1. When the Kidneys Fail
The kidneys function to maintain fluid and electrolyte balance in the body. The kidneys also process the metabolic waste of protein metabolism, which the body excretes in urine. Lesser-known, but vital kidney jobs include blood pressure regulation via blood volume control and directing the bone marrow to make red blood cells. Finally, the kidneys maintain calcium-phosphorus balance, which is essential to bone maintenance. Because of the far-reaching consequences of these activities, chronic renal failure can cause anemia, hypertension, bone disease, seizures, liver failure, immune dysfunction and nerve damage.
2. Why the Kidneys Fail
Several kidney diseases can cause chronic renal failure. The 1 million glomerulus in each kidney that act as filters are subject to malfunction when diabetes, lupus or amyloidosis allow the entry of large amounts of protein. There are several other kidney diseases classified broadly as nephrotic syndromes that also result in large protein losses in the urine. Kidney stones, primary hypertension and polycystic kidney disease can also cause chronic renal failure.
3. A Balancing Act
When patients develop chronic renal failure, the kidneys struggle to handle sodium and water levels in the body. The doctor must assess the kidney's ability to maintain this balance by checking the excretion of sodium in the urine, monitoring blood pressure, watching for the development of edema and checking sodium levels in the blood. Based on these findings, the doctor can recommend the appropriate diet to maintain health. Although some patients retain sodium, patients with polycystic kidney disease and some other kidney diseases lose sodium. A dietitian can tailor the diet to match sodium and fluid excretion.
4. Vitamins and Minerals Matter
A common complication in patients with chronic renal failure is bone disease, characterized by loss of bone minerals, bone pain or calcification of joints and soft tissues. When the kidneys can't regulate the calcium levels in the body, the parathyroid gland goes into overdrive to raise calcium levels by robbing the bones, and to retain more phosphate than the body requires. The dietary response is to increase calcium intake and decrease phosphorus, but therein lies the problem: Foods high in calcium are also high in phosphorus. The doctor may advise calcium supplementation, while restricting phosphate intake to 1200 milligrams.
5. Managing Progressive Disease
When the kidneys can no longer process adequate amounts of waste in the body, patients develop symptoms of uremia, characterized by vomiting, cramps, fatigue and impaired thinking. The doctor may give this diagnosis to patients whose blood urea nitrogen level is greater than 100 and creatinine more than 10. Treatment options for these patients include dialysis or kidney transplantation. Patients can seek support to deal with their feelings regarding the lifestyle changes that come with a progressive illness.
