Talk:Kidney failure

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Np2021, David 21, Szarnke, Nsayed2, WikiTweeks11, Dkrishnan97. Peer reviewers: Np2021, David 21.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 01:46, 17 January 2022 (UTC)

Article Mistakes
This article refers to "African-American" as a "race" which it is not.

—The preceding unsigned comment was added by 63.240.201.51 (talk) 19:49, 11 January 2007 (UTC).

I agree African-American is totally inapropraite in this context. It implies that it only applies to black Americans and not Africans or black Europeans or Caribeans or any other person that can trace their recent heritage to Africa.


 * So be BOLD and change it. &mdash; Gaff  ταλκ 06:06, 4 June 2007 (UTC)


 * looks like someone already did it. onya. Markjohndaley 17:46, 12 June 2007 (UTC)

Wikipedia 'Renal Failure' Article Discussion
Given some of the discussion that has occurred below (see 'split'), it would be interesting to create a 'renal failure' article that covers the following issues (that have been suggested as being worthy of consideration below) :

i)Symptoms of the 2 given forms of renal failure.

ii)(Dialysis) treatments

iii)Prognosis.

iv)Etiology (the causes of diseases and pathologies – in this case, the cause of renal failure).

There are, I am sure, several other headlines that it is worth making a note of on the article, but the above would suffice as a first try. An interesting point that I have been thinking about concerns metal poisoning and how this may result in renal failure, though I can imagine that renal failure (of both types) has many varied causes. Does anyone know about any 'flow charts' or 'flow diagrams' that show how it is that symptoms can be used to determine if someone suffers from renal failure (and, possibly, an etiology flow chart that could show how various causes of renal failure actually induce renal failure). This would be much effort, but I can imagine that such information is online somewhere (I will post it here if possible).

Renalsfailure 20:07, 19 December 2006 (UTC)
 * I think most of the things you've listed are already in the sub-articles chronic renal failure (CRF) and acute renal failure (ARF).


 * Speaking broadly, the symptoms, treatment, prognosis and etiology of renal failure can be divided into two: ARF and CRF. Individuals with ARF, frequently, are sick acutely (suddenly), get rehydrated and observed and/or dialysis, and then get better.  The etiology is often pre-renal (cardiac-related, trauma, severe dehydration... anything that drops the blood pressure).  Individuals with CRF generally have a long and protracted course-- they often have a chronic disease/condition of some sort (e.g. diabetes mellitus, systemic lupus erythematous, benign prostatic hypertrophy, congestive heart failure) or congenital conditions (e.g. polycystic kidney disease).  I think that the way the articles are arranged currently is ideal-- it is hard to integrate the differences between CRF and ARF into one article.  That isn't to say I don't think things can be improved.


 * On the question of "by symptoms" -- the American Academy of Family Physicians has a nice set of "Search by Symptom" charts. They aren't specific to kidney disease.  That said, diagnosing the etiology of kidney failure is not a trivial matter and cannot be done by symptoms alone, i.e. symptomatically many kidney diseases have the similar symptoms.  Most often, the diagnosis cannot be made without some sort of lab testing, which can be frustrating for the individual undergoing the tests 'cause they can sometimes take weeks.  In some cases, lab tests are not enough and doctors have to do what is known as a kidney biopsy.  In a kidney biopsy a small part of the kidney is removed from the body so that it can be examined under the microscope and stained with special dyes to make apparent subtle structural changes.  Sometimes (minimal change disease), an electron microscope is need to make the diagnosis.  If you're looking for the search by symptom charts in the hope of diagnosing yourself-- I strong advise against this and suggest you talk with your doctor.
 * Based on your comments... I'll see if can create a few little flow charts. I have a few sample flow charts on my Notes page. Based on your user name-- it sounds like you're interested in kidneys-- we have a little project where people with interest in kidney hang-out.  It is called WikiProject Nephrology. Nephron  T|C 22:20, 19 December 2006 (UTC)

Urine Production Figures
I just spent 20 minutes on google trying to find urine productions figures that match "0.5 mL" for children, but the few numbers I came across weren't specific to children and were approximate to eachother. I don't remember peeing that much more when I was a kid than now, perhaps it was a typo and meant "500 mL" or "0.5 dL", however I do not feel qualified to do anything but bring this to people's attention, hoping someone with some real knowledge (or at least the knowledge of where to find the answer) will chime in. Half a cubic centimeter of urine just seems, well, low. Hope I did this talk page thing right. - Jay Straw (thisiswherejunkgoes@gmail.com) @ 12:22 AM US-EST 9 Sept 2006 Over and out
 * It's a unit problem. I'm fixing it now. - Nunh-huh 04:26, 9 September 2006 (UTC)

