From the Guidelines
Kidney failure presents with a range of symptoms that develop as the kidneys lose their ability to filter waste and maintain fluid balance, and the most recent evidence suggests that early signs include decreased urination, swelling in the legs, ankles, and feet due to fluid retention, shortness of breath from fluid buildup in the lungs, and persistent fatigue, as noted in the 2021 study published in the Journal of the American College of Radiology 1. The symptoms of kidney failure can be acute or chronic and may include:
- Decreased urination
- Swelling in the legs, ankles, and feet due to fluid retention
- Shortness of breath from fluid buildup in the lungs
- Persistent fatigue
- Nausea, vomiting, loss of appetite, confusion, and difficulty concentrating as waste products accumulate in the bloodstream
- Sleep problems, muscle twitches, cramps, and persistent itching Blood tests typically show elevated levels of creatinine and blood urea nitrogen (BUN), and kidney failure can be life-threatening without proper treatment, which may include dialysis or transplantation depending on the severity and cause, as defined by the National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification 1. It is essential to note that kidney failure can be acute (developing suddenly) or chronic (progressing gradually over months or years), and the symptoms appear because the kidneys can no longer effectively remove waste products, regulate electrolytes, control blood pressure, or produce hormones that regulate red blood cell production and bone health, as discussed in the 2018 narrative review published in the British Journal of Pharmacology 1. The most critical aspect of managing kidney failure is early detection and intervention, and the 2021 study published in the Journal of the American College of Radiology 1 emphasizes the importance of identifying the specific cause of acute kidney injury (AKI) to provide appropriate treatment. Key points to consider in the diagnosis and management of kidney failure include:
- The definition of kidney failure as a GFR less than 15 mL/min per 1.73 m2 or the need to start kidney replacement therapy (dialysis or transplantation) 1
- The classification of chronic kidney disease into five stages based on estimated GFR, with stage 5 being kidney failure 1
- The importance of regular monitoring of renal function to detect early signs of kidney failure and prevent progression to end-stage renal disease (ESRD) 1
- The need for individualized treatment plans based on the underlying cause of kidney failure and the patient's overall health status, as noted in the 2003 study published in the Annals of Internal Medicine 1.
From the Research
Signs and Symptoms of Kidney Failure
The signs and symptoms of kidney failure can vary depending on the severity and progression of the disease. Some common symptoms include:
- Anemia, which can cause fatigue, weakness, and shortness of breath 2, 3, 4
- Hypertension, which can contribute to cardiovascular morbidity and mortality 5
- Edema, which can cause swelling in the legs, ankles, and feet
- Electrolyte imbalances, which can cause muscle cramps, weakness, and arrhythmias
- Uremia, which can cause nausea, vomiting, and changes in mental status
Anemia in Kidney Failure
Anemia is a common complication of kidney failure, and it can have significant consequences for patients. Studies have shown that anemia is associated with:
- Faster progression of chronic renal failure 2
- Decreased quality of life 2, 3
- Clinical manifestation of cardiovascular disease 2
- Increased risk of hospitalization and mortality 3
Treatment of Kidney Failure
Treatment of kidney failure can slow its progression to end-stage renal disease (ESRD). Some common treatments include: