Kidney weakness or renal insufficiency (also renal failure) is divided into acute and chronic manifestations. Acute renal failure can occur suddenly and within a few hours. The cause is usually impaired renal perfusion. However, if renal insufficiency occurs more frequently or persists over a longer period of time, it can be referred to as chronic renal insufficiency.
What is kidney weakness (renal insufficiency)?
Dialysis is a blood purification procedure used as part of renal replacement therapy for kidney failure. In prolonged kidney weakness (renal insufficiency), these two bean-shaped organs in the back of the pelvis become chronically inflamed. In the case of kidney weakness, this inflammation leads to progressive destruction of the kidney tissue, so that blood purification can no longer take place completely. If the symptoms of kidney weakness remain undetected, acute kidney failure with coma can occur, which is life-threatening. Depending on the degree of kidney weakness, it is divided into 5 stages. Chronic kidney weakness can also go unnoticed for a long time until it leads to acute kidney failure. The tissue of the kidneys is then so destroyed that only about 10% actually function for detoxification. Due to the lack of detoxification of the body, all other organs are affected when the kidneys are weak, and water excretion and purification of the blood must then be performed by regular dialysis or transplantation.
Causes
Kidney weakness or renal insufficiency occurs in 40% of all cases as a result of diabetes mellitus. In 25% of patients, this disease develops due to unknown factors. In addition, there are also hereditary factors that favor cyst formation in the kidney, which also leads to inflammation of the renal corpuscles. Furthermore, high blood pressure and the use of drugs that damage the kidneys in other chronic diseases can lead to permanent damage and renal insufficiency. Genetic predisposition also appears to play a role in the development of this chronic form of renal insufficiency. There are congenital malformations of the urethra in which urine is partially backwashed into the kidney, where it can also lead to inflammation and chronic kidney weakness. Apart from this, obesity and smoking are factors that further promote kidney weakness. Kidney weakness can initially start harmlessly with more frequent bladder complaints or faintness and infections. Those who discover and treat the symptoms early protect themselves from the progressive destruction in kidney weakness and the life-threatening acute kidney failure as well as the consequential damage.
Symptoms, complaints and signs
Kidney weakness may initially go completely unnoticed. Especially the chronic form does not show any typical features at the beginning. Later, patients usually suffer increasingly from blood pressure that is difficult to adjust. More often, they exceed the limit of 140/90 mmHg for no apparent reason. Changes in the color and consistency of the urine are common. The urine is lighter in color. An increased proportion of proteins leads to a clearly visible formation of foam when urinating. Sometimes small admixtures of blood cause a cloudier and darker tone. As a rule, however, the proportion is not in the visually perceptible range (microhematuria). Due to the impaired performance, the body stores water in the form of edema. Affected individuals also notice weight gain that is difficult to track, loss of appetite and general malaise. As a result, fluctuations occur in the electrolyte and acid-base balance. In addition to a reduced efficiency of the immune system, the deficiency of the hormone erythropoietin (EPO) reduces the number of red blood cells. As a result, anemia develops, accompanied by a general feeling of weakness, pale skin and concentration problems. In the long term, blood pressure problems and the lack of blood purification provoke organic malfunctions throughout the body. Visual disturbances, nausea, diffuse pain in bones and severe itching result from uremic syndrome. Permanent changes in the cardiovascular system additionally burden the physical well-being. Extreme contamination threatens drowsiness, convulsions and even unconsciousness up to coma.