Split?
This page deserves to become a disambig with seperate pages dealing with acute renal failure and chronic renal failure. They are so different that they can't possibly be dealt with in one article! JFW | T@lk  10:51, 12 May 2004 (UTC)


 * This page can't be a disambig stub if the two disambiguators are barely a full typed page each. Our current cap for FA's are at around 50k, so this should not be viewed as a particularly extensive article. Try to look at this from the perspective of someone who isn't a major fan of medicine if anything. They are certainly similar enough to keep in the same article. Splitting the article shouldn't be an issue until we start getting over 30k.
 * Peter Isotalo 11:54, 13 July 2005 (UTC)

Peter, perhaps you are under the impression that all forms of renal failure should be lumped on one page because both are due to dysfunctioning of the kidneys. This is completely untrue. The causes are completely different, the symptoms are different, the treatment is different and the underlying mechanism is different. ARF is usually due to low blood pressure or sudden damage, it presents with cessation of urine output, is rarely treated with dialysis and is usually due to acute tubular necrosis. CRF, in contrast, is usually due to progressive damage to the glomeruli, is rarely oliguric, and is the main indication for dialysis.

Please do not make such sweeping changes without discussing them. It's like putting Ford and Mitsubishi on the same page because they both manufacture cars. The size of the respective articles is utterly irrelevant. JFW | T@lk  14:27, 13 July 2005 (UTC)


 * This can be said about virtually anything that one has a major interest in. Both are about kidney failure and as long as the actual information in the individual articles is so close to stub-level, it makes the split completely superfluous, so please expand or merge. The need to have separate article needs to be more self-evident. And that this would be as big a disambig as between Ford and Mitsubishi is as easily dismissed as counting the amount of similar letters. We're a general encyclopedia, not academic literature for med students.
 * And why are you saying I need to discuss it first? You don't have consensus for your move anymore...
 * Peter Isotalo 04:00, 15 July 2005 (UTC)


 * CRF (chronic renal failure) and ARF (acute renal failure) are a different breed of animal and the medical management is very differnt. ARF Pts are almost always unstable-- e.g. hyperkalemic (high risk of cardiac death) or hypotensive (risk of multi-organ failure)... whilst CRF Pts are usually quite stable in this respect.  The dialysis treatments are much different CVVHD & SLED vs. CCPD, CAPD, HHD, IHD... as is the prognosis and etiology.


 * Pts that have CRF, generally aren't interested in ARF and ESRD (end-stage renal disease) Pts don't give a hoot about ARF... 'cause they basically can't get it. I think for that reason alone-- the ARF and CRF should be separate.


 * >We're a general encyclopedia, not academic literature for med students.
 * I think the line btw "general" and "academic" is very fuzzy if you talk to ESRD patients-- they know a lot about their condition. Also, I think wikipedia isn't like a 'general encyclopedia.' There isn't a hard space limit... and no reason there cannot be a detailed article on ARF and a detailed article on CRF. Nephron 07:32, 15 July 2005 (UTC)

Peter, I find your approach offensive. You say We're a general encyclopedia, not academic literature for med students. Will you please go ahead and merge all those esoteric LGBT articles that have proliferated into the thousands? Will you also go and VFD all those academic mathematics pages, because they fall outside of what you consider the scope for a general encyclopedia?

Wikipedia is not academic literature for med students, but it is supposed to reflect the state of the art in medicine. Ask any doctor (e.g. on WikiProject Clinical medicine) - all will inform you that ARF and CRF are completely disparate and that it would be wrong to cast the impression that they are very similar.

Then about the size. Wikipedia is rife with stubs that are easily merged, yet are kept on seperate pages because they are different subjects.

