Kidney Failure

Kidney failure (renal failure) is when the kidneys can no longer clean the blood well enough. It can happen suddenly (acute kidney injury, AKI) or slowly (chronic kidney disease, CKD). In India, diabetes and high blood pressure are the two biggest drivers, followed by GN, stones/obstruction, and a growing burden of "CKDu" (CKD of unknown cause) in parts of Andhra, Odisha, and Odisha–Chhattisgarh.

Acute kidney injury (AKI)

• Rapid fall in kidney function over hours to days.
• Common Indian triggers: severe infections (sepsis, dengue, malaria, leptospirosis, snake bite), severe diarrhoea/vomiting, unregulated NSAID + herbal/ayurvedic drug exposure, urinary obstruction (stones, enlarged prostate), severe heat illness, post-surgery, contrast imaging in dehydrated patients.
• Often reversible if the cause is treated early — and prevented in many cases.

Chronic kidney disease (CKD)

• Gradual loss of kidney function over months to years.
• Staged by eGFR (estimated glomerular filtration rate) 1–5; dialysis or transplant usually needed by stage 5.
• Often silent until advanced — no pain, just tiredness and anaemia. Screening tests are a urine albumin + creatinine and a blood creatinine.

Warning signs

• Swelling of feet, ankles, face (especially mornings).
• Frothy urine or visible blood.
• Breathlessness, high BP that is hard to control.
• Fatigue, poor appetite, nausea, weight loss.
• Itching, cramps, restless legs.
• Reduced urine output in AKI.

What protects kidneys

• Good control of blood sugar, blood pressure (target ~130/80), cholesterol.
• ACE inhibitor / ARB class for people with diabetes + albumin in urine — slows progression.
• SGLT2 inhibitors — a major advance for CKD in and beyond diabetes.
• Avoid unnecessary painkillers (especially long-term NSAID class) and nephrotoxic drugs.
• Avoid unregulated Ayurvedic / Unani / herbal products — several have caused kidney failure (heavy-metal contamination, nephrotoxic plants).
• Hydration (but not excess water forcing) — especially in Indian heat.
• Annual screening (urine ACR + eGFR) in anyone with diabetes, high BP, family history of kidney disease, or over 60.
• Vaccinations — flu, pneumococcal, Hep B (especially if dialysis is likely).

Advanced care

• Dialysis — haemodialysis or peritoneal dialysis. See Dialysis.
• Kidney transplant — the best long-term option when eligible. See Kidney Transplantation.
• Palliative / conservative care — appropriate for some older patients with multiple illnesses; focus on symptom control.
• Ayushman Bharat, PM-JAY, and state schemes cover dialysis and part of transplant costs at empanelled centres — ask the hospital's social worker.