Kidney is a vital organ. It removes waste material from the body in the form of urine. Failing to do so, waste and toxic chemicals, metabolites, among others, go on accumulating in the body; producing various toxic manifestations and culminating in death. 

 Acute renal failure develops suddenly and  is characterised by sudden diminution of urine flow. 

It  usually develops because of severe dehydration or blood loss from the body when the perfusion of kidneys is reduced suddenly. 

Congenital abnormalities of the kidneys, infections of the kidneys, even malaria can lead to acute cessation of kidney function. 

Stones in the urinary tract or kidneys, stricture or obstruction anywhere in the urinary system also cause sudden renal failure, leading to death. 

Chronic renal failure is the failure of kidney function which develops over a period of time. This has more dramatic clinical features, most typical being swelling over the face. 

In the initial stages swelling appears over the face in the morning and as the disease progresses it  becomes generalised. This occurs because of inability of the kidneys to eliminate extra salt and water from the body.

In the later stages one starts developing breathlessness because of accumulation of fluid in the lungs. Accompanying loss of appetite, nausea and vomiting become troublesome and make a person asthenic. 

Bones become soft in kidney failure because of metabolic disturbances. This makes a person prone to osteoporosis and pathological fractures.  

The main avoidable cause of chronic renal failure is drugs, particularly painkillers such as diclofenac, aspirin, among others; some antibiotics like amino glycosides (streptomycin, gentamycin), antifungal agents like amphoterecin B are also nephrotoxic. These should be used judiciously.

 Kidneys are damaged by long standing hypertension and diabetes, especially if uncontrolled. It is vital to keep these conditions controlled by regular medicines, diet and exercise.

Patients of arthritis can  develop kidney failure in the later stages of the illness because of both the illness and analgesics drugs taken over a long time. 

Systemic diseases such as cardiac and hepatic failure are also associated with kidney failure in the advanced stage of illness. 

Drinking much water ensures good kidney function and also prevents infection and stone formation, which cause kidney damage. In acute renal failure, recovery can occur if the cause is eliminated early.

Once kidneys stop functioning, nothing much can be done. One has to suffer with various complications related to the kidney failure and its treatment till the end.  

Dr Pande is a specialist in internal medicine at Ruhengeri Hospital