An Overview of Renal Failure and Its Treatment Option Renal failure can affect any population in society with no discrimination to age or race. There are several different types of renal failure and a multitude of treatment options depending on the severity or complexity of the disease process. With a change in healthcare on the horizon an examination into the area and the current school of thought is a must. While renal failure is just one small area of the healthcare sector, it is rapidly growing and affecting more and more every day. According to the data from the CDC more than 4.4 million Americans are diagnosed with some form of kidney disease (CDC).
Renal Failure is best defined when the kidneys no longer work properly. Now one might ask, what do the kidneys do? The kidney’s simply remove metabolic waste and water from the human body and maintain homeostasis. Without the kidneys functioning properly the body will no longer make urine and dangerous electrolyte abnormalities can occur. One must realize there are several categories of renal failure. The two main classifications are Acute and Chronic Renal Failure. Acute Renal Failure is best defined as rapid and new onset renal failure sometimes reversible when treated appropriately while Chronic Renal Failure long term and irreversible unless treated via transplant. Now that a basic foundation definition of Renal Failure has been established, one must gain knowledge of what causes Renal Failure. Now that there is a basic understanding to what Renal Failure is the next step is to find out causes of the disease. This is where Acute Renal Failure (ARF) and Chronic Renal Failure (CRF) start to really differ. ARF can be caused by many disease processes or injuries such as; dehydration, rhabdomyolysis, trauma, renal infection, drug toxicity, and sepsis. In fact research conducted by the staff at the May Clinic place causes of ARF into 3 categories: “Acute kidney failure can occur when on the following happens: you have a condition that slows blood flow to your kidneys, you experience direct damage to your kidneys, or your kidneys' urine drainage tubes (ureters) become blocked and wastes can't leave your body through your urine.” (Mayo Clinic). CRF on the other hand usually occurs over a long period of time and is caused by an underlying comorbidity. The top two leading causes of CRF in the United States are Diabetes and Hypertension. Ethnicity also plays a large role in CRF. The National Kidney Disease Education Program notes that “African Americans are almost four times as likely as Caucasians to develop kidney failure. While African Americans make up about 13 percent of the population, they account for 32 percent of the people with kidney failure in the United States. Diabetes and high blood pressure are the leading causes of kidney failure among African Americans” (NKDEP). CRF also has other causes than what is previously listed such as: recurrent kidney infections, prolonged renal obstructions, polycystic kidney disease, and glomerulonephritis (Mayo Clinic). Of course ARF can also transition into CRF as well if not caught or treated soon enough and even sometimes if ARF is caught and treated appropriately the damage is already been done to the kidneys. The manifestation of Renal Failure is also broken into the two categories of ARF and CRF. Symptoms of ARF according to the staff of the Mayo Clinic include: “Decreased urine output, although occasionally urine output remains normal; Fluid retention, causing swelling in your legs, ankles or feet; Drowsiness, Shortness of breath; Fatigue, Confusion, Nausea, Seizures or coma in severe cases, and Chest pain or pressure” (Mayo Clinic). These symptoms are not meant to be exact by any means, because there is not at an exact symptom for ARF research shows. The exact same can be said for CRF. Mayo Clinic website states, “Signs and symptoms of kidney failure develop slowly over time if kidney damage progresses slowly. Signs and symptoms of kidney failure may include: Nausea, Vomiting, Loss of appetite, Fatigue and weakness, Sleep problems, Changes in urine output, Decreased mental sharpness, Muscle twitches and cramps, Hiccups, Swelling of the feet and ankles, Persistent itching, Chest pain; if fluid accumulates around the lining of the heart, Shortness of breath; if fluid accumulates in the lungs, High blood pressure (hypertension) that's difficult to control. Signs and symptoms of kidney failure are often nonspecific, meaning they can also be caused by other illnesses. In addition, because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms of kidney failure may not appear until irreversible damage has occurred” (Mayo Clinic). Yet again another vague description of symptoms when it comes to Renal Failure, research has proven that the best thing to do when someone is experiencing anything out of the ordinary he or she should go see a physician for further testing and management. A referral to a Nephrologist, a physician specializing in renal disease, will most likely occur.
While the symptoms of Renal Failure can be vague the testing that is performed is exact and the same tests are used to determine ARF and CRF. The differences in the diagnosis of the two are within the definition which was covered earlier. Current research shows that “the best indicator of global kidney function is excretory capacity as measured by the glomerular filtration rate (GFR)” (Gall and Moore 300). While other sources advise test such as BUN, Creatinine Clearance, Serum creatinine, Serum potassium, and a Urinalysis are good in determining Renal Failure (Medline Plus). All of these test or studies are relatively harmful to the human body other than a needle stick and under normal circumstances the results only take a few hours to come back.