Disease progression
In acute kidney failure, it is important to consult the doctor as early as possible. Symptoms of illness in kidney weakness resemble symptoms of a cold or flu and are therefore often difficult to interpret. Faintness, weakness, elevated temperature or high fever with pain in the kidney area or around the bladder are signs that kidney disease is present. If the first sign is an inflammation of the bladder with a frequent urge to urinate, any family doctor can take a urine sample and immediately determine under the microscope whether there are acute pathogens for an influenza infection. These pathogens are combated with special antibiotics. If the symptoms still do not disappear within three days and the symptoms worsen, a urologist should be consulted or the clinic visited. The condition of the skin with extreme pallor and the respiratory and heart rates as well as the blood filling of the neck veins also give the doctor indications of kidney weakness. The white blood cell count, C-reactive protein, liver values and fat values are further clues to the doctor’s diagnosis. Physicians also refer to kidney weakness as prerenal and postrenal kidney failure. In prerenal cases, the doctor can prevent further complications such as cardiac arrhythmias, infections and pulmonary edema; in postrenal kidney failure, the aim is to detect damage caused by urine stagnation in the renal cavities. Renal puncture is then necessary, and tissue is also removed for histologic diagnosis.
Complications
If left untreated, renal failure progresses until complete kidney failure occurs. The more kidney tissue that is destroyed, the slower the kidneys can process the fluid they absorb. In the final stage of renal insufficiency, the harmful substances that should be excreted by the kidneys accumulate in the blood, so that only dialysis can help. Here, the blood is regularly withdrawn from the body, cleansed of harmful substances and returned – a lengthy and strenuous procedure. Since the hormones of the kidneys, the angiotensin-aldosterone–renin system, also regulate blood pressure, this can lead to further complications. Physicians speak of renal, i.e. kidney-triggered, hypertension. The list of other complications of renal insufficiency is long: an increased tendency to bone fractures, water retention in the legs and tissues, urine odor of the skin, pale yellowish skin color, cardiac arrhythmias, water in the lungs, convulsions triggered by the brain, poor excretion of medications, salt deficiency, potassium deficiency, vomiting and diarrhea. Each individual complication should be taken seriously and discussed with the physician without fail.
When should you see a doctor?
Kidney weakness is often not recognized until the kidney tissue is already severely damaged. This makes early clarification of typical symptoms all the more important. For example, fatigue, edema in the legs and signs of anemia should be examined by a family doctor. The physician can determine whether the symptoms are indicative of kidney weakness and, if necessary, initiate treatment directly. People suffering from kidney weakness should consult their family doctor regularly. If there is any suspicion that the symptoms are getting worse, a visit to the doctor is recommended. In particular, sudden cramp-like pain or swelling in the area of the kidneys must be clarified, as a kidney infarction may be imminent. If a kidney infarction occurs, the emergency doctor must be called. The affected person must receive immediate medical attention. Kidney weakness is treated by the family doctor or a specialist in diseases of the kidneys. Other contacts are the internist and the gastroenterologist, always depending on the presenting symptoms and the cause of the kidney weakness. Advanced kidney weakness must be treated in hospital. Since a cure is only possible through organ transplantation, appropriate preparatory measures must be taken. Furthermore, it is necessary to change the diet, for which a visit to a nutritionist is recommended. In the case of chronic diseases, therapeutic help is also advisable.
Treatment and therapy
As soon as the blood is no longer adequately filtered in kidney weakness (renal insufficiency), substances to be excreted, such as creatinine and urea, rise in the blood. This is determined by a blood test. The higher the proportion of these substances in the blood, the weaker the function of the kidneys.If the urea value has risen above 450 milligrams per liter of blood, a disorder is present. Above all, the increase of proteins in the urine is also a sure indication of kidney weakness. The general practitioner will make an initial diagnosis based on this value using the rapid test. Using the GFR, the globular filtration rate, the family doctor can also immediately determine how acute the disease is. Increased urine sediment is always an indicator of a disorder. Subsequently, the amount of creatinine in particular should be measured. Unfortunately, this value only shows an increase when the kidney function has already decreased by more than 50%. Kidney weakness is therefore unfortunately often diagnosed too late. To prevent the patient from falling into acute kidney failure with coma, treatment must then be initiated immediately. A more suitable method of diagnosis is creatinine clearance. This determines how quickly the kidneys filter the available creatinine out of the blood. Only when kidney function drops by 60% is the condition referred to as acute insufficiency. If kidney weakness exceeds 80%, the affected person must be treated by dialysis to mechanically purify the severely disturbed blood. Dialysis always takes several hours. Dialysis patients have to go to a clinic dialysis unit every 2-4 weeks, depending on the severity, to be hooked up to a dialysis machine for a few hours. This is a significant reduction in quality of life. To prevent kidney weakness, doctors advise herbal medicines such as herbal teas and tablets made from medicinal herbs for strengthening the urogenital tract in case of repeated bladder infections. Hardening through Kneipp cures is also recommended.
