An Overview of Chronic Kidney Disease

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Chronic kidney disease (CKD) is the gradual loss of kidney function, which can be caused by everything from diabetes and high blood pressure to recurrent infection and urinary tract obstruction. CKD impairs the kidneys' ability to filter waste and regulate water and acid in the blood. While there may be no signs of the disease in the early stages, symptoms will develop with time. CKD can be diagnosed with blood and urine tests, and treatment is focused on treating the underlying cause of the kidney impairment as well as any complications.

Unlike acute kidney failure, which develops rapidly and is potentially reversible, CKD is a long-standing condition in which damage to the kidneys is permanent and progressive. Chronic kidney disease can progress to end-stage renal failure (ESRF), which is fatal without dialysis or a kidney transplant.

Symptoms

The symptoms of CKD progressively develop as fluids, waste, and other substances (such as uric acid, calcium, and albumin) are not excreted from the body as they should be. This imbalance may not be felt in the early stages of the disease, but, as levels rise over the course of months and years, the excessive accumulation of water and waste starts to affect multiple organ systems, including the heart, lungs, brain, and even the kidneys themselves.

Common signs and symptoms of CKD include difficulty urinating (dysuria), dizziness, foamy urine, frequent urination at night (nocturia), metallic taste (dysgeusia), swelling of the feet, ankles, feet, hands, or face (edema), and others.

As the kidney function falls below 25 percent of its normal capacity, symptoms of CKD will become far more apparent, manifesting with such complications as coronary artery disease, memory problems, pulmonary edema (a build-up of fluid in the lungs), and renal hypertension (high blood pressure caused by kidney disease), among others.

Kidney failure, known as end-stage renal disease (ESRD), occurs when kidney function falls below 10 to 15 percent. Unless dialysis or a kidney transplant is performed, ESRD can lead to seizures, coma, and sudden death. Cardiac arrest is the most common cause of death in people with CKD.

Causes

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing progressive and irreversible damage to the architecture of the kidneys.

No less than 75 percent of all CKD cases are caused by three conditions:

Other less common causes of CKD include, but are not limited to, autoimmune diseases, like IgA nephropathy and lupus; genetic disorders, like polycystic kidney disease; prolonged urinary tract obstruction (including kidney stones), and recurrent kidney infections.

CKD is more common in African-Americans, older people, smokers, people who are obese, and people with a family history of kidney disease.

Diagnosis

Chronic kidney disease is primarily diagnosed with a battery of blood and urine tests that measure how well your kidneys are functioning. Called renal function tests, they are not only used to diagnose CKD but to track both the progression of the disease and your response to treatment.

Among some of the tests used to evaluate kidney (renal) function:

  • Serum creatinine (SCr), a blood test that measures a substance called creatinine
  • Glomerular filtration rate (GFR), which uses the SCr value to estimate how much blood passes through the glomeruli in a minute
  • Urinary albumin measures how much of a protein, called albumin, is being abnormally excreted in urine (a sign of kidney disease)
  • Blood urea nitrogen (BUN), which measures a waste by-product produced by the accumulation of uric acid in the blood

Imaging tests, such as ultrasound, X-ray, and computed tomography (CT), are primarily used to detect damage or monitoring changes in the kidneys.

A biopsy may also be performed to obtain kidney tissue sample for evaluation in the lab. This is most often indicated when there is blood in the urine, the cause is unknown, or ESRD is diagnosed.

Kidney disease is staged based on GFR results. Stages range from 1 to 5 and are used to objectively describe how severe your condition is and direct the course of treatment, with 1 indicating minimal loss of renal function and 5 indicating renal failure/ESRD.

Treatment

The goal of CKD treatment is threefold: to treat the underlying cause; to slow the progression of kidney damage; and to minimize any harm the disease can cause the other organs, most predominately the heart and blood vessels.

Treatment options vary based on the underlying cause of disease. With that being said, even if the underlying cause (such as high blood pressure or diabetes) is controlled, kidney damage can still progress, albeit at a generally slower rate.

Among the possible treatment options:

  • A lower protein diet helps prevent the accumulation of byproducts caused by the metabolism of protein.
  • A restriction of dietary sodium, potassium and, phosphorus may be needed to compensate for the accumulation of these electrolytes in the body.
  • Antihypertensives like ACE inhibitors or angiotensin receptor blockers may be used to control high blood pressure.
  • Statin drugs like Lipitor (atorvastatin) may be prescribed to lower cholesterol common in people with CKD.
  • Erythropoietin supplements aid in the production of red blood cells, which may help relieve symptoms of anemia.
  • Diuretics ("water pills") like Lasix (furosemide) may be used to remove excess fluid from the body.
  • Calcium and vitamin D supplements may be prescribed to prevent bone damage and reduce the risk of fractures.

If ESRD is diagnosed, meaning that your kidneys are no longer functional, dialysis or a kidney transplant is needed in order for you to survive.

Dialysis is a mechanical procedure used to filter your blood when your kidneys no longer can. It may involve either hemodialysis, in which a machine removes waste and excess fluid from your blood, or peritoneal dialysis, in which a solution is fed into your belly through an abdominal catheter to absorb excess waste and fluid.

A kidney transplant involves surgically placing a healthy kidney from either a live or deceased donor into your body. Of all of the organ transplant types, this has the longest waiting list with an average wait time of five years. If approved, you will be prioritized by how long you've been waiting, your blood type, your current health, and other factors. After the transplant has been performed, you will no longer need dialysis but will have to remain on immune suppressive drugs for the rest of your life to avoid organ rejection.

Coping

If you or a loved one has been diagnosed with CKD, learning to cope can be difficult. As a disease marked by uncertainty, you need to focus on those factors you can control and to build a support network able to help normalize CKD in your life.

Here are just some of the things you can do:

  • Speak with your doctor about a low-sodium DASH diet, which emphasizes portion control with a limited intake of protein and sodium.
  • Avoid hidden salt by reading food labels. Only foods labeled "no salt" are sodium-free.
  • Exercise regularly. Doing so helps build lean muscle while lowering your blood pressure and improving your overall mood and energy levels.
  • Stop smoking. Cigarette smoke further constricts blood flow to the kidneys and speeds the progression of your disease.
  • Find strategies to manage stress. In addition to exercise, get plenty of rest each night by improving your sleep hygiene. You can even explore mind-body therapies, such as meditation and guided imagery, to help routinely decompress at the end of a day.
  • Build a support network. This not only helps emotionally but ensures that everyone is onboard and understands the "rules" of living with CKD.

A Word From Verywell

If you or a loved one has chronic kidney disease, it not uncommon to feel anxious about the future. To better overcome these feelings, try to remain resilient and continue to work closely with your doctor and medical team. Routine monitoring and the early detection of complications are paramount to preventing further kidney damage.

If you have end-stage kidney disease or are close to starting dialysis, be sure to talk honestly and openly with your doctor about your concerns, options, expectations, and goals. Ultimately, you are in charge of any treatment decisions, including whether you want to be treated or not.

If you have end-stage renal disease and choose not to have or continue dialysis, speak with your doctor about palliative care. You may require family counseling to ensure that others support your decision.

While discussions about palliative care are built into certain diagnoses (such as cancer), with kidney failure, you often need to initiate the conversation on your own. Doing so can help ensure the best care and quality of life possible with whatever time you have remaining.

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