Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In the beginning, kidney failure may be asymptomatic (not producing any
symptoms). As kidney function decreases, the symptoms are related to the
inability to regulate water and electrolyte balances, to clear waste products
from the body, and to promote red blood cell production. Lethargy,
shortness of breath, and generalized swelling may occur. Unrecognized or
untreated, life-threatening circumstances can develop.
Metabolic acidosis, or increased acidity of the body due to the inability to
manufacture bicarbonate, will alter enzyme and oxygen metabolism, causing organ
Inability to excrete potassium and rising potassium levels in the serum
(hyperkalemia) is associated with fatal heart rhythm disturbances (arrhythmias)
including ventricular tachycardia and ventricular fibrillation.
Rising urea levels in the blood (uremia) can affect the function of a variety
of organs ranging from the brain (encephalopathy) with alteration of thinking,
to inflammation of the heart lining (pericarditis),
to decreased muscle function because of low calcium levels (hypocalcemia).
Generalized weakness may be due to
anemia, a decreased red blood cell count,
because lower levels of erythropoietin produced by failing kidneys do not adequately stimulate the bone
marrow. A decrease in red cells equals a decrease in oxygen-carrying capacity of
the blood, resulting in decreased oxygen delivery to cells for them to do work;
therefore, the body tires quickly. As well, with less oxygen, cells more readily
use anaerobic metabolism (an=without + aerobic=oxygen) leading to increased
amounts of acid production that cannot be addressed by the already failing
As waste products build in the blood,
loss of appetite, lethargy, and fatigue
become apparent. This will progress to the point where mental function will
decrease and coma may occur.
Because the kidneys cannot address the rising acid load in the body,
breathing becomes more rapid as the lungs try to buffer the acidity by blowing
off carbon dioxide. Blood pressure may rise because of the excess fluid, and
this fluid can be deposited in the lungs, causing
congestive heart failure.
Reviewed by Melissa Conrad Stöppler, MD on 2/4/2013