Kidney Failure

Organ failure, including kidney failure, is a hallmark of sepsis. As the body is overwhelmed, its organs begin to shut down, causing even more problems. The kidneys are often among the first to be affected.

According to the National Kidney Foundation, one of the major causes of acute kidney injury (also called AKI) is sepsis. Some studies have found that between 32% and 48% of acute kidney injury cases were caused by sepsis.

What kidneys do

Most people are born with two kidneys. It is possible to live with one kidney, and many people do. Located in the lower back, these bean-shaped organs are each about the size of your fist.

The kidneys’ main role is to filter the blood for waste products from what you eat and drink. The body keeps the nutrients, and the urine carries out the waste. After the kidney makes the urine, it flows down to the bladder to wait until you empty it by urinating.

Renal function is another term for kidney function.

How sepsis affects the kidneys

There are two ways sepsis can affect the kidneys. The first is if the infection that caused the sepsis begins in the kidney through a kidney infection or a bladder infection that has spread to the kidney. The second is if the cascade of events from sepsis causes kidney damage.

In sepsis and septic shock, your blood pressure drops dangerously low, affecting how the blood flows through your body. Because the blood can’t flow as quickly as it should, it can’t deliver the nutrients needed by the body’s tissues and organs. At the same time, the blood begins to clot within the blood vessels (called disseminated intravascular coagulation, or DIC), slowing down blood flow even more. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Low blood pressure and DIC both contribute to the kidneys’ failure.

Acute kidney failure symptoms

The fluid and toxin buildup in the body cause the signs that your kidneys are not working effectively. The most obvious sign is decreased urine output, although this isn’t always the case. Some people continue to produce urine, but lab tests will show that the urine is not normal.

Someone with acute kidney injury usually also looks swollen as the fluid accumulates in the body’s tissues. This swelling is called edema and can come on very quickly.

Other symptoms of acute kidney failure can include:

  • Shortness of breath
  • Confusion
  • Fatigue
  • Nausea
  • Seizures
  • Coma

Urine and blood tests tell doctors how well your kidneys are functioning, so many samples are taken during diagnosis and treatment. For example, the doctors test for creatinine, which is created when muscle begins to break down. A BUN test (blood urea nitrogen) tells you if a substance called urea is building up in the blood. This is an indicator that the kidneys are not filtering waste properly.

Treatment for acute kidney failure caused by sepsis

When someone has sepsis or is in septic shock, the doctors work to treat the sepsis, the infection that caused the sepsis, and the damage that the sepsis has done, such as the kidney failure.

If the kidneys are not working efficiently enough to filter toxins and allow urine to flow, an artificial way of filtering the kidneys, dialysis, can take over. Dialysis is not a cure though. Instead, it gives the doctors a way to clean the blood while trying to control everything else.

There are two types of dialysis, hemodialysis, and peritoneal dialysis. Peritoneal dialysis is generally used to manage chronic kidney failure. But it can be used for acute kidney failure where hemodialysis isn’t possible in areas with limited resources. For example, peritoneal dialysis has been used in Africa for patients who have malaria-associated acute kidney injury.

With hemodialysis, a machine called a hemodialyzer is the artificial kidney. A catheter (tube) placed into the patient’s vein leads to the other end of the catheter in the hemodialyzer. When the process starts, blood flows a few ounces at a time from the patient’s body to the machine. The machine filters it and sends the blood back through the catheter to the body.

People who receive dialysis are at risk of infection at the catheter site since the catheter is an invasive device. Therefore, it’s essential that they monitor the site for any signs of infection, like redness, swelling, skin warmer to touch, and fever.

Treatment time varies

How often and how long each procedure takes depends on how much kidney function still exists, patient size, and how much toxins have accumulated in the blood since the previous treatment. Dialysis can be intermittent (for three or four hours every or every other day) or continuous but at a slower rate.

In acute kidney failure, dialysis is usually a temporary measure as the doctors work to fix the problem that caused the kidney failure. If the kidneys begin to work properly again, even if not at 100 percent, dialysis can usually stop.

Some people need to continue receiving dialysis treatments if the kidney damage is too severe and permanent. Since dialysis is not a cure, they may be candidates for a kidney transplant if they qualify.

Post-sepsis kidney function

Some sepsis survivors continue to have problems with their kidneys, despite recovering from the sepsis itself. Doctors monitor their patients’ kidney function through regular check-ups and blood tests if there is lasting kidney damage.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.” 

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance. Sepsis and Kidney Failure. 2023.

Updated February 7, 2023.

Read Personal Stories of Sepsis and Kidney Failure

Darren Greentree


I boarded a flight from Brisbane to Sydney. Within one hour I experienced severe pain, like a muscle spasm in my up left leg and lower back. 2 hours later, I arrived in Sydney, I could hardly walk, Called an ambulance that night at 3.30am, and they transported me to emergency. The pain was excruciating. That night I also experienced vomiting and diarrhoea. The emergency dept thought I had muscle spasm issues. They gave me pain killers and let me go. One day later back in Brisbane I went to my local doctor, once again misdiagnosed and sent me home. ... Read Full Story

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James L.

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Hi. My husband, James (Jay for short) had spent years on an immunosuppressant medication for rheumatoid arthritis. We knew there was risk of infection, but he had always been fine. (Sepsis and Impaired Immune System) One morning in July 2019, he awoke extremely sick. It seemed like food poisoning so I sent him back to bed. But because of Covid I was taking his temperature just in case. Well his temperature spiked and he was in and out of consciousness. I rushed him to the hospital where he was admitted in septic shock. He was in kidney failure and having ... Read Full Story

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Adam A.

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My son, age 7, had sickness daily no temp just sickness. I was turned away three times from doctor’s saying it’s maybe norovirus. He continued to be sick, didn’t eat for ten days, no tests were done nothing. Day 8 took him hospital, no drip, no tests just sent home. Still sick I took him back next day he was admitted because the sickness wasn’t stopping. All his vitals were fine then. Day three after admission he went down hill so quickly. His breathing was rapid, his oxygen low, his coughing was so bad all a sudden. They moved him ... Read Full Story

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Melissa Adams

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I was two years old in 1971, the first time that I sepsis so I don’t remember it at all but I still have a huge scar on my left hip from my surgery. It was arthritic sepsis in my left hip from a strep infection and it left lifelong debilitating effects on me. (Sepsis and Bacterial Infections) The doctors told my parents I would probably have a normal early childhood but to expect physical problems later in my childhood. They were right. By the age of ten my left leg was 3/4″ shorter than my right leg and I ... Read Full Story

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Brittany G.

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It was Easter Sunday April 2023 that I went into septic shock. (Sepsis and Septic Shock) Early in the day I started vomiting, having chills, dizziness. It just didn’t stop along with other symptoms. Each hour got worse, I couldn’t eat or drink anything. Then I couldn’t stand up, it felt like my head was a slab of heavy concrete holding me down. My body was weak and yet my heart was racing at an alarming rate. As an overall healthy 32 year old/ avid runner and gym-goer, this wasn’t normal to me. It felt like my system was shutting ... Read Full Story

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Kidney Failure

Organ failure, including kidney failure, is a hallmark of sepsis. As the body is overwhelmed, its organs begin to shut down, causing even more problems. The kidneys are often among the first to be affected.