Chronic kidney disease: Everything you need to know

Chronic kidney disease is a gradual and progressive loss of function in the kidney over a many year span. One individual ultimately develops permanent kidney failure.

Chronic kidney disease, also known as chronic renal failure, chronic renal disease, or chronic kidney failure, is much more common than people realize; it frequently goes undetected and undiagnosed until the condition is well advanced.

It is not uncommon for people to know that they only have chronic kidney disease when their activity in the kidney is down to 25 percent normal.

As kidney failure progresses and the function of the organ becomes seriously impaired, hazardous waste and fluid levels can rapidly build up inside the body. Treatment is meant to interrupt or delay the disease progression – this is typically achieved by monitoring the underlying cause.

Fast facts on chronic kidney disease

Here are some key points about chronic kidney disease. More detail and supporting information is in the main article.

  • Common symptoms include blood in urine, high blood pressure, and fatigue.
  • Causes include diabetes and specific kidney diseases, which includes polycystic kidney disease.
  • There is no cure for chronic kidney disease, which means treatment is focussed on reducing symptoms.
  • Diagnosis commonly occurs after blood tests, kidney scans, or biopsy.

Symptoms

Chronic kidney disease symptoms
Chronic kidney disease rarely shows symptoms until the later stages, so screening is recommended for those who are at risk..

Chronic kidney failure is a sluggish and slowly progressing condition, in contrast to acute kidney failure. Even if one rein stops functioning, the other can perform normal functions. Typically, signs and symptoms are not apparent until the disease is relatively well advanced and the illness has become severe; by this point much of the damage is irreversible.

It’s critical that people at high risk of developing kidney disease periodically test their kidney functions. Early detection can significantly help to avoid severe damage to the kidneys.

The most common signs of chronic kidney disease and their symptoms include:

  • anemia
  • blood in urine
  • dark urine
  • decreased mental alertness
  • decreased urine output
  • edema – swollen feet, hands, and ankles (face if edema is severe)
  • fatigue (tiredness)
  • hypertension (high blood pressure)
  • insomnia
  • itchy skin, can become persistent
  • loss of appetite
  • male inability to get or maintain an erection (erectile dysfunction)
  • more frequent urination, especially at night
  • muscle cramps
  • muscle twitches
  • nausea
  • pain on the side or mid to lower back
  • panting (shortness of breath)
  • protein in urine
  • sudden change in bodyweight
  • unexplained headaches

Stages

Changes in GFR levels may determine how the kidney disease is progressing. The phases of kidney failure in the UK, and many other countries, are listed as follows:

Stage 1 – GFR rate is normal. However, evidence of kidney disease has been detected.

Stage 2 – GFR rate is lower than 90 milliliters, and evidence of kidney disease has been detected.

Stage 3 – GFR rate is lower than 60 milliliters, regardless of whether evidence of kidney disease has been detected.

Stage 4 – GRF rate is lower than 30 milliliters, regardless of whether evidence of kidney disease has been detected.

Stage 5 – GFR rate is lower than 15 milliliters. Renal failure has occurred.

Most patients suffering from chronic kidney disease rarely progress past Stage 2. Diagnosing and treating kidney disease early is critical for preventing serious damage.

Diabetes patients should undergo an annual test which measures microalbuminuria (small amounts of protein) in urine. This test can detect diabetic nephropathy early on (diabetes-related early kidney damage).

Treatment

Chronic kidney disease does not actually get healed. However, some therapies can help manage the signs and symptoms, decrease the risk of complications and slow disease progression.

Chronic kidney disease patients usually require taking a significant number of drugs. Treatments cover:

Anemia treatment

Hemoglobin is the material that brings essential oxygen throughout the body, in red blood cells. If the levels of hemoglobin are small the patient may have anemia.

Some patients with anemia from the kidney disease may need blood transfusions. A patient with kidney disease will typically need to take iron supplements, either in the form of daily ferrous sulfate tablets or in the form of injections sometimes.