Outlook and prognosis
The sooner chronic kidney failure is diagnosed and treated, the more favorable the prognosis. However, damage to kidney tissue that has already occurred cannot be reversed. Chronic renal insufficiency takes a gradual course, with a more rapid progression expected in men and older and physically weakened patients than in otherwise physically healthy patients and women. High blood pressure and hypertension levels have a negative influence on the course of the disease. Smoking, alcohol consumption, obesity and other risk factors also have a negative impact on prognosis. Chronic kidney failure usually shortens the life expectancy of patients. People with chronic diseases such as diabetes mellitus or high blood pressure are particularly at risk. In general, poor physical condition has a negative impact on prognosis. Acute renal failure leads to kidney failure and subsequently to the death of patients in half of the cases. The cause of death is usually concomitant diseases such as sepsis or myocardial infarction. Accordingly, life expectancy is greatly reduced. Only in a few patients does kidney function recover to a large extent, provided that the cause of the acute kidney failure is corrected quickly. The prognosis for chronic and acute renal failure is determined by a specialist in internal medicine with regard to the patient’s symptom picture and constitution.
Follow-up care
Many patients resign themselves to the finding of renal failure and feel powerless. In a necessary aftercare support network, consisting of relatives, loved ones and the medical dialysis staff, help and support have a high priority. During aftercare, patients must be prepared to live with the necessary control and renunciation. The attending physician and nephrologist will face and individually answer the patient’s questions and fears about the future related to the disease. Thus, psychotherapeutic support is enormously important in order to better cope with psychosocial stress, repressed feelings and depressive moods. The reduced quality of life caused by renal failure is improved and stabilized by follow-up care. This also improves the situation in the family environment. A zest for life and a sense of confidence for the future combined with the necessary self-assurance return. During the aftercare, however, the ongoing medical dependence and restriction to control the functioning of the kidneys associated with drug treatment remains. Only a stable family and social environment can help bear these burdens of the patient during aftercare and prevent him from social withdrawal.
You can do it yourself
Loss of appetite and nausea as a result of kidney weakness often lead to malnutrition, which results in the loss of muscle mass and impairment of many bodily functions. Sufferers should therefore attach great importance to a balanced diet, but protein, sodium, potassium and phosphate should only be consumed in moderation. A diet rich in carbohydrates is ideal, and salt should be used sparingly. To ensure an adequate supply of vital (essential) amino acids, a combination of animal and vegetable protein sources such as milk and wheat or pulses and egg is recommended. Milk, hard and soft cheeses may be consumed sparingly; it is better for sufferers to avoid processed cheese, canned fish, heavily salted sausages and meats, and convenience foods. Potassium is abundant in fruit and vegetable juices, nuts, bananas, dried fruit and mushrooms, so these foods should rarely be on the menu. In cases of renal insufficiency requiring dialysis, it is not necessary to restrict protein intake, since blood washing removes all urinary substances. The amount of fluid required per day depends on the severity of the kidney weakness and is determined by the attending physician. Patients requiring dialysis in particular must strictly adhere to a restriction on the amount they drink: Ice cubes and lemon wedges are suitable for quenching thirst between meals, and rinsing the mouth and chewing sugar-free chewing gum can also relieve feelings of thirst.