Kidney Failure – Symptoms, Causes & Treatment

Understanding kidney failure: from early detection to renal replacement therapy

Meta Summary: A structured clinical education playbook on kidney failure covering acute kidney injury and chronic kidney disease progression to end-stage renal disease. Includes symptoms, causes, diagnostic workup, treatment pathways, and patient management for health professionals and care teams.

Table of Contents

• Chapter 1: Foundations of Kidney Failure
• Chapter 2: Acute Kidney Injury – Rapid Onset
• Chapter 3: Chronic Kidney Disease to ESRD
• Chapter 4: Treatment – Dialysis, Transplant, Conservative Care
• Chapter 5: Prevention, Management & Patient Support
• Related Topics
• FAQ
• References

Chapter 1: Foundations of Kidney Failure

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Introduction: What Is Kidney Failure?

Kidney failure, also called renal failure, is when your kidneys no longer work well enough to keep you alive. The kidneys clean blood by removing waste and extra fluid, which leaves the body as urine. They help control blood pressure, balance salt and minerals, make red blood cells, and keep bones strong.

There are two main types. Acute kidney failure, now called acute kidney injury, is loss of kidney function that develops quickly over hours or days and can sometimes recover. Chronic kidney failure results from kidney damage that develops slowly over months or years and cannot be reversed. When chronic kidney disease progresses to the point that 85 to 90% of kidney function is gone, it is called end-stage renal disease or end-stage kidney disease.

With kidney failure, harmful levels of wastes may build up and the blood’s chemical makeup may get out of balance. Without treatment by dialysis or kidney transplant, ESRD is fatal due to complications such as hyperkalemia or pulmonary edema.

Key Concepts & Terminology

• Acute Kidney Injury: Sudden decline in kidney function, previously called acute kidney failure. Can be mild to severe and sometimes reversible.
• Chronic Kidney Disease: Long-term condition where kidneys are damaged for more than a few months. Measured by eGFR and albumin in urine.
• End-Stage Renal Disease: Stage 5 CKD with 85-90% function lost. Requires dialysis or transplant to survive.
• eGFR: Estimated glomerular filtration rate. Normal is ∼90 or higher. Stage 3 CKD is eGFR 30-59; Stage 5 is less than 15.
• Uremia: Waste buildup in blood when kidneys fail. Causes nausea, fatigue, itching, and confusion.
• Renal Replacement Therapy: Treatments that replace kidney function: hemodialysis, peritoneal dialysis, or kidney transplant.

Global Burden & Why Early Detection Matters

An estimated 674 million people have chronic kidney disease worldwide, most in low- and middle-income countries. In the U.S., more than 35 million people have CKD, that is 1 in 7 adults. Kidney disease causes substantial morbidity, disability, and premature mortality, in part because it causes and is caused by cardiovascular disease.

Simple blood and urine tests used in primary health care can detect CKD. However, kidney disease is often asymptomatic until late stages. Most people with early CKD have no symptoms. This is why regular testing is important for people at risk, including those with diabetes, hypertension, or family history.

Acute kidney injury is most common in people who are in the hospital, mostly in people who need intensive care. If severe, ongoing and not treated, it can be fatal. But it also can be reversed. People in otherwise good health may get back typical or nearly typical use of their kidneys.

Chapter 2: Acute Kidney Injury – Rapid Onset

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Symptoms of Acute Kidney Injury

Acute kidney injury happens when the kidneys suddenly can't filter waste products from the blood. Symptoms may include less urine output, fluid buildup causing shortness of breath and swelling in the legs, ankles or feet, tiredness, confusion or fogginess, nausea, pain in the belly or side below the rib cage, weakness, irregular heartbeat, itching, loss of appetite, chest pain or pressure, and seizures or coma in severe cases.

Sometimes acute kidney injury causes no symptoms. Then it may be found through lab tests done for something else. See your healthcare professional right away or seek emergency care if you have symptoms of acute kidney injury.

Loss of kidney function can cause a buildup of fluid or waste in the body. It also can cause acids, potassium and phosphate to build up in the blood.

Causes of AKI: Pre-renal, Intrinsic, Post-renal

Acute kidney injury can happen when you have a condition that slows blood flow to your kidneys, you have damage to your kidneys, or your kidneys’ urine drainage tubes get blocked.

