 | pmid = 24070587 | doi = 10.1053/j.jrn.2013.08.004 }}</ref> A high protein diet from either animal or plant sources appears to have negative effects on kidney function at least in the short term.<ref>{{cite journal | vauthors = Bernstein AM, Treyzon L, Li Z | title = Are high-protein, vegetable-based diets safe for kidney function? A review of the literature | journal = Journal of the American Dietetic Association | volume = 107 | issue = 4 | pages = 644–50 | date = April 2007 | pmid = 17383270 | doi = 10.1016/j.jada.2007.01.002 | s2cid = 39551628 }}</ref>

=== Slowing progression ===
People who receive earlier referrals to a nephrology specialist, meaning a longer time before they must start dialysis, have a shorter initial hospitalization and reduced risk of death after the start of dialysis.<ref>{{cite journal | vauthors = Smart NA, Dieberg G, Ladhani M, Titus T | title = Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD007333 | date = June 2014 | pmid = 24938824 | doi = 10.1002/14651858.CD007333.pub2 }}</ref> Other methods of reducing disease progression include minimizing exposure to [[Nephrotoxicity|nephrotoxins]] such as [[Nonsteroidal anti-inflammatory drug|NSAIDs]] and [[Radiocontrast agent|intravenous contrast]].<ref>{{Cite book|url=http://accessmedicine.mhmedical.com/content.aspx?aid=1145435499|title=Current Medical Diagnosis & Treatment 2018| vauthors = Dirkx TC, Woodell T, Watnick S |date=2017|publisher=McGraw-Hill Education| veditors = Papadakis MA, McPhee SJ, Rabow MW |location=New York, NY}}</ref>

== References ==
{{Reflist}}

== External links ==
{{Medical condition classification and resources|DiseasesDB     = 26060
|ICD10          = {{ICD10|N|17||n|17}}–{{ICD10|N|19||n|17}}
|ICD9           = {{ICD9|584}}–{{ICD9|585}}
|MedlinePlus    =
|eMedicineSubj  =
|eMedicineTopic =
|MeshName       = Renal+Failure
|MeshNumber     = C12.777.419.780.500
|}}

{{Nephrology}}
{{Organ failure}}
{{Authority control}}

<!--Categories-->
[[Category:Kidney diseases]]
[[Category:Organ failure]]
[[Category:Wikipedia medicine articles ready to translate]]