RENAL FAILURE

Renal Failure



Renal Failure

Introduction

Kidney or renal failure is the loss of the ability of the kidney to eliminate waste and excess material from the bloodstream and to recycle important nutrients back into the blood. Without correctly functioning kidneys, excess fluid and waste products like urea and excess potassium can accumulate to dangerous levels in the body. This process can be acute (suddenly occurring) or chronic (developing overtime). Both types cause damage to the kidneys but are associated with different medical conditions and also have very different disease courses and outcomes. A common treatment for kidney failure is dialysis during which the blood is filtered mechanically to compensate for the nonfunctioning kidneys. This paper discusses renal failure in a concise and comprehensive way.

Renal Failure: A Comprehensive Reflection

Cohn (2000) mentions renal failure (kidney failure) is caused primarily by chronic high blood pressure (hypertension) over many years. Hypertension is the second major cause, after diabetes, of end stage renal disease (ESRD) and is responsible for 25-30% of all reported cases. In addition, many people with diabetes also have hypertension, thus high blood pressure plays an even larger role in kidney failure.

About 398,000 people were diagnosed with end-stage renal disease in 1998. Of these, about 83,000 had hypertension and about 133,000 had diabetes. That same year, approximately 63,000 people with ESRD passed away. Most people with ESRD have had symptoms for a long time and may have had kidney disease (nephropathy) for as many as 20 years or more prior to experiencing kidney failure (Cohn, 2000).

It is believed that most cases of hypertension leading to kidney failure have a genetic element. Finding a genetic link is complicated by the fact that nearly half of all people with renal failure have three or more serious disorders, such as diabetes. Animal studies have been done to find genetic linkages to hypertension and kidney failure, but genetic studies on humans are in their infancy. A recent breakthrough came in a study of African American subjects with hypertensive end-stage renal disease. Researchers found a significant association between severe hypertension and mutations on the HSD11B2 gene. This is a gene that plays a role in sodium retention and related factors. Their data suggested that the 16q22.1 chromosome region was the location of the mutation (Malay and Richard, 2000).

In another study, researchers studied an Israeli family of Iraqi-Jewish origin whose members suffered from hypertension and renal failure. The researchers found a genetic locus at 1q21 that was autosomal dominant. They also hypothesized that the gene encoding atrial natriutetic peptide receptor-1 (NPR1) was the disease gene that led to the hypertension/renal failure.

Other families with high rates of hypertension have also been studied. For example, researchers observed a family of Old Order Amish in Lancaster, Pennsylvania and found a genetic link for hypertension to chromosome 2q31-34. The subjects were not experiencing kidney failure, thus, further study would be needed to determine if the identified genetic locus also coded for ESRD (Watson and Bracie, 2006).

Demographics

People of all ages, races, and both sexes may ...