The kidneys work continuously to remove waste products, regulate fluid levels, balance electrolytes and support several important functions in the body. When both kidneys become severely impaired, the body's ability to perform these functions can be significantly reduced.

People often search for “both kidney failure” when they have been told that both kidneys are damaged, kidney function is very low, or a scan shows abnormalities in both kidneys.

However, having abnormalities in both kidneys does not always mean that the kidneys have completely stopped working. Kidney function can range from mildly reduced to severely impaired.

The appropriate treatment depends on the cause, severity and whether the condition is acute or chronic.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides evaluation and management for complex kidney conditions and advanced kidney disease.

What Happens When Both Kidneys Fail?

Healthy kidneys perform several essential functions, including:

• Removing waste products from the blood

• Controlling fluid balance

• Regulating electrolytes

• Helping maintain acid-base balance

• Supporting blood pressure regulation

• Producing hormones involved in red blood cell production

• Supporting bone and mineral health

When both kidneys lose substantial function, waste products and excess fluid can accumulate.

This may lead to complications involving:

• Fluid balance

• Potassium levels

• Blood pressure

• Red blood cells

• Acid-base balance

• Bone and mineral metabolism

Severe kidney failure may eventually require kidney replacement therapy, such as dialysis or transplantation.

Causes of Failure of Both Kidneys

There are many possible causes of severe kidney dysfunction.

Diabetes

Long-term diabetes can damage the kidney's filtering units and gradually reduce kidney function.

High Blood Pressure

Uncontrolled hypertension can damage kidney blood vessels and contribute to progressive kidney disease.

Glomerular Diseases

Diseases affecting the kidney's filtering units can cause proteinuria, blood in the urine and declining kidney function.

Some may be related to autoimmune conditions.

Severe Acute Kidney Injury

Both kidneys can become severely impaired over a short period because of:

• Severe infection

• Shock

• Major blood loss

• Severe dehydration

• Certain medicines or toxins

• Major surgery

• Other serious illnesses

Some cases of acute kidney injury can improve substantially after the underlying problem is treated.

Urinary Obstruction

Blockage of urine flow can damage kidney function. Causes may include:

• Kidney stones

• Enlarged prostate

• Urinary tract abnormalities

• Tumors

• Scar tissue

When obstruction affects both kidneys or a person has only one functioning kidney, prompt treatment can be particularly important.

Inherited Kidney Disorders

Conditions such as polycystic kidney disease can progressively affect both kidneys.

Recurrent Kidney Infections

Repeated or severe kidney infections can cause kidney damage in certain patients, particularly when associated with structural urinary abnormalities or obstruction.

Symptoms of Both Kidney Failure

Early kidney disease may cause few or no symptoms.

As kidney function becomes severely impaired, possible symptoms include:

• Swelling of the feet, ankles or face

• Reduced urine output

• Fatigue

• Nausea

• Vomiting

• Poor appetite

• Itching

• Muscle cramps

• Changes in urination

• Difficulty concentrating

• Breathlessness

• Changes in blood pressure

These symptoms can occur with many medical conditions, so testing is necessary to determine whether kidney failure is responsible.

Does Kidney Failure Cause Pain?

Kidney failure itself does not necessarily cause severe pain.

Some underlying conditions causing kidney damage can cause pain, such as:

• Kidney stones

• Kidney infection

• Urinary obstruction

• Certain inflammatory conditions

Chronic kidney disease can progress significantly without noticeable kidney pain.

How Is Both Kidney Failure Diagnosed?

Doctors evaluate kidney function using blood tests, urine testing and imaging when appropriate.

Blood Tests

Common assessments include:

• Serum creatinine

• eGFR

• Blood urea

• Potassium

• Sodium

• Bicarbonate

• Hemoglobin

These tests help determine the severity of kidney dysfunction and identify complications.

Urine Tests

Urine testing can detect:

• Protein or albumin

• Blood

• Signs of infection

• Other abnormalities

Imaging

Ultrasound or other imaging may help assess:

• Kidney size

• Kidney structure

• Stones

• Hydronephrosis

• Urinary obstruction

The appropriate investigations depend on the suspected cause.

Can Both Kidneys Fail Suddenly?

Yes.

Acute kidney injury can cause a sudden and substantial reduction in kidney function.

Potential triggers include severe infection, dehydration, low blood pressure, certain medicines, toxins and urinary obstruction.

Importantly, acute kidney injury is not necessarily permanent. Some patients recover partially or substantially after the underlying cause is treated.

Can Both Kidneys Recover?

Recovery depends largely on the cause and severity of kidney injury.

When the problem is acute and reversible, kidney function may improve significantly.

For chronic kidney disease, treatment usually focuses on:

• Slowing further progression

• Treating the underlying disease

• Managing complications

• Protecting remaining kidney function

Some patients with advanced chronic kidney disease eventually require dialysis or transplantation.

Treatment for Both Kidney Failure

There is no single treatment that works for every patient.

Treatment may involve several approaches.

Treating the Underlying Cause

Examples include:

• Managing diabetes

• Controlling high blood pressure

• Treating kidney inflammation

• Treating infections

• Removing urinary obstruction

• Managing medication-related kidney injury

Managing Fluid Overload

When the kidneys cannot remove sufficient fluid, swelling and breathlessness may develop.

Depending on kidney function and the clinical situation, doctors may use medicines and dietary measures to manage excess fluid.

Managing High Potassium

Severe kidney dysfunction can cause potassium to accumulate in the blood.

Significantly elevated potassium can be dangerous and requires appropriate medical treatment.