Slowed blood flow causes include: Loss of too much body fluid called dehydration, infection with or without sepsis or septic shock, medicines such as aspirin, ibuprofen or naproxen sodium, blood or fluid loss, severe low blood pressure from blood pressure medicines, heart attack, heart failure or heart disease, liver cirrhosis or failure, bad allergic reaction called anaphylaxis, and bad burns.

Damage to kidneys: Conditions that damage the kidneys themselves include glomerulonephritis, drugs or toxins, and conditions such as lupus that cause inflammation.

Blocked drainage: Conditions that block urine flow include kidney stones, enlarged prostate, and tumors.

Diagnosis & Emergency Management

Acute kidney injury is diagnosed using a blood test. Your blood will be checked for levels of creatinine, a waste product made by your muscles and removed by your kidneys. If you have higher levels of creatinine than usual, it means your kidneys are not working as well as they should.

Tests to diagnose acute kidney injury include blood tests showing fast-rising levels of urea and creatinine, measuring urine output over 24 hours, urine tests, imaging tests such as ultrasound and CT scans, and removing a sample of kidney tissue for testing called a biopsy.

Treatment most often means a hospital stay. Treatment involves finding the illness or injury that damaged your kidneys and may involve stopping a medicine that’s damaging your kidneys. To prevent complications and give kidneys time to heal, treatments include IV fluids for dehydration, diuretics for fluid overload, medicines to control blood potassium such as sodium zirconium cyclosilicate or patiromer, calcium infusion for low calcium, and dialysis to remove poisons and excess fluids.

Chapter 3: Chronic Kidney Disease to ESRD

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Symptoms of Chronic Kidney Disease

Chronic kidney disease symptoms tend to develop slowly over time. Symptoms are often vague. Most people with kidney disease have no symptoms until the very last stages of kidney disease. This is known as advanced kidney disease.

When chronic kidney disease becomes advanced, loss of kidney function can cause nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, decreased mental sharpness, high blood pressure that’s hard to manage, and shortness of breath if fluid builds up in the lungs.

Other symptoms include itchy and/or dry skin, trouble concentrating, numbness or swelling in arms, legs, ankles, or feet, achy muscles or cramping, and trouble sleeping. In Stage 3 CKD with eGFR between 30 and 59, kidney damage affects how well they work and you may start to notice symptoms.

Major Causes & Risk Factors

The most common cause of kidney failure is diabetes. Other causes include high blood pressure, autoimmune diseases like lupus or IgA nephropathy, genetic conditions such as polycystic kidney disease, nephrotic syndrome, and problems in the urinary tract such as kidney stones.

CKD is characterized by a persistent reduction in glomerular filtration rate, accumulation of toxins, salt and water retention, and abnormalities in electrolyte and hormonal balance. If untreated, kidney disease can lead to end-stage renal failure, requiring life-sustaining dialysis or transplantation.

Risk factors include being over age 60, being Black, Hispanic, Native American, or Asian American, living with obesity, smoking or using tobacco products, and having a family history of kidney disease.

Progression to End-Stage Renal Disease

In Stage 3 CKD, your kidneys have mild to moderate damage and are less able to filter waste and fluid out of your blood. Waste buildup or uremia can build up in your body and lead to complications such as high blood pressure, anemia, and problems with your bones. Stage 3a is eGFR 45-59, Stage 3b is eGFR 30-44.

Treatment for chronic kidney disease aims to slow down damage to the kidneys. This often is done by managing the cause of the damage. But, even after a cause has been found and treated, kidney damage could still get worse. Chronic kidney disease can progress to end-stage kidney failure. This is fatal unless a person gets a kidney transplant or starts dialysis.

With kidney failure, 85-90% of your kidney function is gone. People with kidney failure have stage 5 CKD, also known as end-stage kidney disease or ESKD. People with kidney failure will need dialysis or a kidney transplant to survive.

Chapter 4: Treatment – Dialysis, Transplant, Conservative Care

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Medications to Slow CKD Progression

Managing CKD is focused on four goals: managing the disease causing CKD, taking steps to slow progression, lowering cardiovascular risk, and treating complications. Your healthcare professional may prescribe one or more medicines to help slow down or stop your CKD from getting worse. These medicines can include an ACE inhibitor/ARB, an SGLT2 inhibitor and/or an nsMRA.

