Kidney stones

Disease Description (Causes and Symptoms)

Renal failure (kidney failure) is a condition in which the kidneys lose the ability to remove waste products from the blood and maintain fluid, electrolyte, and acid–base balance. Clinically, it is divided into acute renal failure (acute kidney injury, AKI), chronic renal failure (chronic kidney disease, CKD), and end-stage renal disease (ESRD).

• Main causes: diabetic nephropathy, glomerulonephritis, hypertensive nephropathy, polycystic kidney disease, systemic lupus erythematosus (SLE), medications (nephrotoxic antibiotics, NSAIDs, contrast media, etc.), preeclampsia, severe hypovolemia/sepsis, and others.
• Pathophysiology summary: Decreased glomerular filtration rate (GFR) → accumulation of waste products (uremic toxins), fluid, K+, and phosphate; metabolic acidosis; anemia; and mineral and bone metabolism disorders → impaired function of systemic organs (heart, nervous system, etc.).
• Main symptoms: Decreased urine output (or proteinuria), generalized edema (face, legs, and entire body), shortness of breath (pulmonary edema), fatigue, malaise, loss of appetite, nausea, vomiting, itching, altered consciousness (in severe cases), decreased skin elasticity, and others.

Treatment Methods

Treatment varies depending on the cause and whether the condition is acute or chronic.

• General principles

  • Treatment of the underlying cause (resolving infection, hypotension, obstruction, etc.)
  • Correction of fluid, electrolyte, and acid–base imbalances
  • Management of complications (hyperkalemia, pulmonary edema, metabolic acidosis, uremia, etc.)

• Medication treatment

  • Blood pressure control: ACE inhibitors or ARBs (however, kidney function and potassium monitoring are required during acute worsening)
  • Hyperkalemia: Potassium-restricted diet, potassium binders (patiromer, sodium zirconium cyclosilicate), emergency treatment such as insulin + glucose
  • Metabolic acidosis: Oral sodium bicarbonate in mild cases
  • Hyperphosphatemia: Phosphate binders (sevelamer, calcium acetate, etc.)
  • Anemia: Iron therapy, erythropoiesis-stimulating agents (ESA)
  • Avoid or use caution with nephrotoxic medications such as NSAIDs when managing pain and inflammation

• Dialysis and transplantation

  • Dialysis: Temporary hemodialysis (HD) or continuous renal replacement therapy (CRRT) in acute cases; hemodialysis or peritoneal dialysis in chronic cases
  • Kidney transplantation: A definitive treatment that improves survival and quality of life in end-stage renal disease (evaluation of transplant eligibility is required)

• Lifestyle management

  • Restriction of salt (sodium) and fluids; adjustment of potassium and phosphate intake (dietary education)
  • Strict management of blood pressure and blood glucose, smoking cessation, maintenance of an appropriate body weight, and regular exercise (within the range recommended by a doctor)
  • Vaccination (influenza, pneumococcal disease, hepatitis B, etc.) is recommended, especially for dialysis patients

Checklist Before an Outpatient Visit (Including Example Questions)

Items/records to prepare

• A list of all medications currently being taken (including prescription drugs, OTC medications, herbal medicines, and supplements)
• Recent test results: serum creatinine and eGFR, electrolytes (especially K+), BUN, CBC (anemia), albumin, urinalysis (proteinuria and hematuria), and urine albumin-to-creatinine ratio (ACR)
• Changes in blood pressure, body weight, urine output, and edema (photos or a diary)
• Recent changes in symptoms (shortness of breath, vomiting, decreased consciousness, etc.) and when they began
• For dialysis patients: Dialysis schedule and access status (arteriovenous fistula/catheter) information

Examples of materials to show or submit to the doctor during the outpatient visit:

• Recent test reports (paper or electronic) or screenshots of the results
• Photos of medications or medication bags

General Example Questions to Ask the Doctor

• What are the main side effects of this medication (or treatment)?
• What is my current kidney function (or CKD stage), and what is the future prognosis?
• What are my target blood pressure and blood glucose levels? Which lifestyle changes should I prioritize?
• Are there any medications or activities I should avoid to prevent worsening kidney function?
• When might dialysis or transplantation be needed? How should I prepare for it?

Examples of Condition-Specific Questions

• Based on the trend in my recent eGFR, how quickly do you expect my kidney function to progress? (Regarding the rate of progression and expected timing)
• Proteinuria (or hyperkalemia) has been observed. What additional medications or lifestyle measures (e.g., increasing the dose of an ACE inhibitor/ARB, a low-salt diet, etc.) do you recommend to reduce the proteinuria?
• (For patients considering dialysis) Which method is more suitable for me, hemodialysis or peritoneal dialysis? What are the advantages and disadvantages of each, and how would they affect my daily life?