Phosphate balance

People with renal disease can not be able to adequately remove phosphate from their bodies. Patients should be recommended to reduce their intake of dietary phosphate-this typically means reducing dairy foods, red meat, eggs, and fish consumption.

High blood pressure

High blood pressure is a common issue among chronic kidney disease patients. It is necessary to bring down the blood pressure to protect the kidneys, and then slow down the disease’s progression.

Skin itching

Antihistamines, such as chlorphenamine, may help alleviate symptoms of itching.

Anti-sickness medications

Patients can feel sick (nausea) if toxins build up in the body because the kidneys don’t function properly. Drugs such as cyclizine or metaclopramide help relieve sickness.

NSAIDs (nonsteroidal anti-inflammatory drugs)

NSAIDs such as aspirin or ibuprofen should be avoided, and taken only if prescribed by a doctor.

End-stage treatment

It is when the kidneys work at a normal capacity of less than 10-15 per cent. Measures used to date – diet, drugs, and therapies that regulate the underlying causes – are no longer adequate. The kidneys of end-stage kidney disease patients can not keep up with the waste and fluid removal cycle alone – the patient may require dialysis or a kidney transplant to survive.

Many physicians will try as long as possible to postpone the need for dialysis or a kidney transplant as they bear the possibility of potentially severe complications.

Kidney dialysis

a man undergoing peritoneal dialysis treatment
Peritoneal dialysis is a treatment option for chronic kidney disease.

There are two main forms of dialysis of the kidney. Every type has subtypes, as well. The two primary forms are:

Hemodialysis: blood is pumped out of the patient’s body and passes into an artificial kidney (dialyzer). The patient undergoes about three hemodialysis per week. Each session has a minimum length of 3 hours.

Researchers now agree that more frequent treatments contribute to a better quality of life for the patient but new home-use dialysis machines make it easier to use hemodialysis more often.

Peritoneal dialysis: in the patient’s own belly, the blood is filtered; in the peritoneal cavity that comprises a large network of small blood vessels. A catheter is inserted into the uterus, in which a dialysis solution is injected and pumped out for as long as toxins and excess fluid are removed.

Kidney transplant

The donor and recipient of the kidney will have the same blood type, cell-surface proteins, and antibodies to reduce the likelihood of the new kidney being rejected. The best types of donors are usually siblings or very close relatives. When a living donor cannot be identified, the search for a cadaver donor (dead person) must begin.

Diet

Following a healthy diet is important for successful kidney failure treatment. Restricting the amount of protein in the diet can help slow down the progression of the disease.

Diet can also help in alleviating nausea symptoms.

To reduce hypertension, the salt intake has to be carefully controlled. Consumption of potassium and phosphorus can also need to be limited over time.

Vitamin D

Kidney-ill patients usually have poor vitamin D levels. Vitamin D is important to healthy bones. The vitamin D we get from the sun or food needs to be activated by the kidneys before it can be used by the body. Alfacalcidol, or Calcitriol can be given to patients.

Fluid retention

People with chronic kidney disease need to be vigilant of their consumption of fluids. Some patients may be asked to reduce their consumption of the fluid. When the kidneys are not functioning well, the patient is much more vulnerable to build-up of fluids.

Causes

Kidneys conduct the complex filtration mechanism in our bodies-accumulated waste and fluid content is extracted from the blood and excreted from the body.

In most cases, the kidneys are able to recycle much of the waste materials our body produces. However, if the blood supply to the kidneys is impaired, they do not function properly due to injury or disease, or if the outflow of urine is obstructed, complications do occur.