Managing Anemia

Advanced chronic kidney disease can cause anemia.

Depending on the underlying cause, treatment may include iron therapy or other specific treatments.

Managing Mineral and Bone Abnormalities

Advanced kidney disease can affect phosphorus, calcium and parathyroid hormone levels.

These abnormalities may require dietary management and prescribed medicines.

When Is Dialysis Needed?

Not everyone with reduced function in both kidneys immediately needs dialysis.

Dialysis may be required when kidney function is insufficient to safely control serious complications.

Possible indications include:

• Severe fluid overload

• Significant high potassium

• Severe metabolic acidosis

• Symptoms caused by accumulation of waste products

• Certain toxin exposures

• Other serious complications that cannot be adequately managed medically

In acute kidney injury, dialysis may sometimes be temporary if kidney function recovers.

Dialysis Options for Advanced Kidney Failure

When long-term kidney replacement therapy is necessary, the major options include:

Hemodialysis

Blood is filtered through a dialysis machine to remove waste and excess fluid.

It may be performed at a dialysis center or, in selected circumstances, at home.

Peritoneal Dialysis

The lining of the abdomen, called the peritoneum, is used as a natural filtering membrane with the help of dialysis fluid.

Kidney Transplantation

A kidney transplant can provide functioning kidney tissue from a suitable donor.

Transplantation requires detailed medical evaluation and lifelong follow-up.

Can a Person Live With Both Kidneys Failing?

Yes, but severe kidney failure requires appropriate medical management.

People with advanced kidney failure may live with dialysis or, when medically suitable, after kidney transplantation.

Some patients may also choose a conservative kidney care approach when dialysis is not appropriate or does not align with their goals. This decision should be made with a qualified medical team.

Is Kidney Transplant Possible When Both Kidneys Fail?

Yes.

For eligible patients with irreversible advanced kidney failure, transplantation may be an important treatment option.

A transplant evaluation considers:

• Overall health

• Heart and blood vessel health

• Infection status

• Other medical conditions

• Suitability for surgery

• Donor availability

• Ability to take lifelong anti-rejection medicines

A transplant does not eliminate the need for long-term specialist follow-up.

Can Lifestyle Changes Repair Failed Kidneys?

Lifestyle changes cannot replace severely damaged kidney tissue.

However, appropriate lifestyle measures can support overall health and may help protect remaining kidney function.

Depending on the individual's condition, these may include:

• Reducing excessive salt intake

• Maintaining appropriate physical activity

• Managing blood pressure

• Controlling blood sugar

• Avoiding tobacco

• Taking medicines as prescribed

• Following an individualized kidney-friendly diet

Fluid and dietary requirements should be customized according to kidney function and treatment.

When Is Both Kidney Failure an Emergency?

Seek immediate medical attention for:

• Very little or no urine

• Severe breathlessness

• Chest discomfort

• Confusion

• Severe weakness

• Repeated vomiting

• Rapidly increasing swelling

• Severe electrolyte abnormalities

• Sudden deterioration in kidney function

These may indicate potentially life-threatening complications.

Kidney Failure Care at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke provides specialized assessment and management for patients with reduced kidney function and advanced kidney disease.

Evaluation may include:

• Identifying the cause of kidney dysfunction

• Kidney function testing

• Urine protein assessment

• Blood pressure monitoring

• Electrolyte evaluation

• Imaging review

• Management of kidney disease complications

• Dialysis assessment

• Kidney transplant evaluation and coordination when appropriate

• Long-term kidney disease monitoring

Treatment is individualized based on the patient's kidney function, underlying disease and overall medical condition.

Frequently Asked Questions

What happens if both kidneys stop working?

When both kidneys lose nearly all effective function, waste, excess fluid and electrolytes can accumulate. Dialysis or kidney transplantation may be needed to perform essential kidney functions.

Can both kidneys fail at the same time?

Yes. Severe acute kidney injury, toxins, shock, infection or urinary obstruction can affect kidney function rapidly. Chronic diseases can also progressively damage both kidneys.

Is kidney failure in both kidneys reversible?

Acute kidney injury can sometimes recover significantly. Advanced chronic kidney failure is generally not reversible, although treatment can manage complications and protect remaining function.

Do both kidneys need to be removed if they fail?

No. Kidney failure does not usually mean that both kidneys must be surgically removed. Dialysis or transplantation may provide kidney replacement when necessary.

Can someone live without functioning kidneys?

A person with little or no effective kidney function can survive with appropriate kidney replacement therapy, such as dialysis or a functioning kidney transplant.

Conclusion

Both kidney failure is a serious condition, but the outlook depends greatly on whether the kidney damage is acute or chronic, the underlying cause and the amount of remaining kidney function.

Some acute kidney injuries can improve with timely treatment. When kidney failure becomes irreversible and severe, dialysis or kidney transplantation may be considered.

Early specialist evaluation is important because identifying a treatable cause and managing complications can make a significant difference in kidney health.

For individualized evaluation and advanced kidney care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is provided for general educational purposes only and does not constitute medical advice, diagnosis or treatment. “Both kidney failure” can describe different medical situations, ranging from acute and potentially reversible kidney injury to advanced chronic kidney disease. Treatment must be based on individual blood tests, urine tests, imaging, symptoms and overall health. Do not stop medicines, alter dialysis schedules or use herbal or alternative treatments without medical supervision. Seek urgent medical attention for very low or absent urine, severe breathlessness, chest discomfort, confusion, repeated vomiting or sudden worsening of health. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized care.