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Re: Kidney Failure

Posted By JR on August 01, 1998 at 09:04:47:

In Reply to: Re: Kidney Failure posted by HFHS M.D.-JJ on July 31, 1998 at 16:16:32:






When both my parents died, one with cancer and the other 17 days post-brain stem bleed, hours before their death, they experienced kidney failure.    My family is curious, what causes this to happen, can renal function return at this point, and  is this just a symptoms of multisystem failure?   Thank you.
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Dear J Ryan,
Renal failure(Azotemia) can be due to a variety of factors that would be too lengthy and cumbersome to review in this forum.  However, renal failure is divided into 3 types based on their cause:
Prerenal, Renal, and Postrenal
Prerenal causes for renal failure result from poor blood flow to the kidneys.  When the blood flow to the kidneys is compromised, less urine is formed resulting in  toxic metabolite and fluid accumulation.  Factors that may lead to a prerenal condition include, Cardiovascular problems such as congestive heart failure or heart attack, sepsis due to infection, dehydration, blood loss, abnormally low blood pressure due to medication, etc. to name a few.
Renal causes for renal failure result from injury to the kidney either from medications and toxins, or inadequate oxygen delivery to the kidney which results in damage to the tubules, medical renal disease which includes a long list of diseases, etc. to name a few.
Postrenal causes for renal failure result from obstruction of the collecting system of the kidney, ureter, and bladder.  The high back pressure generated can result in poor kidney function and ultimately lead to kidney failure.  Causes include from BPH (benign prostatic hypertrophy), ureteral obstruction by metestatic lymph nodes in some cases of cancer, stricture disease, obstruction secondary to stones, etc.  These are problems that are usually urologic (taken care of by a urologist).
It would be impossible for me to say what factors came into play in your parents individual situation.  However, you are probably correct by suspecting that these changes are most likely part of a multi-system organ failure that occurs just prior to death.  Once one or two organ systems start failing, the kidneys are usually effected either by prerenal, renal, or postrenal affects of those changes and subsequently begin to fail.  Many of the factors indicated above are reversible causes for renal failure, however this is much more difficult in the presence of other failing organs.  I hope this answers your question to your satisfaction.
Wish you the best.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: Renal failure
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Thank you for your response.   I am assuming that in the case of someone with terminal cancer or, as iin my mother's case, someone's body deteriorating because of a deep coma resulting from a stroke, that the kidney damage would more than likely be irreversible.   While trying to find out information on the latter ordeal, I read that the older the patient the more likely eventual multisystem failure and deterioration.   If I have assumed wrong, please correct me.
Again--any information I reeive from you forum is for general medical education only.     Thank you.

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