Can kidney failure be reversed?

Certain types of kidney failure can be reversed. The treatment of reversible kidney failure usually needs hospitalization. Not all kidney failures are reversible, but reversible kidney failure is more common than you think. I have personally treated and reversed kidney failure many times in the last 15 years. Most patients I treated that were hospitalized for kidney failure didn’t know their kidney failures could be reversed. I am writing this article to help other patients and families that are going through a similar situation understand reversible kidney failure.

In this article, I will review different types of reversible kidney failures based on my personal experience as well as a review of relevant research articles.

Here are 8 different types of kidney failures that can be reversed:

  1. Kidney failure from bleeding
  2. Kidney failure from severe dehydration
  3. Kidney failure from heat exhaustion
  4. Kidney failure caused by certain medications
  5. Kidney failure from sepsis
  6. Kidney failure due to an enlarged prostate
  7. Kidney failure due to kidney stones blocking both kidneys
  8. Kidney failure due to a bladder tumor
A diagram showing how certain factors lead to the kidneys shutting down and how it can be reversed if treated quickly.
A diagram showing possible causes of the kidneys shutting down

When can kidney failure be reversed?

Before we go into specific types of kidney failures, it is important to understand the basic concept of when kidney failure can be reversed and how to recognize those situations.

These are the common features of all reversible kidney failures:

  1. Timeline: In most situations, reversible kidney failure presents itself as acute kidney failure. In medical terms, acute means a fast start. Kidney failure that can be reversed develops within a short period of time. Most reversible kidney failures happen over a few days. Some may happen over a few weeks. Days and weeks are still considered short periods of time when we are discussing the timeline of kidney failures. Kidney failures that develop over a year or more are very unlikely to be reversed with treatment.
  2. Serious illness: Most, if not all, kidney failures that can be reversed are associated with a serious illness. You are likely to be hospitalized with a serious illness when diagnosed with a possibly reversible kidney failure.
  3. Low potassium levels: The potassium level in your blood is a very important number when evaluating any kidney failure. In the right context, a low potassium level means that the kidney failure is more likely to be reversible.
  4. Urine output: In most cases of reversible kidney failures, the amount of urine you make is drastically reduced. The change in urine output is noticeable to patients and families.
  5. Pattern of kidney function blood tests: When evaluating kidney function, doctors rely on two specific compounds in the blood: Blood Urea Nitrogen (BUN) and Creatinine (Cr). When the ratio of these two compounds is more than 20:1, the kidney failure is more likely to be reversed with treatment.
  6. Kidney ultrasound: A kidney ultrasound is almost always done in hospitalized patients with kidney failure. When the size and texture of the kidneys are normal under the ultrasound, the kidney failure can most likely be reversed.

Kidney failure from bleeding

Significant bleeding within a small period of time almost always results in some degree of kidney failure. Examples of significant bleeding that can cause reversible kidney failure are: excessive bleeding during surgery, bleeding from trauma, internal bleeding inside the stomach or intestines, an unstoppable nose bleed, heavy bleeding after childbirth, etc. The degree of kidney failure is proportional to the amount of blood loss. These types of bleeding almost always make you end up in the hospital. The good news is that most kidney failures from bleeding can be reversed with treatment. All we need to do to reverse the kidney failure in this situation is stop the bleeding and transfuse blood as required. Once the blood volume is properly restored, kidneys start to function normally.

Kidney failure from severe dehydration

Severe dehydration is one of the most common causes of reversible kidney failure. Dehydration can be a serious life-threatening disorder. Read “Hospitalized for Dehydration” if you would like to understand what to expect when hospitalized for dehydration. Kidney failure is one of the most common complications of dehydration.

During the early stages of every dehydration, your kidneys essentially shut themselves down to preserve water. Once the dehydration is corrected, the kidneys start to open up and quickly get your urine production back to normal. The blood tests I mentioned earlier help decide whether the kidney failure is still in the early rapidly reversible state. If the ratio of BUN to Cr is equal to or more than 20, your kidney failure from dehydration is likely in the early rapidly reversible stage.

When the treatment of dehydration is delayed for several days, your kidneys go into the second stage of kidney failure. Small tubes inside the kidneys start to die off and you have structural damage inside the kidneys. This type of kidney failure is medically called Acute Tubular Necrosis or ATN. Necrosis simply means dying off. ATN is still reversible in most cases, but it takes longer to recover from. The tubes that die off will have to regenerate so that the kidney failure can ultimately be reversed. It may take a few weeks to reverse the kidney failure when ATN is present.

Kidney failure from heat exhaustion

When you are exposed to extreme heat for prolonged periods of time, your body goes into heat exhaustion. If you are involved in physical activity or exercise in places with a high temperature, you may go into heat exhaustion even earlier. Kidney failure from heat exhaustion is essentially caused by severe dehydration associated with heat exhaustion. Kidney failure from heat exhaustion can be reversed by active cooling and treatment with IV fluids.

Kidney failure caused by certain medications

Medications are a common cause of kidney failures. There are numerous medications that can cause kidney failure and not all of them are reversible. However, many of them can be reversed. A commonly-used class of medications called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are an example of such medications. NSAIDs are very common medications. Some of them are available over-the-counter. They are used to decrease fevers and pain. They usually cause kidney failure in high doses, but some people are more susceptible than others. In the early phase, they reduce blood supply to the kidneys and cause a quickly reversible type of kidney failure similar to that caused by bleeding. With continued use, the kidney failure may proceed to ATN, but it is still reversible if identified in time. If you have kidney failure from NSAIDs, you need to stop using them immediately to reverse your kidney failure.

Kidney failure from sepsis

Kidney failure is very common in sepsis, but it can be reversed most of the time with the proper treatment of sepsis. If you would like to understand what sepsis is, please read this article: “Low blood pressure and a fever, think sepsis.” In summary, sepsis is a potentially life-threatening complication from an infection where the body can get overwhelmed and crash down.

Patients with severe sepsis and kidney failure may need intensive care in the ICU. The treatment is focused on treating the infection and supporting the body to maintain good blood circulation. If a good blood circulation with normal blood pressure is restored, the kidneys start to recover, and the kidney failure can be ultimately reversed back to normal.

Kidney failure due to the blockage of urine

I am combining the last 3 causes of reversible kidney failures into one because they all cause kidney failure by blocking the flow of urine. An enlarged prostate or kidney stones on both sides of a bladder tumor can stop the flow of urine. When the urine stops flowing, it builds up and makes it harder for the kidneys to filter any new blood. Ultimately, the kidneys stop working and you have kidney failure. As long as you restore the flow of urine before there is any permanent kidney damage, you can reverse these types of kidney failure.

In conclusion, it is important to get an urgent medical evaluation when you are diagnosed with kidney failure; there are several types of kidney failures that can be reversed if treated in time. If you are hospitalized with bleeding, sepsis, heat exhaustion, or urine obstruction, you can expect your kidney failure to be reversed most of the time.