Chronic kidney failure - Chronic kidney disease

Chronic kidney disease is the progressive loss of kidney function until it becomes permanent. The kidneys are responsible for filtering waste products from the blood and excreting them, along with excess fluid, in the urine.

It is more common with advancing age and in black and Asian American people. Other factors that contribute to its occurrence include: smoking, high blood pressure, diabetes, obesity, and the use of medications that damage the kidneys.

There are multiple causes, including hypertension, diabetes, kidney disease (glomerulonephritis, interstitial nephritis, pyelonephritis, polycystic kidneys, etc.) and urine reflux due to obstruction of the urinary tract below the kidneys.

In the early stages of the disease, most patients are asymptomatic. When they do develop symptoms, they are usually very non-specific: nausea, vomiting, fatigue, swelling of the lower body, drowsiness, and decreased mental acuity. In more severe cases, it can cause respiratory distress due to fluid accumulation in the lungs and chest pain due to fluid accumulation in the pericardium surrounding the heart.

It is diagnosed by a focused clinical history and physical examination. Diagnostic suspicion is confirmed by blood and urine tests and an imaging test, usually an ultrasound, to examine the condition of the kidneys and urinary tract. In some cases, a kidney biopsy may be needed to complete the examination of the kidney tissue.

When the condition is described as chronic, it generally means that the kidney failure is not curable. Treatment should be directed first to treating the cause, if known, and then to treating the associated symptoms. Blood pressure, cholesterol levels, anemia if present, and excess fluid should be controlled with diuretic medications. In advanced stages, dialysis may be needed to remove excess fluids and waste from the body. In some cases, kidney transplantation is chosen to replace the lack of function of the diseased kidneys; this requires lifelong immunosuppressive treatment to prevent rejection of the transplanted organ.