Guidelines recommend a statin for people with CKD who also have diabetes, a history of heart disease, or are age 50 or older. Even if you do not have high cholesterol, a statin can help lower your risk of having a heart attack or stroke. You may also need additional medications or supplements to manage complications.

Treating the cause is key. Getting better blood pressure control, improved sugar control and diabetes, and reducing weight are often key interventions. A lower-protein diet may also be recommended to reduce the amount of waste your kidneys need to filter.

Dialysis: Hemodialysis & Peritoneal Dialysis

When kidneys fail, dialysis does the job of the kidneys. Dialysis helps remove poisons and excess fluids from your body while your kidneys heal or as long-term therapy. During hemodialysis, a machine pumps blood out of your body through an artificial kidney called a dialyzer that filters out waste. The blood is then returned to your body.

Two needles are inserted for every treatment. The place they are inserted is called the access. A surgeon may connect two of your blood vessels to create a fistula, causing the vein to get larger and stronger. Another option is a graft using a plastic tube between vessels. In urgent situations, a catheter may be placed temporarily into a large vein in your neck.

Early patient education should be initiated regarding dialysis modalities. Over 80% of patients in the US are initiated on dialysis via a central venous catheter, which has higher infection rates than permanent access. Permanent access requires preparation, as the mean time for arteriovenous fistula maturation is 3 months.

Kidney Transplant & Preemptive Options

Renal transplantation is the best and most cost-effective renal replacement therapy for suitable patients. For appropriate candidates, kidney transplantation from a living donor or deceased donor provides the best outcomes among available modalities of RRT. Time spent on dialysis awaiting referral for transplantation increases mortality and compromises outcomes after transplantation.

Referral for kidney transplantation evaluation is generally done when the eGFR falls to less than 20 ml/min/1.73m2. Preemptive transplantation before dialysis is initiated is recommended for eligible patients. There are no data to indicate that any defined subgroup of patients with CKD benefits from dialysis before transplantation.

Where possible, the preferred therapy is a kidney transplant. While an organ transplant can sound daunting, it’s actually often the better alternative, and the closest thing to a cure, if you qualify.

Conservative & Palliative Care

If you choose not to have a kidney transplant or dialysis, you can choose palliative or supportive care to help manage your symptoms and feel better. You also can combine palliative care with kidney transplant or dialysis.

Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. Death can occur quickly or take months or years. Supportive care might include management of symptoms, measures to keep you comfortable and end-of-life planning.

Advance care planning is an ongoing process of learning patient values and goals to outline preferences for current and future care. Early ACP is useful for all dialysis patients and should ideally begin in the absence of clinical setbacks. Interdisciplinary teams with expertise from social work, palliative care, and hospice can be helpful.

Chapter 5: Prevention, Management & Patient Support

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Early Identification & Reversible Factors

It is important to identify and refer patients with advanced and progressive renal failure as they will be at risk of developing ESRD. Look for reversible factors such as obstructive uropathy, drug nephrotoxicity or renal vasculitis, and try to conserve renal function, principally by controlling hypertension.

Early recognition allows time for patients to become fully informed about treatment options and to institute therapy electively. However, ESRD may occur unpredictably, for example following acute kidney injury, and 20% of patients still present requiring urgent or emergency dialysis.

Talk to your doctor about getting a blood and urine test to check your kidneys if you have risk factors for CKD. While kidney damage can't be repaired, if found early, there are ways you can keep it from getting worse, such as following a kidney-friendly eating plan, being active, and taking certain medicines.

Lifestyle & Complication Management

Managing the disease causing CKD is critical. For example, your diabetes, high blood pressure, or IgA nephropathy. Preventing or managing health conditions that cause CKD may help prevent CKD or slow its progression.

Adopting healthy lifestyle habits may help keep your kidneys healthier longer: eating right, maintaining a healthy weight, staying physically active, and avoiding medicines that can injure the kidneys. Treatment might include high blood pressure medication, diuretics to reduce fluid and swelling, supplements to relieve anemia, statins to lower cholesterol, or medications to protect your bones and prevent blood vessel calcification.

