Chronic Kidney Disease

1 What is Chronic Kidney Disease?

Chronic kidney disease, also called chronic kidney failure, is a condition in which there is gradual impairment of your kidney function.

Kidneys are a pair of excretory organs that eliminate wastes and excess fluids from your blood via urine.

You may not notice signs and symptoms till it reaches an advanced stage, which can cause accumulation of fluid, electrolytes and wastes in your body.

Identifying and treating the underlying cause can slow down kidney damage.

If left untreated, chronic kidney disease can progress to end-stage kidney failure which requires artificial filtering (dialysis) or a kidney transplant.

2 Symptoms

The signs and symptoms chronic kidney disease include:

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3 Causes

Some common causes chronic kidney disease are:

Various disease and conditions can initiate damages to kidney that progress over months or years.

4 Making a Diagnosis

Chronic kidney disease is diagnosed by performing several tests.

If you have signs and symptoms that concern you, visit your primary care doctor who can order lab tests to detect any kidney impairment. If lab results are positive, s/he may refer you a specialist in kidney problems (nephrologist).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms. Write down your key medical information.

Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

  • What's the extent of my kidney damage?
  • Is my condition worsening?
  • What tests do I need?
  • What's the most probable cause of my condition?
  • Can treatments reverse my condition?
  • What are the treatments available and their side effects?
  • What are the potential side effects of each treatment?
  • Do I need to follow any dietary guidelines?
  • Will you refer me to a dietitian?
  • Should I see a specialist?

The tests and procedures for chronic kidney disease include:

Blood tests

Blood tests determine kidney function by measuring the level of creatinine and urea, in your blood.

Urine tests

Your urine can be evaluated for abnormalities indicative of chronic kidney failure.

Imaging tests

Ultrasound imaging can be used to determine your kidneys' structure and size.

Biopsy

Under local anesthesia, sample of kidney tissue is removed by inserting a long, thin needle into your kidney and the sample is sent to lab for further analysis.

5 Treatment

Treatment for chronic kidney disease involves identifying and treating the underlying causes. However, many cases of chronic kidney disease have no cure.

Usually, treatment focuses on controlling signs and symptoms, reducing complications, and delaying disease progression.

If your kidney damage has reached an advanced stage, you are likely to receive treatment for end-stage kidney disease.

Treating the cause

Treatments can control the underlying causes responsible for kidney damage. Remember that your kidney damage can still be worsening even if underlying cause such as high blood pressure, has been controlled.

Treating complications

Kidney disease can cause a wide range of complications. Treatments can lower or control these complications.

Such treatments are:

High blood pressure medications

Kidney disease can raise your blood pressure or worsen it if you already have high blood pressure. Pressure lowering medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers may be prescribed to keep blood pressure in check while preserving kidney function. Your kidney function is lowered initially while starting these medications, therefore frequent blood tests may be required to continuously monitor your condition. You may also need to limit your salt intake or take water pill (diuretic).

Cholesterol lowering medications

You may need to take “statins” to lower your cholesterol.

Treatment for anemia

Anemia associated fatigue and weakness can be controlled by taking the hormone erythropoietin, which promotes formation of RBC (red blood cells).

Treatments for swelling

Functional impairment of your kidneys can cause accumulation of fluids that results in swelling in the legs, as well as high blood pressure. Water pills (diuretics) can relieve such signs.

Medications to prevent bone weakening

Calcium and vitamin D supplements can prevent bone weakening and reduce your risk of fracture.

Medications to lower blood level of phosphate

These medications help to prevent calcium deposition (calcification) in your blood vessels.

A low protein diet

Protein digestion forms waste products in your blood that are removed out of the body by your kidneys. Lowering your protein intake helps to minimize the amount of such waste products thus reducing the workload on your kidneys. You may consult a dietitian to plan a low-protein healthy meal.

Treatment for end-stage kidney disease

End-stage kidney disease occurs when the damage to your kidneys is so severe that they can no more eliminate waste products from the body.

This represents almost complete kidney failure which requires:

Dialysis

It’s like artificially filtering the waste products from your body. Hemodialysis is a dialysis method that uses a machine to filter waste and excess fluids from your blood.

Peritoneal dialysis uses a thin tube (catheter) that pours dialysis solution into the abdominal cavity. The solution absorbs waste and excess fluids, which is then drained out after some time.

Kidney transplant

The damaged kidney is replaced by one from a donor, deceased or living. Following a transplant, medications are given to prevent rejection of the new kidney.

You will have to take these immune suppressing drugs for rest of your life. If you don’t opt for dialysis or a kidney transplant, you may consider another option that includes conservative measures to treat your kidney failure.

Complete kidney failure takes only a few weeks to take your life.

6 Prevention

Here are some suggestion to help prevent your risk of chronic kidney disease:

  • If you drink, drink in moderation. Ask your doctor about what’s the safe level of drinking for you.
  • Take over-the-counter medications only as directed. Exercise special care when taking nonprescription pain relievers, such as aspirin, ibuprofen and acetaminophen.
  • Maintain a healthy weight. Lose weight if necessary. Follow a healthy diet and exercise regimen to maintain your weight.
  • Don't smoke.
  • Control the risk factors. If you have diseases or conditions that put you at risk of kidney disease, keep them in check with consultation from your doctor.
  • Talk your doctor if continuous monitoring is required.

7 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with chronic kidney disease.

A diet customized to your condition can be planned by your dietitian.

Your dietitian may recommend you to:

  • Avoid products with added salt.
  • Choose lower potassium foods such as apples, cabbage, carrots, green beans, grapes and blueberries.
  • Limit your protein intake.

Following tips can help you cope with the stress of having a diagnosis of chronic kidney disease:

  • Join a support group in your community or online. Or contact organizations such as the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund for groups in your area.
  • Maintain your normal routine, when possible. Try to maintain a normal routine, doing the activities you enjoy and continuing to work, if your condition allows. This may help you cope with feelings of sadness or loss that you may experience after your diagnosis.

Stay active

Involve yourself in any form of exercise at least 30 minutes most days of the week. It can reduce stress and increase strength.

Keep talking

Share your feelings with someone you trust, a friend or a family member.

8 Risk and Complications

Factors that may increase your risk of chronic kidney disease include:

Complications

  • Inability to remove excess fluid can result in swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
  • Higher than normal blood level of potassium (hyperkalemia) could be life-threatening
  • Heart and blood vessel disease (cardiovascular disease)
  • Bone weakening and an increased risk of bone fractures
  • Anemia
  • Decreased libido or impotence
  • Central nervous system damages can result in concentration problems, personality changes or seizures
  • Weakened immune system and hence increased risk of getting infected
  • Pericarditis, an inflammation of lining of the heart (pericardium)
  • Pregnancy complications
  • Permanent kidney damage (end-stage kidney disease) which needs dialysis or a kidney transplant for survival
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