Understanding Kidney Failure

Sometimes kidneys are no longer able to filter and clean blood. This can cause unsafe levels of waste products to build up. This is known as kidney (or renal) failure. Unless it is treated, this can cause death.

Kidney (renal) failure is when kidneys don’t work as well as they should. The term “kidney failure” covers a lot of problems. These problems can result in kidney failure: your kidney doesn’t get enough blood to filter; your kidney is hurt by a disease like: high blood sugar (diabetes); high blood pressure; your kidney is blocked by a kidney stone or scar tissue; or it can be due to damage to the kidney’s tiny filters.

Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. But if the kidneys are damaged, they don’t work properly. Harmful wastes can build up in your body. Your blood pressure may rise. Your body may retain excess fluid and not make enough red blood cells. This is called kidney failure.

If less than 15 percent of your kidney is working normally, that’s considered kidney failure. You may have symptoms from the buildup of waste products and extra water in your body. You can protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure.

Black Americans, His-panics, Asians, Pacific Islanders, American Indians and Alaska Natives are at the highest risk for kidney disease and kidney failure. In fact, Black Americans are 3 times more likely and Hispanics are 1½ times more likely to have kidney failure compared to White Americans. High blood pressure strikes 1 out of 3 Black Americans, one of the highest rates in the world. Nearly 1 in 4 Hispanics have high blood pressure and most do not know that high blood pressure can cause kidney disease.

Researchers do not fully understand why minorities are at a higher risk for kidney disease. While most renal disorders are not hereditary, some kidney conditions have known inherited genetic components. However, minorities have much higher rates of high blood pressure, diabetes, obesity and heart disease, all of which increase the risk for kidney disease. Access to healthcare (for a number of reasons) is also thought to play a role. Not all minorities will get kidney disease. And not everyone who has diabetes, high blood pressure, heart disease, older age, or a family history of kidney disease will get it. But if you have any of these risk factors you should get tested for kidney disease and get tested for diabetes, high blood pressure, and most importantly do your best to maintain a healthy lifestyle.

Additionally, there is a tendency for African Americans to scar their kidneys more severely than other people. Given a certain kidney injury, an African American may scar in the area and lose function where someone else might heal the injury with no loss of function.

The first step after total kidney function falls below 15 percent is dialysis.

When your kidneys fail, dialysis keeps your body in balance by:

  • Removing waste, salt and extra water to prevent them from building up in the body.
  • Keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate.
  • Helping to control blood pressure.

During treatment, your blood travels through tubes from your body into the dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which removes waste and extra fluid. Once it has been cleaned, the blood travels through tubes from the dialysis machine back into your body. Most patients get dialysis three times a week.

Kidney transplantation is the treatment of choice for many people with end-stage kidney disease. A successful kidney transplant can improve your quality of life and reduce your risk of dying. In addition, people who undergo kidney transplantation do not require hours of dialysis treatment. Ideally, patients who are eligible to get a kidney transplant do so before ever starting on dialysis.

Some patients remain on dialysis for more than 25 years so there is no upper limit to the amount of time spent on dialysis. However, the survival rate of a patient increases when they get a transplant instead.

Promising medical research is finding methods to manage kidney failure with new medications to arrest kidney disease in its earliest stages before patients progress to end-stage renal disease and are faced with life-threatening complications, and only dialysis or a transplant are options to survive.

There are two simple tests to check for kidney disease. You could help save your kidneys with a simple urine test. Ask your doctor about Albumin Creatinine Ratio (ACR) which estimates the amount of a type of protein, albumin, that is in your urine. The Glomerular Filtration Rate (GFR) tells how well your kidneys are working to remove wastes from your blood. It is the best way to check kidney function. Over 90 is good, 60-89 should be monitored, less than 60 for 3 months indicates kidney disease.

Kidney disease often has no symptoms, and it can go undetected until very advanced. But a simple urine test can tell you if you have kidney disease. Remember, it’s important to get tested because early detection and treatment can slow or prevent the progression of kidney disease.

Remember, I’m not a doctor. I just sound like one. Take good care of yourself and live the best life possible!

The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Glenn Ellis is a Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. Ellis is an active media contributor on Health Equity and Medical Ethics. For more good health information listen to Glenn on radio in Philadelphia; Boston; Shreveport; Los Angeles; and Birmingham., or visit: www.glennellis.com.