I hope you understand. Please accept that there are some things you don't know much about, and trust people with a bit of expertise to make the relevant distinctions. My approach now has consensus, with Nephron kindly weighing in. JFW | T@lk  11:35, 15 July 2005 (UTC)


 * This page on renal failure should only summarize ARF and CRF which deserve their own pages. I concur with Jfdwolff and Nephron. Alex.tan 11:45, July 15, 2005 (UTC)


 * No, I don't understand why you would need minimal sub-articles (they barely have more info than the disambig) for something that easily fits in one article; but fine. You're obviously not eager to compromise. It's a matter of article length and disambiguation, not making a point about how similar or different the ailments are. Getting all worked up by winding up rants about how I'm insulting to the medical profession is... well... disproportionate and dishonest. Is it really that hard to keep civil and to the point...?
 * Peter Isotalo 10:14, 16 July 2005 (UTC)

OK, here we go again. I did not accuse you of being insulting to the medical profession. You downplayed two important topics as "academic literature for med students". That is insulting to your readers, who may just have learnt they have a GFR 10 ml/min and will need dialysis very soon, and are not served by having to wade through stuff about acute renal failure.

You seem to confuse article length with notability. Just because these two subjects have pages that are admittedly too short, that does not mean they should be artificially lumped together. When it comes to the decision to merge mathematics articles, you ask a mathematician whether these articles are conceptually similar. The same applies over here. You are perpetuating an argument that really has no base at all, and you seem to have difficulty conceding. It is not "a matter of article length and disambiguation", and I think it is your pushiness that is disproportionate. We'll talk about the dishonesty sometime later. JFW | T@lk  08:02, 17 July 2005 (UTC)


 * I think we have differing views of what exactly merits something being encyclopedic. Disagree all you like, but I will be pushy enough to define my own argumentation. Try to concentrate on defining your own. I mean, c'mon; "I find your approach offensive"? That's pretty obvious incivility...
 * Peter Isotalo 15:52, 25 July 2005 (UTC)

I'm allowed to say what I think of your approach. I am not calling you offensive (that would be incivil).
 * You are acting against consensus (Nephron, Alex.tan and myself against you).
 * You have not addressed my point that ARF and CRF are different medical situations that bear little resemblance.
 * There is no indication you have even entertained my points.
 * You reverted without discussion. JFW | T@lk  16:05, 25 July 2005 (UTC)


 * Humbug! Now you're literally lying and trying to get away with a very cheap "I only insulted your actions"-excuse, which is insulting both our intelligences. I haven't entertained your points or addressed the vast differences between the conditions because I don't really feel them to be relevant. It's a practical layout issue to me and that's it.
 * And "reverted without discussion"? "Acting against consensus"? The revert was only after you alone had posted a very brief and very exaggerated post. Try cleaning up your own act if you feel like screaming bloody murder again. As a pointer for next time: try raising your credibility a smidgen by expanding any of the articles beyond near-stubs. At least that would make it seem as if you're making a fuss about something substantial.
 * Good look in your future editing.
 * Peter Isotalo 16:29, 26 July 2005 (UTC)


 * Peter:


 * >It's a practical layout issue to me and that's it.
 * IMHO, layout isn't a good argument to merge. There are lots of stubby articles out there.


 * >And "reverted without discussion"? "Acting against consensus"?
 * I think you may want to carefully re-read what was above.


 * >Try cleaning up your own act if you feel like screaming bloody
 * >murder again.
 * You could expand the article just as well. Read up on it and perhaps you'll understand why JFW, Alex.tan and I have voiced disagreement with your idea.  Nephron 22:02, 26 July 2005 (UTC)


 * Peter, with all due respect, according to the edit history, you reverted to your preferred version of combining the two articles on July 15th before without consensus on this talk page. At that point, Nephron had already chimed in on JFW's side. The bottom line is that your reasoning for why ARF and CRF should be merged (because their individual content is still at stub level) is less important than that they should be separate articles because of the large physiological and pathological differences between them. Entire chapters could be written either condition - just because this has not yet been done does not mean that it will not be oneday. Alex.tan 23:10, July 26, 2005 (UTC)

== This article refers to "African-American" as a "race" which it is not.

Symptoms
what are some symptoms and when do they occur?


 * sensible question and one I should be able to reel off the top of my head. I'll just check the book...  ARF: depends on how severe, how quick and it depends on the cause. sometimes a reduction in urine sometimes an increase, sometimes bloody looking urine sometimes not (not really an encyclopedic answer), electrolyte disturbances especially hyperkalemia and acidosis, signs of uraemia like encephalopathy or spontaneous bleeding and sepsis (and smelling uraemic..),  signs of acute pulmonary oedema (shortness of breath and pink frothy sputum)  CRF: a bit more list-able: malaise, anorexia, insomnia, osteomalacia, noct/polyuria, polyneuropathy, bone pain, salt and water retention (oedema, raised JVP, heart failure), anaemia, sexual dysfunction, mental status changes.  I'm sure they are (or should be) on the ARF and CRF pages Markjohndaley 17:41, 12 June 2007 (UTC)