Progressive kidney damage is most often the result of a chronic illness (a long-term illness), such as:

  • Diabetes – chronic kidney disease is linked to diabetes types 1 and 2. If the patient’s diabetes is not well controlled, excess sugar (glucose) can accumulate in the blood. Kidney disease is not common during the first 10 years of diabetes; it more commonly occurs 15-25 years after diagnosis of diabetes.
  • Hypertension (high blood pressure) – high blood pressure can damage the glomeruli – parts of the kidney involved in filtering waste products.
  • Obstructed urine flow – if urine flow is blocked it can back up into the kidney from the bladder (vesicoureteral reflux). Blocked urine flow increases pressure on the kidneys and undermines their function. Possible causes include an enlarged prostate, kidney stones, or a tumor.
  • Kidney diseases – including polycystic kidney disease, pyelonephritis, or glomerulonephritis.
  • Kidney artery stenosis – the renal artery narrows or is blocked before it enters the kidney.
  • Certain toxins – including fuels, solvents (such as carbon tetrachloride), and lead (and lead-based paint, pipes, and soldering materials). Even some types of jewelry have toxins, which can lead to chronic kidney failure.
  • Fetal developmental problem – if the kidneys do not develop properly in the unborn baby while it is developing in the womb.
  • Systemic lupus erythematosus – an autoimmune disease. The body’s own immune system attacks the kidneys as though they were foreign tissue.
  • Malaria and yellow fever – known to cause impaired kidney function.
  • Some medications – overuse of, for example, NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin or ibuprofen.
  • Illegal substance abuse – such as heroin or cocaine.
  • Injury – a sharp blow or physical injury to the kidney(s).

Risk factors

The following conditions or situations are linked to a higher risk of developing kidney disease:

  • a family history of kidney disease
  • age – chronic kidney disease is much more common among people over 60
  • atherosclerosis
  • bladder obstruction
  • chronic glomerulonephritis
  • congenital kidney disease (kidney disease which is present at birth)
  • diabetes – one of the most common risk factors
  • hypertension
  • lupus erythematosus
  • overexposure to some toxins
  • sickle cell disease
  • some medications

Diagnosis

A doctor should look for signs and inquire for symptoms. We may also order the following tests:

  • Blood test – a blood test may be ordered to determine whether waste substances are being adequately filtered out. If levels of urea and creatinine are persistently high, the doctor will most likely diagnose end-stage kidney disease.
  • Urine test – a urine test helps find out whether there is either blood or protein in the urine.
  • Kidney scans – kidney scans may include a magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or an ultrasound scan. The aim is to determine whether there are any blockages in the urine flow. These scans can also reveal the size and shape of the kidneys – in advanced stages of kidney disease the kidneys are smaller and have an uneven shape.
  • Kidney biopsy – a small sample of kidney tissue is extracted and examined for cell damage. An analysis of kidney tissue makes it easier to make a precise diagnosis of kidney disease.
  • Chest X-ray – the aim here is to check for pulmonary edema (fluid retained in the lungs).
  • Glomerular filtration rate (GFR) – GFR is a test that measures the glomerular filtration rate – it compares the levels of waste products in the patient’s blood and urine. GFR measures how many milliliters of waste the kidneys can filter per minute. The kidneys of healthy individuals can typically filter over 90 ml per minute.

Complications

The following conditions are likely if the chronic kidney disease progresses to kidney failure:

  • anemia
  • central nervous system damage
  • dry skin or skin color changes
  • fluid retention
  • hyperkalemia, when blood potassium levels rise, possibly resulting in heart damage
  • insomnia
  • lower sex drive
  • male erectile dysfunction
  • osteomalacia, when bones become weak and break easily
  • pericarditis, when the sac-like membrane around the heart becomes inflamed
  • stomach ulcers
  • weak immune system

Prevention

Managing the chronic condition

Many factors make chronic kidney disease (such as diabetes) more likely. Chances of developing kidney failure may be greatly decreased by managing the condition. Individuals should follow guidelines, guidance and suggestions from their doctor.

Diet

A balanced diet with plenty of fruits and vegetables, whole grains and lean meats or fish can help to reduce blood pressure.

Physical activity

Regular exercise is good for maintaining safe levels of blood pressure; it also helps to manage chronic diseases like diabetes and heart disease. Individuals should check with a physician that an exercise plan is suitable for their age, weight and safety.

Avoiding certain substances

Including drug and alcohol misuse. Evite long-term heavy metals exposure, such as lead. Avoid exposure to oils, solvents and other hazardous substances for long periods.

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