Kidney failure: symptoms, causes, treatment and outlook

The NHS says there are usually no symptoms of kidney disease in the early stages, because the body can cope with a significant reduction in kidney function. At a later stage symptoms can develop, and the NHS says this stage of CKD is known as kidney failure, end-stage renal disease or established renal failure.

Symptoms of acute kidney injury can be different and may appear over days. The NHS says many people with AKI do not get symptoms, especially if it is mild, and lists the signs below.

• Weight loss and poor appetite (NHS, chronic kidney disease).

• Swollen ankles, feet or hands from fluid retention (oedema) (NHS).

• Shortness of breath (NHS).

• Tiredness, difficulty sleeping, headaches and muscle cramps (NHS).

• Blood in the pee and an increased need to pee, particularly at night (NHS).

• Itchy skin, feeling sick and erectile dysfunction in men (NHS).

• In acute kidney injury: peeing a lot less than usual, feeling very thirsty, being sick, swollen feet or legs, feeling dizzy, confused or sleepy, and feeling breathless especially when lying down (NHS).

The kidneys clean waste and extra water from the blood. Kidney Care UK describes kidney failure as the stage where the kidneys no longer work well enough to keep us healthy and alive, and says that at this point support from dialysis treatment or a kidney transplant is considered.

The NHS explains two ways it can happen. Acute kidney injury (AKI) is when something suddenly causes your kidneys to stop working as well as they should, and it can be very serious for some people. Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work as well as they should, can get worse over time and eventually may stop working altogether, but this is uncommon.

The NHS says chronic kidney disease is usually caused by other conditions that put a strain on the kidneys, and often it is the result of a combination of different problems.

• High blood pressure, which over time can strain the small blood vessels in the kidneys.

• Diabetes, because too much glucose can damage the kidneys' tiny filters.

• High cholesterol, which can build up in the blood vessels supplying the kidneys.

• Kidney infections and glomerulonephritis (kidney inflammation).

• Autosomal dominant polycystic kidney disease, an inherited condition with cysts in the kidneys.

• Blockages in the flow of urine, such as recurring kidney stones or an enlarged prostate.

• Long-term, regular use of certain medicines such as lithium and NSAIDs.

• For acute kidney injury: infections or sepsis, dehydration, low blood pressure or blood loss, swelling or blockage, long-term conditions of the kidneys, heart or liver, some medicines such as ACE inhibitors, NSAIDs and diuretics, and the dye used for some scans (NHS).

Kidney Care UK says that once the kidneys can no longer work well enough, the options are a kidney transplant, dialysis or conservative treatment, and that your kidney care team will help you choose with a personal care plan. It says it is never too late to review your choice of care.

Transplantation: Kidney Care UK says a transplant is the best treatment for the majority of patients with established renal failure, extending life expectancy and offering freedom from dialysis. Kidneys come from the national deceased donor pool or from a living donor, and one in three kidney transplants in the UK now comes from a living donor. A transplant before starting dialysis (pre-emptive) is described as the gold standard. Not everyone is suitable, and tests are done to check you are fit enough.

Dialysis: Kidney Care UK says dialysis artificially removes waste products and unwanted water from the blood. Haemodialysis cleans the blood through a machine at home or in hospital, usually for around four hours three times a week, and needs a fistula made in the arm. Peritoneal dialysis passes fluid into the abdomen through a catheter, either by hand about four times a day or by machine overnight at home.

Conservative treatment: some people choose not to have dialysis, which may suit people with other medical conditions who feel dialysis is not for them. Kidney Care UK says the priority of care then becomes relieving symptoms and managing complications, and that many units have dedicated nurses for this.

The NHS says AKI is diagnosed using a blood test that checks creatinine, a waste product removed by the kidneys, and that treatment depends on how bad it is and what is causing it. It may include medicine to treat infection or raise blood pressure, stopping or changing any medicine that could be damaging the kidneys, fluids through a drip, a catheter to drain urine, or surgery to remove a blockage.

If AKI is severe, the NHS says your kidneys may need help cleaning the blood with dialysis, usually for just a few days or weeks until the kidneys recover. Many people recover fully within a few weeks with no long-term effects, but some end up with permanent damage and chronic kidney disease.

For chronic kidney disease the NHS says there is no cure, but treatment can help relieve symptoms and stop it getting worse. It lists lifestyle changes, medicine to control associated problems such as high blood pressure and high cholesterol, and medicine to help the kidneys keep working for longer. Good blood pressure control is described as vital to protect the kidneys.

The NHS recommends not smoking, eating a healthy balanced diet, keeping salt below 6g a day (around 1 teaspoon), at least 150 minutes of exercise a week, no more than 14 units of alcohol a week and losing weight if overweight. It says to avoid over-the-counter NSAIDs such as ibuprofen unless advised, because they can harm the kidneys. Some people also need to limit phosphate-rich foods, and to avoid potassium supplements, as advised by their kidney team.

The NHS says many people with CKD are able to live long lives, and that CKD only progresses to kidney failure in around 2 in 100 people with the condition. It adds that CKD, even if mild, increases the risk of other serious problems such as heart attack and stroke. Kidney Care UK describes kidney failure as the beginning of a life-long journey of decisions about treatment.

The sources reviewed for this guide do not give life expectancy figures for kidney failure. How long someone lives depends on age, other conditions and the treatment chosen, and your kidney team can discuss this with you.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you think you may have symptoms of acute kidney injury. It also says to get medical help if you think you have AKI because it can be life-threatening if not treated.

See a GP if you have persistent or worrying symptoms that you think could be caused by kidney disease. The NHS says the symptoms can be caused by many less serious conditions, so it is important to get a proper diagnosis, and kidney disease can be diagnosed with blood and urine tests.

Kidney failure is managed by NHS renal units, with a personal care plan agreed between you and the kidney care team. Dialysis and transplantation are provided through the NHS, and Kidney Care UK says that if your unit cannot provide every treatment option you may want to think about your place of care. Private nephrology consultations are available for assessment and second opinions.