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Updated 07 September 2016

Kidney failure – what are the main causes?

Thousands of South African men and women will die of kidney disease or kidney failure every year. Could you be part of this startling statistic? We investigate kidney failure and its risk factors.

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Kidney disease has been estimated to affect as much as 15 % of the South African population – both young and old – with 20 000 new patients requiring diagnosis and treatment every year. Anyone can develop kidney disease and kidney failure. However, some are at greater risk. 

How kidneys work in the body  

The kidneys are among the most vital organs in your body. According to the National Kidney Foundation of South Africa, these bean-shaped organs are filters which support the various functions of all the organs other than the brain. 

Every day, the kidneys filter about 150 litres of fluid of which about 148 litres of useful substances such as protein is cleansed and reabsorbed, while the waste is excreted in about two litres of urine each day. 

The kidneys:

  • Produce essential chemicals which control your blood pressure. 
  • Create substances that produce red blood cells, which carry oxygen throughout the body.
  • Break down and destroy unnecessary or dangerous chemicals and hormones, such as insulin.
  • Retain and provide the necessary nutrients to nourish the bones and joints, allowing for a solid and healthy skeleton.
  • Control the amount of acidity and alkalinity (pH) in your body, i.e. keeping your blood clean and chemically balanced. This balance is crucial to your overall health.
  • Eliminate toxic waste from the body. 

Who is at risk for kidney failure?

In South Africa, kidney failure is mainly attributed to inherited high blood pressure (60-65 %) or type 2 diabetes (another 20-25 %). 

High blood pressure (hypertension) places stress on the blood vessels throughout the body, including the kidneys. Hypertension is particularly prevalent amongst the black population – hence the incidence of kidney failure is four times higher than in other groups. 

Another contributor to kidney failure or kidney damage is diabetes. Diabetes is characterised by high blood glucose or blood sugar levels and over time, this may result in the kidney filters essentially being blocked. More than 50 % of people with diabetes will develop kidney problems.

A family history of kidney disease can also put you at risk for kidney failure. Other risks include inflammation of the kidneys, blockages (such as kidney stones), and trauma to the kidneys (kidney injury). 

What happens when your kidneys shut down? 

If your kidneys fail completely, waste products that are normally eliminated by the kidneys build up in your body. This condition is called uraemia. Symptoms of uraemia include:

  • Swelling of the hands, ankles and feet.
  • Fatigue or weakness.
  • Shortness of breath.
  • Poor appetite.
  • Nausea and vomiting. 
  • Difficulty sleeping.
  • Confusion. 
  • Weight loss.
  • Headaches.
  • High blood pressure.
  • Muscle cramps.
  • Decrease in the amount of urine produced.

If untreated, uraemia can lead to seizures or coma. If your kidneys stop working completely, you will need dialysis or a kidney transplant.

Keep in mind; symptoms of kidney failure are not the same for everyone. Some people with kidney disease may not even feel sick or notice their symptoms. It is only when the kidneys can no longer perform to do their “job” that some people will feel the effects. This is why kidney disease is often called a "silent" disease.

Treatment and management

There are two treatments for kidney failure: dialysis and kidney transplant. 

Dialysis

Dialysis filters and purifies your blood via a machine. Dialysis helps to keep your body in balance when the kidneys can’t function properly. 

There are two types of dialysis, namely haemodialysis and peritoneal dialysis. 

Haemodialysis requires a minor operation to allow access to your bloodstream, usually through the wrist or chest. Blood is then removed from the body and cleansed by an artificial kidney attached to a dialysis machine. As your blood is filtered, it is returned to your bloodstream. Each treatment lasts for four to six hours, and is done three times a week.     

Peritoneal dialysis is done inside the body, using the body’s own peritoneal membrane – the lining of the abdominal cavity – as a filter to clear waste and cleanse the blood. It also requires a minor operation, but this time a catheter is inserted into the abdomen. The catheter acts as an entrance for the dialysis solution. After a few hours, the used solution is drained and refilled with fresh cleansing solution to begin the process again. This treatment takes place four times a day, seven days a week, and can be performed almost anywhere.

Both haemodialysis and peritoneal dialysis are used for life or until a transplant donor is found. 

Kidney transplant

A kidney transplant is an operation that places a healthy, functioning kidney from another person into your body. The kidney may come from a deceased donor or from a living donor, usually a close relative, spouse or friend. It can also come from an organ donor. The average waiting time for a new kidney varies, but can be anything between six to 12 years.

A kidney transplant takes about three hours and you will need to be hospitalised for about seven days after the operation. Once the procedure is done, you must take special medications to prevent your body from rejecting the new kidney. 

While successful, a kidney transplant is not a “quick fix”, nor is it a cure. Kidney transplant recipients still have kidney failure and may need to continue taking the medication they took before the transplant. 

Keep your kidneys healthy 

Quit smoking: smokers are three times more likely to have reduced kidney function than non-smokers. It also helps to surround yourself with people who don’t smoke. Find healthier alternatives to smoking.      

Limit alcohol intake: excessive alcohol consumption can lead to heart disease and high blood pressure, which can increase your risk for kidney disease. Limit your intake to two standard drinks per day for men, and one per day for women. 

Eat well: nutrition plays a pivotal role in your health and wellbeing. It can help prevent and manage diseases – kidney disease being one of them. Your diet can also help control your weight. Being overweight can put you at an increased risk for developing diabetes and high blood pressure, which are risk factors for kidney disease. Eat plenty of fruit and vegetables, legumes and wholegrain bread and rice. Consume lean meat, such as chicken and fish, at least once a week. Opt for reduced-fat and low-fat dairy products. Limit the amount of fatty foods you eat and lower your salt intake. Avoid processed foods and takeaways. If you need extra guidance, ask your doctor for advice on nutrition and your ideal weight. 

Drink lots of water: water assists in transporting nutrients around the body, and to eliminate waste. Make sure you drink enough water every day. Six to eight glasses should be sufficient. 

Exercise: regular exercise can help you manage your weight, reducing your risk for heart disease and diabetes, which are risk factors for kidney disease. Exercise for at least 30 minutes, five days a week. Choose exercises that you enjoy, get a friend to exercise with you, and walk as much as you can. Make simple daily activities count as part of your daily exercise quota.  

References
Chronic kidney disease on the rise. Health24 [Online] Available at: http://www.health24.com/Medical/Kidney-and-bladder/News/Chronic-kidney-disease-on-the-rise-20120721. Accessed 1 March 2016.

Kidney disease. National Kidney Foundation of South Africa. [Online] Available at: http://www.nkf.org.za/default.htm. Accessed 1 March 2016.

Chronic kidney disease on the rise in SA. Life Healthcare press release. Sept 2015. [Online] Available at: http://www.lifehealthcare.co.za/Hospitals/Life_Healthcare_Kidney_Awareness_Week_PRL_010915.pdf. Accessed 1 March 2016.

UKidney CME Programs. Renal Care Society of South Africa. [Online] Available at: http://www.renalcaresoc.org/Education.asp. Accessed 1 March 2016.

What happens when your kidneys slow down or stop working? [Online] Available at: http://www.mykidneyplan.com/My-Kidney-what-happens-when-your-kidneys-slow-down-or-stop-working. Accessed 1 March 2016.

What happens if my kidneys fail completely? [Online] Available at: http://kidney.templehealth.org/content/fail.htm. Accessed 1 March 2016.

 
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