American Medical Association Family Medical Guide - American Medical Association [544]
WARNING!
Pain Relievers and Kidney Failure
Taking too many analgesics (pain relievers) can lead to a condition called analgesic nephropathy, which can result in chronic kidney failure. People who take several analgesic pills every day for several years are at risk of developing analgesic nephropathy. Analgesics most likely to cause the problem are nonprescription combination medications that mix several pain-relieving ingredients in a single tablet—such as aspirin and acetaminophen combined with caffeine or codeine. To help avoid this potentially serious condition, tell your doctor about any pain-relief medication you are using, especially combination drugs.
Symptoms and Diagnosis
Symptoms of chronic kidney failure develop gradually. At first you may notice that you are urinating less often than usual, because your kidneys are not functioning efficiently. If you are urinating less often during the day, you may awaken at night to urinate. You may also feel increasingly tired and lethargic. If chronic kidney failure continues to get worse, it will produce symptoms of end-stage kidney failure (see right).
If your doctor suspects that you have chronic kidney failure, he or she may order blood and urine tests to measure the levels of electrolytes (essential minerals that help regulate various body processes) and to evaluate kidney function.
Treatment
If you have chronic kidney failure, your doctor will probably recommend eating a low-protein diet to avoid overworking the kidneys. If you develop high blood pressure, the doctor may ask you to exercise regularly and cut back on salt to help lower your blood pressure. You may also be asked to monitor your fluid intake and urine output. Your doctor will probably recommend that you exercise regularly. Do not take any over-the-counter or prescription medications unless your doctor has prescribed them, to avoid potentially dangerous side effects.
Your doctor may prescribe medications to control your blood pressure and prevent bone damage. He or she may also prescribe medications to lower the pressure inside the filters of the kidneys, or to treat anemia (see page 610) or an underlying disease. With regular checkups, a carefully planned diet, and medication, most people with chronic kidney failure can lead active, productive lives.
End-Stage Kidney Failure
End-stage kidney failure is the most advanced form of kidney failure, usually occurring when chronic kidney failure (see page 817) or acute kidney failure (see page 817) progresses to a point at which the kidneys can no longer function. An infection such as pneumonia, which places added stress on the already limited filtering capacity of the kidneys, can tip the balance from chronic kidney failure to end-stage kidney failure.
Symptoms
A variety of symptoms can occur in end-stage kidney failure, including lethargy, weakness, headache, confusion, delirium, and seizures. A person may also have fluid buildup around the heart, an irregular heartbeat, or fluid buildup in the lungs (producing shortness of breath) or just under the skin (producing generalized swelling). The condition can also cause oral thrush (see page 744); nausea, vomiting, and diarrhea; pain in the chest or bones; or intensely itchy skin. Severe anemia (see page 610) results from kidney failure, because the kidneys stop producing erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells (which deliver oxygen to other cells throughout the body). In both men and women, the sex hormones and sexual function are affected. A woman with end-stage kidney failure may stop menstruating.
Diagnosis
Doctors diagnose end-stage kidney failure by the symptoms and the results of urine and blood tests. Your doctor will probably ask you to immediately report any illness or any change in your condition.
Treatment
Most people who develop end-stage kidney failure are already receiving treatment for acute or chronic kidney failure. Treatment for end-stage kidney failure is a complex team effort to tailor