Kashif J. Piracha, MD, is board-certified in internal medicine and nephrology. He has an active clinical practice at Methodist Willowbrook Hospital in Houston, Texas.
Chronic kidney disease (CKD) is marked by the gradual loss of kidney function, which means the kidneys cannot filter waste and regulate water and acid in the blood as well as they should.
In 75% of cases, CKD is caused by one of three conditions: diabetes, high blood pressure, or glomerulonephritis, an inflammation of the glomeruli, which are a component of nephrons (the structural and functional unit of the kidneys).
Early in the disease, there may be no symptoms, but the damage is progressive and permanent. CKD can be diagnosed with blood and urine tests, and treatment is focused on treating the underlying cause of kidney impairment as well as any complications.
Chronic kidney disease can progress to end-stage renal failure (ESRF), which is fatal without dialysis or a kidney transplant.
Chronic kidney disease occurs when another condition impairs kidney function. In most cases, CKD is caused by diabetes, hypertension, or a group of infections known as glomerulonephritis, but it may also be caused by autoimmune diseases like lupus; genetic disorders like polycystic kidney disease; obstructions such as tumors, kidney stones, or an enlarged prostate; or frequent kidney infections.
Unlike acute renal failure, which can be reversible, chronic kidney disease is marked by progressive, irreversible damage to the nephrons of the kidneys. Treatment may help slow the course of the disease, but dialysis or a kidney transplant may eventually be required if the kidneys stop functioning.
Treating chronic kidney disease first requires identifying the underlying cause, then trying to slow the progression while also reducing complications that may affect other organs, like the heart. Treatment options may include a protein-restricted diet, antihypertensive medications, diabetes medications, diuretics, bone-marrow stimulants, and calcium reducers.
CKD is often referred to as "the silent killer," as early symptoms often go unnoticed, and noticeable symptoms don't take effect until the disease has significantly progressed. Early signs of CKD may include fatigue, ammonia-smelling breath, loss of appetite, malaise, ankle swelling, weight gain, difficulty urinating, and kidney pain. As kidney function worsens, symptoms become more severe.
Preventing CKD involves staying on top of healthy lifestyle habits, like exercising, quitting smoking, and following a heart-healthy diet, which can help keep blood pressure in check.1 If you have other chronic conditions, such as diabetes or high blood pressure, it's important to keep them well-controlled within the target ranges your doctor has set for you in order to protect your kidneys.
As chronic kidney disease progresses to later stages, you may require dialysis, a procedure which serves as a mechanical way to replace some of the kidneys' functions. Hemodialysis is a process in which a patient's blood passes from an access point through a filter (dialyzer) to remove waste and balance electrolytes before returning the purified blood to the body.
An umbrella term for any type of infection or inflammation affecting the glomeruli (a component of a nephron), the functional units responsible for filtration in the kidneys.
Also known as hypertension, high blood pressure is defined as a chronic condition in which the force of blood in your arteries is too high. High blood pressure can contribute to chronic kidney disease, as it hardens the blood vessels fueling the nephrons, making it harder for your kidneys to work efficiently.
An inflammation of the spaces between the kidney tubules, which can hinder kidney function. In some cases, interstitial nephritis may be related to long-term use of analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), known as analgesic nephropathy. It's often an acute condition, but when chronic, it can lead to chronic kidney disease.
A surgical procedure in which a donated kidney is used to replace a diseased kidney. This is performed when a patient is in end-stage renal failure (ESRF), and the best option to preserve kidney function is to replace the damaged kidneys. A transplanted kidney typically keeps you healthier than dialysis, but not everyone is a candidate for surgery, and getting a donated kidney can be difficult.
A bacterial infection of the kidneys, which causes one or both kidneys to become inflamed and typically causes fever, flank pain, and nausea/vomiting. Antibiotics are required. If left untreated, pyelonephritis may lead to sepsis, permanent kidney damage, and chronic kidney disease.
Also known as kidney failure, renal failure occurs when your kidneys fail to function—they can no longer filter waste from your blood or balance body fluids—due to damage. If CKD is left untreated, it will progress to renal failure, then requiring dialysis or a kidney transplant.
Typically, urine flows down the urinary tract from your kidneys through the ureters (ducts) to the bladder. But with vesicoureteral reflux, urine may flow backward from the bladder to the kidneys, potentially passing bacteria to the kidneys, which can cause a kidney infection and lead to permanent scarring. If VUR is severe (grade V), it can progress to chronic kidney disease.
Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Updated March 11, 2019.
Rodger RS. Approach to the management of end-stage renal disease. Clinical Medicine. 2012 Oct;12(5):472. doi:10.7861%2Fclinmedicine.12-5-472
Veridiana A, Rodrigo R, Wilson A. Primary vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt?. Int. Braz J Urol. 2020 Mar; 46(2): 262-268. 10.1590/s1677-5538.ibju.2020.02.02
Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017;32(4):577-587. doi:10.1007/s00467-016-3394-5
National Institutes of Health: National Institute of Diabetes and Digestive Kidney Issues. Managing chronic kidney disease. Updated October 2016.
National Institutes of Health: National Institute of Diabetes and Digestive Kidney Issues. Preventing chronic kidney disease. Updated October 2016.
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