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.

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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.