Complications of CKD include cardiovascular disease, anemia, bone disease, and fluid overload. Your healthcare professional may prescribe medicines to control blood potassium, restore blood calcium levels, or manage anemia.

Patient Education & Shared Decision-Making

Early patient education should be initiated regarding the natural progression of the disease, various modalities for dialysis, and renal transplantation. All potential modalities should be discussed with patients in an interdisciplinary team setting, and patients should be closely monitored once they reach stage 4 CKD.

You don't have to face Stage 3 alone. Sign up for emails to receive guidance, resources and ways to get involved from the American Kidney Fund to help you manage kidney disease and feel more in control of your health.

For ESRD, ensure patients can choose their most appropriate treatment. Create an arteriovenous fistula in preparation for hemodialysis to avoid using central line access. Ensure appropriate conservative/palliative care services are available for patients with ESRD.

Related Topics

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These topics expand the playbook into broader nephrology care. Useful for clinicians, nurse educators, dialysis units, and transplant coordinators building comprehensive kidney health programs.

• Diabetic Kidney Disease: Leading cause of CKD, develops in approximately 40% of patients with diabetes. SGLT2 inhibitors and nsMRAs slow progression.
• Glomerulonephritis: Inflammation of kidney filters. May be identified during routine testing. Treatment directed to underlying cause.
• Polycystic Kidney Disease: Genetic condition passed down from parents. Causes cysts that damage kidneys over time.
• Nephrotic Syndrome: Kidney disorder causing body to excrete too much protein in urine. Increases risk of CKD.
• Hypertension & CKD: High blood pressure damages kidneys and is a complication of kidney disease. Requires aggressive management.
• Anemia of CKD: Kidneys make erythropoietin for red blood cells. CKD causes anemia requiring supplements or ESA therapy.
• Mineral & Bone Disorder: CKD disrupts calcium, phosphate, PTH balance. Managed with phosphate binders and vitamin D analogs.
• Dialysis Access Planning: AV fistula vs graft vs catheter. Timing and patient education critical for outcomes.

FAQ

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Can kidney failure be reversed?

Acute kidney injury can sometimes be reversed if caught early and the cause is treated. People in otherwise good health may get back typical or nearly typical use of their kidneys. Chronic kidney failure results from kidney damage that develops slowly and cannot be reversed. However, treatment can slow progression.

What are the first signs of kidney problems?

In early CKD, you might not feel sick or have any symptoms. You might not know you have kidney disease until the condition is advanced. When symptoms appear, they include nausea, vomiting, loss of appetite, fatigue, sleep problems, decreased mental sharpness, high blood pressure that’s hard to manage, and shortness of breath if fluid builds up in lungs.

What happens if I reach kidney failure?

With kidney failure, 85-90% of your kidney function is gone. You will need dialysis or a kidney transplant to survive. Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. You can also choose palliative care to manage symptoms.

Is dialysis permanent?

For acute kidney injury, dialysis may be temporary until kidneys recover, usually for a few days or weeks. For chronic kidney failure or ESRD, dialysis is typically long-term unless you receive a kidney transplant. Some patients remain on dialysis for years while awaiting transplant.

References

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1. Acute kidney injury - Symptoms and causes. Mayo Clinic.
2. Acute kidney injury - Diagnosis and treatment. Mayo Clinic.
3. Chronic kidney disease - Symptoms, causes, treatment. National Kidney Foundation.
4. Chronic kidney disease - Symptoms and causes. Mayo Clinic.
5. Kidney failure - Symptoms, stages, & treatment. National Kidney Foundation.
6. End-stage renal disease - Symptoms and causes. Mayo Clinic.
7. End-stage renal disease - Diagnosis and treatment. Mayo Clinic.
8. Chronic kidney disease symptoms, treatment and prevention. American Kidney Fund.
9. Kidney failure - symptoms, causes and treatment. Healthdirect Australia.
10. Kidney disease. World Health Organization.
11. End-Stage Renal Disease. StatPearls, NCBI Bookshelf.
12. A practical guide for the care of patients with end-stage renal disease near the end of life. PubMed.