Once a person has been diagnosed with Renal Failure depending upon whether it is ARF or it is CRF decides the next course of action, which is treatment. With ARF under normal circumstances the clinician will try to fix the underlying cause of said Renal Failure. Rebecca Sumnall describes in her research that the single most important intervention performed to halt ARF is intravenous fluid resuscitation (Sumnall 29). The use of diuretics for the treatment of both ARF and CRF are both quite common. A clinician may give doses of diuretics to a patient in renal failure to jumpstart the kidneys or keep the patient from retaining potentially harmful levels of fluid that could result increased morbidity (Sumnall 31). The use of fluids and diuretics are seen as less invasive treatments. The next in line for treatments is renal replacement therapy.
Treatments that fall into the category of renal replacement therapy (RRT) include: continuous renal replacement therapy (CRRT), hemodialysis (HD), and peritoneal dialysis (PD). These previous listed treatments use alternative means such as machines and fluid do to what the body and the kidneys would normally do. PD uses the stomach lining of the body as a membrane to filter out waster products. The waste and fluid is removed by a catheter that has been implanted by a surgeon. Research findings show that PD is the least affective treatment in ARF due to the high infection rate and catheter malfunction while in CRF it shows comparable results to HD (Pannu and Gibney 142). HD involved the use of a machine and an external filter called a dialyzer. The patient’s blood is pumped out of the body through a circuit and returned cleansed without losing blood volume. Electrolytes can be adjusted using HD based on the type of dialysate (fluid) that is used by the machine, also to be noted the HD machine can also be adjusted to remove a set amount of fluid volume over time. HD treatments usually last between 2 to 5 hours and conducted 3 to 4 times a week (Pannu and Gibney 142). HD is the primary treatment for CRF. CRRT works a lot like HD. CRRT filter blood and removes waste and water, but the greatest advantage that CRRT has over any other treatment is that it mimics the actual human kidney the most. Where HD treatments are broken up over a few hours and 3 to 4 days a week CRRT is continuous 24 hours as long as it is necessary and the patient can tolerate it (Pannu and Gibney 146). CRRT differs from PD and HD where as it is only used for patients that suffer from ARF.
The closest thing to a cure for anyone diagnosed with CRF is a transplant. “A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis. During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working” (Medline Plus). These kidneys are usually harvested from an organ donor that has died or sometimes they are willfully given by a close friend or relative (Mayo Clinic). Even when the kidney transplant is a success and there is no longer a diagnosis of CRF, the transplanted subject will still be required to take anti-tissue rejection drugs as long he or she has the donated organ. The other noted drawback to a renal transplant is just the availability of donor kidneys. According to the data found on the Organ Procurement and Transplantation Network there are currently 2116 people on the transplant list waiting on kidney (OPTN). In the grand scheme of things that does not seem like a large number, but to a person on that list he or she probably sees a big difference in being 5 or 6 on that list or being just placed on it.
Dealing with any form of renal failure can be daunting. Medicine is not an exact science and sometimes treatments are trial by error. ARF if caught early enough treated appropriately irreversible damage can be prevented and transition to CRF can halt. Now once a person is diagnosed with CRF eventually PD or HD will have to be discussed as a treatment option with renal transplant being the ultimate goal.
With so many Americans diagnosed with kidney disease there is more research and advances in treatment than ever before. The thought process behind this informative research paper was to give a brief insight into renal failure without getting to far in depth that the reader is lost, while making the reader more aware and educated about the disease.

Works Cited
CDC. N.p, 30 May 2013. Web. 21 July 2013.
Gall, Iain, and John Moore. “Renal Failure and Its Treatment.” Anesthesia and Intensive Care Medicine 10.6 (2009): 300-306. Print.
Mayo Clinc. N.p, n.d. Web. 20 July 2013.
Medline Plus. U.S. National Library of Medicine, n.d. Web. 21 July 2013.
National Kidney Disease Education Program. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, n.d. Web. 18 July 2013.
Organ Procurement and Transplantation Network. U.S. Dept. Health and Human Services, 2013. Web. 20 July 2013.
Pannu, Neesh, and RT Noel Gibney. “Renal Replacement Therapy in the Intensive Care Unit.” Therapeutics and Clinical Risk Management 1.2 (2005): 141-150. Print.
Sumnall, Rebecca. “Fluid Management and Diuretic Therapy in Acute Renal Failure.” British Association of Critical Care Nurses, Nursing in Critical Care 12.1 (2007): 27-33. Print.