What Causes Kidney Failure?

Kidney failure, also called end-stage renal disease (ESRD), is a condition where your kidneys are functioning at 15% of their normal levels. Kidneys help filter out waste products and excessive fluids from your body. Kidney failure may occur due to a sudden injury or long-term chronic kidney disease. About 808,000 people in the United States are living with kidney failure.

Diabetes and high blood pressure (hypertension) are the two most common causes of kidney failure. However, the condition can develop due to other diseases. There are also several lifestyle factors that can increase your risk of kidney failure.

Diabetes

Diabetes is the leading cause of kidney failure, responsible for 47% of kidney failure cases in the U.S. Diabetes—a chronic condition that leads to high blood sugar—can damage the blood vessels in your kidneys. The damage can make it so that the kidneys are unable to filter wastes and excess fluid from the blood normally.

Most often, the initial sign of kidney disease due to diabetes is the presence of the protein albumin in your urine. Under normal circumstances, albumin does not pass from your blood into the urine. However, improper filtering of blood causes albumin to pass into your urine.

High Blood Pressure

Hypertension is the second most common cause of kidney failure, leading to about 27% of kidney failure cases in the U.S.

High blood pressure can cause the narrowing and weakening of blood vessels throughout your body, including in the kidneys. The damaged blood vessels cannot properly filter waste and excess fluid from the blood. Excess fluid can, in turn, cause a further increase in blood pressure, leading to a continuing cycle.

Polycystic Kidney Disease

Polycystic kidney disease is a genetic condition where multiple fluid-filled cysts (pouches of tissue) grow in your kidneys. It affects about 500,000 people in the U.S. Polycystic kidney disease can change the shape of your kidneys, making them larger than normal. The change can reduce kidney function and eventually lead to kidney failure.

Glomerulonephritis

Glomerulonephritis is a disease affecting the glomeruli, which are small blood vessels that act as the filtering units of the kidneys. Damaged glomeruli are unable to filter waste and fluids from the blood, which can eventually lead to kidney problems and failure.

Glomerulonephritis leads to about 10-15% of kidney failure cases in the U.S.

Kidney Infections

Bacteria or viruses can enter your kidneys—mostly through the urinary tract—and lead to kidney infections. Kidney infections can also occur when the flow of urine is blocked through the urinary tract due to the presence of kidney stones or an enlarged prostate. If left untreated, kidney infections can cause permanent damage to the kidneys and progress to kidney failure.

Is Kidney Failure Hereditary?

You may be at a higher risk for kidney failure if you have a biological parent or sibling with the condition. Variations in certain genes, especially myosin heavy chain 9 (MYH9) and apolipoprotein L1 (APOL1), can increase the risk of kidney failure among communities of color and communities that have fewer resources.

Research has identified several other genes that may be associated with kidney disease and failure. A few of them include:

• Glutathione peroxidase 1 (GPX1)
• Glutathione S-transferase omega 1, 2 (GSTO1, GSTO2) 
• Uromodulin (UMOD)
• Matrix Gla protein (MGP)
• Methenyltetrahydrofolate synthetase (MTHFS)
• Transcription factor 7-like 2 (TCF7L2)

Not all people with these genetic variations will develop kidney failure, and people without these variations can also develop kidney disease and kidney failure.

Who Develops Kidney Failure?

Anyone can develop kidney failure. In fact, kidney disease is becoming the fastest-growing noncommunicable disease (a disease that isn't passed from one person to another) in the U.S.

Certain people may be more likely to have kidney failure, including:

• Those who are 65 years or older
• People who are Black American, Hispanic, Afro-Caribbean, or Asian
• People assigned male at birth 

Risk Factors

Common risk factors that can increase your chances of kidney failure include:

• Smoking
• Drinking excessive amounts of alcohol
• Being overweight or having obesity
• Eating a diet high in protein and salts like sodium and phosphorus
• Not getting enough sleep
• Taking pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs) on a regular basis
• Leading an inactive lifestyle 

A Quick Review

Kidney failure is a condition where your kidneys are functioing at less than 15% of their normal level. Because your kidneys are not functioning properly, waste and fluids can build up in your body and lead to complications.

Diabetes is the most common cause of kidney failure. Hypertension is the second most common cause. Together, diabetes and high blood pressure cause or contribute to two out of every three cases of kidney failure.

Other conditions that can cause kidney failure include polycystic kidney disease, glomerulonephritis, and kidney infections. Additionally, certain genetic, environmental, and lifestyle factors can increase the risk of kidney failure.