Creatinine
I'm wondering about the statement:''However, serum creatinine levels are also affected by the patient's existing muscle mass, which varies with age, sex, and race. For instance, younger patients, male patients, and African descended patients typically have higher muscle mass, while certain disease states, such as liver failure, lead to a decrease in muscle mass. Therefore, neglecting to account for high muscle mass may lead to a false suspicion of kidney failure; conversely, neglecting to account for low muscle mass may lead to a missed diagnosis in which the creatinine from kidney failure has actually brought the total creatinine back into the "normal" range.'' I was under the impression that this would be more appropriate a statement about the interpretation of eGFR. Do american doctors use creatinine like eGFR? If not I think that woould be better put in that page. We were taught that creatinine is a guide and can only be compared to itself (unless it is tremendously high) and the best differentiator for acute and chronic renal failure is still history (and U/S), or so says Bill our Nephrologist with the sticky up hair. Markjohndaley 17:41, 12 June 2007 (UTC) I have breifly read some of the articles and comments. I'm not sure if it's the people that are taking the medications or maybe some of their children. Anyway i'm on the medication and i'm now getting off of it slowly, because i've developed a severe rash around my neck. i think that the medication is the cause of it. alone with the fact that i'm highly allergic to alot of things, but medication is not one of them. not that i know of yet. can anyone tell me if there have been any report of this kind of side effect. —Preceding unsigned comment added by 68.191.85.124 (talk) 07:14, 29 March 2009 (UTC)

Flowchart
The flowchart near the top of the page is very helpful in elucidating the many confusing subcategories of renal failure! —Preceding unsigned comment added by 71.101.145.61 (talk) 02:30, 25 September 2007 (UTC)
 * I agree with you! ;) SweetNightmares (talk) 17:58, 21 September 2008 (UTC)

Victims?
Does anyone here know of anybody who died of kidney failure (apart from Wolfgang Amadeus Mozart)? --121.7.203.206 (talk) 08:20, 24 May 2009 (UTC) —Preceding unsigned comment added by 76.67.77.84 (talk) 04:23, 12 October 2009 (UTC)

Attack
I'm very confused why this article might have become a victim of an organised vandalism attack from numerous IPs. JFW &#124; T@lk  03:44, 23 January 2011 (UTC)


 * 4chan's /b/ board sometimes picks a article at random to deface. That's all that happened here. — Gavia immer (talk) 03:53, 23 January 2011 (UTC)

Weight loss vs weight gain and low blood pressure vs high blood pressure
I understand how weight loss can be a symptom of any severe illness especially associated with an organ failure, but isn't increase of weight caused by edemas more common in renal failure than weight loss?

Also in a lot of cases: kidney disease that causes insufficient blood flow in kidneys (even if blood pressure is normal in the whole body) -> kidneys secrete renin -> blood flow in the kidneys barely gets any better because the capillaries are damaged -> even more renin -> high blood pressure

— Preceding unsigned comment added by 78.56.165.74 (talk) 09:43, 28 June 2012 (UTC)

renal failure versus renal insufficiency
The article uses the terms renal failure and renal insufficiency as synonyms, which I do not agree with. Renal insufficiency is due to reduced blood flow to the kidneys resulting in a decrease in urine production, increased plasma volume and resultant increase in blood pressure. Renal failure is what this article discusses. Kidney damage resulting in a decreased ability to concentrate urine. Urine produced due to renal failure is dilute (isotonic) and excreted in vast amounts (polyuria). Recommend references to "renal insufficiency" be removed from this article and a new article regarding renal insufficiency be created at some point.Sumostorm (talk) 18:38, 3 November 2012 (UTC)

Suggestions for Kidney Failure page
Hello, we are a group of medical students editing this page as part of a class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

We propose to insert the following content into the Kidney Failure#treatment section:

1) Prevention of Progression to End-Stage Renal Disease (ESRD)

"A 2014 review of forty studies concluded that people who received early referrals (one to six months before the start of dialysis) to a nephrology specialist displayed reduced mortality, better uptake of dialysis, and reduced hospitalization. The authors highlighted the resulting importance of early referral in preventing progression to ESRD. "

"Other methods of reducing a person’s progression to ESRD include minimizing their exposure to nephrotoxins such as NSAIDS and intravenous contrast.
 * Can you explain what a nephrotoxin is here in lay terms?JenOttawa (talk) 01:38, 9 November 2017 (UTC)

“In non-diabetics and people with type 1 diabetes, a limited protein diet is found to have a preventative effect on progression to ESRD. However, this effect does not apply to people with type 2 diabetes. "
 * Use "people" instead of individualsJenOttawa (talk) 03:57, 15 November 2017 (UTC)

Nsayed2 (talk) 15:17, 15 November 2017 (UTC)Thank you for the feedback. We have made the changes to number 1 and will go live with it shortly.

