Kidney Transplant (cont.)
Various conditions can damage the kidneys, including both primary kidney diseases and other conditions that affect the kidneys.
- If kidney damage becomes too severe, the kidneys lose their ability to function normally. This is called kidney failure.
- Kidney failure can happen rapidly (acute kidney failure), usually in response to a severe acute (sudden, short-term) illness in another body system or in the kidneys. It is a very common complication in patients hospitalized for other reasons. It is often completely reversible with resolution of the underlying condition.
- Kidney failure can also happen very slowly and gradually (chronic kidney failure), usually in response to a chronic (ongoing, long-term) disease such as diabetes or high blood pressure.
- Both types of kidney failure can occur in response to primary kidney disease as well. In some cases, this kidney disease is hereditary.
- Infections and substances such as drugs and toxins can permanently scar the kidneys and lead to their failure.
People with the following conditions are at greater-than-normal risk of developing kidney failure and end-stage renal disease:
- Diabetes (type 1 or type 2)
- High blood pressure, especially if severe or uncontrolled
- Glomerular diseases (These are conditions that damage the glomeruli, such as glomerulonephritis.)
- Hemolytic uremic syndrome
- Systemic lupus erythematosus
- Sickle cell anemia
- Severe injury or burns
- Major surgery
- Heart disease or heart attack
- Liver disease or liver failure
- Vascular diseases (These conditions, including progressive systemic sclerosis, renal artery thrombosis [blood clot], and scleroderma, block blood flow to different parts of the body.)
- Inherited kidney diseases (polycystic kidney disease, congenital obstructive uropathy, cystinosis, prune belly syndrome)
- Diseases affecting the tubules and other structures in the kidneys (acquired obstructive nephropathy, acute tubular necrosis, acute interstitial nephritis)
- Taking antibiotics, cyclosporin, heroin, and chemotherapy (These can cause inflammation of kidney structures.)
- Certain cancers (incidental carcinoma, lymphoma, multiple myeloma, renal cell carcinoma, Wilms tumor)
- HIV infection
- Vesicoureteral reflux (This is a urinary tract problem.)
- Past kidney transplant (graft failure)
- Rheumatoid arthritis
Chronic kidney failure is associated with complications that can be debilitating or have a negative effect on quality of life.
- Fluid retention
- Pulmonary edema (This is fluid retention in the lungs that can cause breathing problems.)
- High blood pressure from chemical imbalances and fluid retention
- Renal osteodystrophy (This is weakening of the bones from calcium depletion, which can cause bones to fracture easily.)
- Amyloidosis (This is deposition of abnormal proteins in the joints, which causes arthritis-like symptoms.)
- Stomach ulcers
- Bleeding problems
- Neurological damage
- Sleeping problems related to dialysis
Michael B McDonnell, MD, Staff Physician, Department of Emergency Medicine, University of Southern California
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