Kidney Failure

Overview

Kidney failure means your kidneys are not filtering your blood well enough. Kidneys are two bean-shaped organs that remove waste and extra fluid, balance salts, and help make red blood cells and healthy bones. Kidney failure can happen suddenly (acute kidney injury) or slowly over months or years (chronic kidney disease). It is not the same as a kidney infection, and it does not always mean you will need dialysis.

Kidney disease is common. Severe kidney failure is less common. Many people have early kidney changes and do not know it, which is why check-ups matter.

Anyone can get kidney failure. It is more common in older adults and in people with diabetes or high blood pressure. It is also more common in some families and in people of South Asian and Black heritage. Children can have kidney problems too, but this is less common.

Symptoms

Common symptoms

• Feeling very tired or weak
• Swollen ankles, feet, hands, or face
• Shortness of breath
• Feeling sick or being sick
• Poor appetite or weight loss
• Itchy skin
• Muscle cramps
• Needing to pee more or less than usual
• Foamy urine
• Blood in your urine
• Trouble sleeping or restless legs
• Confusion or trouble concentrating

Symptoms in children

• Poor feeding or vomiting
• Swelling around the eyes, feet, or belly
• Passing much less urine
• Being very sleepy or hard to wake
• Poor growth or weight gain
• Wetting the bed after being dry
• Pale skin or tiredness

Symptoms in older adults

• Confusion or new falls
• Poor appetite and weight loss
• Swelling in the legs
• Shortness of breath
• Very tired or weak
• Less urine or dehydration

Causes

Main causes

• Diabetes (high blood sugar) is a leading cause
• High blood pressure
• Glomerulonephritis (inflammation of the kidney filters)
• Polycystic kidney disease (an inherited condition with fluid-filled sacs in the kidneys)
• Blockages in the urinary tract, such as stones or an enlarged prostate
• Repeated kidney infections
• Some medicines or toxins
• Severe dehydration, heart failure, or liver failure
• Sepsis (a severe infection in the body)

Risk factors

• Having diabetes
• Having high blood pressure
• Heart disease or a past heart attack
• Family history of kidney disease
• Being older
• Obesity
• Smoking
• A previous sudden kidney injury
• Autoimmune conditions such as lupus
• Being of South Asian or Black heritage
• Long-term use of medicines that can harm the kidneys

When to see a doctor

See a doctor urgently if:

• You are passing very little or no urine
• Swelling gets worse quickly
• You cannot keep fluids down because of vomiting or diarrhea
• You have a fever with kidney pain or burning when you pee
• You see blood in your urine
• You have a severe headache with vision changes and high blood pressure
• You have new severe back or side pain

Book a routine appointment if:

• You feel tired, weak, or short of breath for weeks
• Your ankles, feet, or face are puffy
• Your urine looks foamy or you see blood
• You need to pee more or less than usual
• You have diabetes or high blood pressure and have not had a kidney check
• A close family member has kidney disease
• You have ongoing itchy skin, cramps, or poor appetite

Diagnosis

Your doctor will ask about your symptoms, past health, medicines, and family history. They will check your blood pressure and may feel your belly. They will order blood and urine tests. Sometimes they use pictures of your kidneys or a small sample of kidney tissue.

Tests that may be done

• Blood tests for creatinine and eGFR (an estimate of how well your kidneys filter)
• Blood tests for urea and electrolytes (salts in your body)
• Urine tests for protein or albumin (a protein that can leak into urine)
• Urine tests for blood or infection
• Blood pressure checks
• Ultrasound scan of the kidneys
• CT or MRI scan in some cases
• Kidney biopsy (a small sample of tissue) in some cases

What to expect at your appointment

You may need repeat tests to see if things change. Your doctor may use a stage to describe how much kidney function you have. You may be referred to a kidney specialist (nephrologist). Ask what your results mean for you.

Treatment

Treatment aims to protect your kidneys, treat the cause, and manage symptoms. If your kidneys are failing badly, treatment can replace some kidney work. There is no single cure, but there is a lot you and your team can do.

Self-care at home

• Take medicines as prescribed
• Check blood pressure and blood sugar as advised
• Follow your meal plan
• Limit salt
• Stay active
• Do not smoke
• Limit alcohol
• Keep vaccines up to date
• Ask before taking any new medicine, supplement, or herbal product
• Avoid pain medicines that can harm kidneys unless your clinician says it is okay

Medical treatments

Treatment may include medicines to control blood pressure and blood sugar, medicines to remove extra fluid and balance salts, and medicines to treat anemia and protect bones. A dietitian can help with meal planning. If kidney failure is advanced, dialysis can filter your blood, and a kidney transplant can replace a failing kidney. Your team will tailor treatment to you.

When is surgery considered?

Surgery may be needed to create a dialysis access (a way to connect you to a dialysis machine), to place a kidney transplant, or to fix a blockage. Not everyone needs surgery. Your team will discuss the risks and benefits with you.

Living with this condition

Kidney failure can mean more appointments, tests, and medicines. You may need to plan around dialysis. It can affect work, school, travel, and energy. Planning ahead and asking for help can make daily life easier.

Lifestyle tips

• Keep blood pressure and blood sugar in your target range
• Eat a balanced diet and limit salt
• Be active most days if you can
• Get enough sleep
• Do not smoke
• Limit alcohol
• Keep vaccines up to date
• Ask your team before taking new medicines or supplements

Diet and exercise

A dietitian can help you plan meals. You may need to limit salt, potassium, phosphorus, or fluid. Protein needs vary from person to person. Exercise can help your heart and mood; choose activities you enjoy and build up slowly.

Mental health and emotional wellbeing

It is normal to feel worried, sad, or angry. Many people with kidney disease feel anxious or low. Talk with your team. If you feel you might harm yourself, call your local emergency number or a crisis support line right away.

Prevention

Many cases of kidney failure can be prevented or delayed. The key is to find and treat kidney problems early. Control blood pressure and blood sugar, stay active, keep a healthy weight, do not smoke, and limit alcohol.

Vaccines

Keep up with vaccines your clinician recommends. Infections can be harder when kidneys are weak. Ask your team which vaccines are right for you.

Screening programmes

If you have diabetes, high blood pressure, heart disease, or a family history of kidney disease, ask about kidney checks. A blood pressure check, urine test, and blood test can find problems early. Screening for diabetes and high blood pressure also helps.

Complications

If left untreated

• Too much fluid in the body, which can cause breathlessness and swelling
• Dangerously high potassium, which can affect the heartbeat
• Anemia (low red blood cells) and tiredness
• Bone and mineral problems
• Poor appetite and malnutrition
• Nerve damage and numbness
• Heart and blood vessel disease
• Infections
• Confusion, seizures, or coma
• Need for dialysis or transplant
• Death in severe cases

Long-term outlook

The outlook varies. Many people with early kidney disease stay stable for years with good care. Even with advanced kidney failure, dialysis and transplant can support life and help you feel better. Early diagnosis and a good care team make a real difference.

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