Hypertensive Renal Failure

Diagnosis

Diagnosis is based on the results of a physical examination and laboratory blood and urine tests. A patient who has end stage renal disease looks very ill and has obvious fluid retention and clear indicators of severe disease. Anemia is common. Blood pressure is elevated, and even patients who did not have hypertension prior to the onset of ESRD will develop hypertension. Patients also usually have massive amounts of protein in the urine and high levels of serum creatinine. Urea levels are also raised.

Treatment and management

Once physicians diagnose end stage renal disease, they must make a plan for dialysis. In addition, patients may be placed on restricted fluids. Anemia is treated and transfusions are given if anemia is severe. ACE inhibitor drugs may be prescribed at low doses to treat cardiac symptoms. Diuretics may be prescribed to reduce fluid retention. Multivitamins may be recommended because of food restrictions.

All patients with kidney failure, despite the cause of the failure, must receive kidney dialysis or kidney transplantation. Eventually, those on dialysis will require transplantation of a kidney, either from a recently deceased person or a live donor. (Each person has two kidneys and can live normally with only one kidney.) About 13,000 kidney transplants are performed in the United States each year and about 47,000 people wait for a donated kidney per year.

There are two types of dialysis. The most common type of treatment is "hemodialysis," a procedure that uses a machine called a dialyzer to clean and filter the blood, since the kidneys can no longer perform that function. A connection from the machine is made to the patient's bloodstream and the blood travels through the dialyzer where it is cleaned for 2–4 hours. This procedure is generally performed three times a week. Patients must also change their diets to carefully limit the amount of salt, potassium, and fluids that are consumed, among other dietary restrictions that are given.

Peritoneal dialysis is another option for patients with kidney failure. In this procedure, the patient's own abdominal lining (the peritoneal membrane) is used to help clean the blood. Rather than the patients own blood traveling to a machine, as with a dialyzer, a cleansing solution is transferred through a special tube (catheter) directly into the body. The catheter remains in the body. The number of treatments and time to perform the cleansing procedures vary.

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Author Info: Christine Adamec, Thomson Gale, Gale, Detroit, Gale Encyclopedia of Genetic Disorders Part II, 2005

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