2) Dialysis

"Dialysis is currently used to extend the lives of hundreds of thousands of patients with ESRD. AKI typically does not require dialysis except when there is pre-existing CKD. Currently, there are no studies which have compared the outcomes of hemodialysis to peritoneal dialysis. However, based on reporting, both forms of dialysis appear to be equally effective. The choice of therapy may be selected based upon considerations of patient preference and quality of life. "
 * Word "currently" see comments belowJenOttawa (talk) 03:57, 15 November 2017 (UTC)

3) Transplantation

"Kidney transplantation is a primary treatment option for advanced chronic kidney failure. The 1-year survival rate for patients who receive a kidney from a living donor (living-donor graft) is 96%, while the 1-year survival rate for patients who receive a kidney from a deceased donor (deceased-donor graft) is 92%. "

4) Treatment for AKI

“The treatment of AKI comprises varying possibilities, depending on individual cases, and includes diuretics, nutritional support, and dialysis. Overall, its primary goal is to hasten recovery and minimize complications and progression of the disease. "
 * Can you simplify your first sentence by saying, "There are many different treatment approaches for AKI, including a,b,c." Please include a citation after every sentence, even if it is from the same source. You may also simplify the second sentence. Many ways to do this, one idea could be to remove "Overall", and just write, "The primary goal of treatment is to...."JenOttawa (talk) 01:34, 9 November 2017 (UTC)

Thank you very much for your time and we appreciate any feedback or suggestions you may have!

WikiTweeks11 (talk) 02:42, 8 November 2017 (UTC)
 * Thanks for asking for feedback - here is some:
 * nothing is "current" or "recent" in Wikipedia, as articles have no datelines. See WP:RELTIME.
 * We don't talk about "patients" but rather "people" or "people with X". Per WP:MEDMOS.
 * per WP:MEDREV, if something comes from a high quality MEDRS source and is not contested by other high quality sources, you don't need to attribute it. You can just say it as fact.  The only reason to attribute in such a situation, is to give a date.  So the first example you give could be simply: "People with impaired kidney function who received early referrals to a nephrology specialist had reduced mortality, better uptake of dialysis, and reduced hospitalization; the earlier the referral the better the outcome." OR "A 2014 review found that people with..."
 * "Other methods of reducing a patient’s progression to ESRD include intravenous contrast " does not make sense.
 * I am stopping here. Please revise per these suggestions and review that the content makes sense and accurately summarizes the sources before reposting. Jytdog (talk) 03:38, 8 November 2017 (UTC)
 * References to books should have page numbers. David notMD (talk) 04:34, 8 November 2017 (UTC)

Nsayed2 (talk) 15:21, 15 November 2017 (UTC) Thank you for the feedback David notMD. We have made changes to the first part of our suggested changes and are going live with it. We will make revisions to the other parts in the coming days.

Chronic kidney disease vs chronic kidney failure
The above two entities are completely different: this article covers the two entities resulting in failure. It should not address chronic kidney disease, which has 5 stages, 4 of which are not kidney failure, but impaired kidney function. Thus my edits changing "disease" to "failure". IiKkEe (talk) 15:51, 26 June 2019 (UTC)

kidney failure, heat stress, and climate change
There is some recent literature on the relationships between kidney failure, heat stress, and climate change, for instance:


 * https://pubmed.ncbi.nlm.nih.gov/31203298/

This is certainly not my area, so I am just flagging the issue for others more qualified to consider. With best wishes, RobbieIanMorrison (talk) 19:59, 18 May 2021 (UTC)

Kid named finger
It sounds like kid named finger Fanumstein 09 (talk) 19:56, 10 November 2023 (UTC)

Merge of renal failure index
I am merging the renal failure index article here without discussion as it seems uncontroversial to me. Darcyisverycute (talk) 04:50, 4 December 2023 (UTC)