Description

Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. The kidneys filter waste and excess fluid from the blood, which are then eliminated in the urine. Advanced chronic kidney disease can cause levels of fluid, electrolytes and wastes that build up in your body.

In the early stages of chronic kidney disease, you may have few signs or symptoms. You may not realize that you have kidney disease until the disease is advanced.

The treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the causes. But, even controlling the cause could not maintain kidney damage progresses. Chronic kidney disease can progress to end-stage renal failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.

Symptoms

The signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. The loss of kidney function can cause a buildup of fluid or waste of the body, or electrolyte problems. Depending on how serious it is, the loss of kidney function that can lead to:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue and weakness
  • Sleep problems
  • Urinating more or less
  • Decreased mental acuity
  • Muscle cramps
  • Swelling of feet and ankles
  • Dry, itchy skin
  • High blood pressure (hypertension) that is difficult to control
  • Shortness of breath, if fluid builds up in the lungs
  • Chest pain, if fluid builds up around the lining of the heart

The signs and symptoms of kidney disease are often nonspecific. This means that they can also be caused by other diseases. Because the kidneys are able to recover the lost function, you may not develop signs and symptoms until irreversible damage has occurred.

When to see a doctor

Make an appointment with your doctor if you have signs or symptoms of kidney disease. The early detection can help prevent kidney disease progresses to kidney failure.

If you have a medical condition that increases your risk of kidney disease, your doctor may control your blood pressure and kidney function with urine and blood tests during the office visits. Ask your doctor if these tests are necessary for you.

Causes

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.

The diseases and conditions that cause chronic kidney disease include:

  • Type 1 or type 2 diabetes
  • High blood pressure
  • Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the filtering units of the kidneys (glomeruli)
  • The nephritis interstitial (in-tur-STISH-ul-nuh-FRY-tis), an inflammation of the tubules of the kidney and surrounding structures
  • Polycystic kidney disease or other hereditary renal diseases
  • Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some types of cancer
  • Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
  • Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors

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

  • Diabetes
  • High blood pressure
  • Heart (cardiovascular) disease
  • Smoking
  • Obesity
  • To be Black, Native American or Asian-American
  • Family history of kidney disease
  • Abnormal kidney structure
  • Age
  • The frequent use of medications that can harm the kidneys

Complications

Chronic kidney disease can affect almost any part of your body. The potential complications include:

  • Fluid retention, which could lead to swelling in the arms and legs, high blood pressure, or fluid in the lungs (pulmonary edema)
  • A sudden increase in the levels of potassium in your blood (hyperkalemia), which could affect the functions of the heart and can be life-threatening
  • Anemia
  • Heart disease
  • The weakness of the bones and an increased risk of bone fractures
  • Decreased sexual desire, erectile dysfunction or reduced fertility
  • The damage to his central nervous system, which can cause difficulty concentrating, personality changes or seizures
  • Decreased immune response, which makes them more vulnerable to infection
  • Pericarditis, an inflammation of the saclike membrane that surrounds the heart (pericardium)
  • Pregnancy complications that carry risks for the mother and the developing fetus
  • Irreversible damage to the kidneys (renal failure), finally, that requires dialysis or a kidney transplant to survive

Prevention

To reduce your risk of developing kidney disease:

  • Follow the instructions in over-the-counter medications. When the use of non-prescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others), follow the instructions on the package. Taking too many pain relievers for a long time can lead to kidney damage.
  • Maintain a healthy weight. If you are at a healthy weight, maintain by being physically active most days of the week. If you need to lose weight, talk with your doctor about strategies for healthy weight loss.
  • Do not smoke. Cigarette smoking can damage the kidneys and improve kidney damage worse. If you are a smoker, talk to your doctor about strategies for quitting smoking. Support groups, counseling and medication can help to stop.
  • Manage your medical conditions, with the help of your doctor. If you have diseases or conditions that increase the risk of kidney disease, work with your doctor to control them. Ask your doctor about tests to look for signs of kidney damage.

Diagnosis

As a first step toward diagnosis of kidney disease, your doctor discusses your personal and family history with you. Among other things, your doctor may ask you questions about whether you have been diagnosed with high blood pressure, if you've taken a medication that might affect kidney function, if you have noticed changes in your eating habits urinary and if you have family members who have kidney disease.

Then, the doctor performs a physical examination, checking for signs of problems with your heart or blood vessels, and carried out a neurological examination.

For the diagnosis of kidney disease, you may also need certain tests and procedures to determine the severity of your kidney disease (stage). Tests may include:

  • Blood tests. Kidney function tests to seek the level of waste products, such as urea and creatinine in the blood.
  • Urine tests. The analysis of the urine sample can reveal abnormalities that suggest kidney failure, chronic, and help identify the cause of chronic kidney disease.
  • Imaging tests. Your doctor may use ultrasound to assess kidney size and structure. Other imaging tests may be used in some cases.
  • Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy, which involves removing a sample of kidney tissue. The renal biopsy is typically done with local anesthesia using a long, thin needle that is inserted through the skin and into the kidney. The biopsy sample is sent to a lab for testing to help determine what is the cause of your kidney problem.

Treatment

Depending on the cause, some types of kidney disease can be treated. Often, however, the chronic kidney disease that has no cure.

The treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow the progression of the disease. If your kidneys become severely damaged, you may need treatment for end-stage renal disease.

The treatment of the cause

Your doctor will work to lessen or control the cause of your kidney disease. Treatment options vary depending on the cause. But the kidney damage may continue to worsen even when an underlying condition, such as diabetes mellitus or high blood pressure has been controlled.

The treatment of the complications

Renal complications of the disease can be controlled so that you feel more comfortable. Treatments may include:

  • High blood pressure medications.People with kidney disease may have worsening of high blood pressure. Your doctor may recommend medication to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers and to preserve kidney function. High blood pressure medications can initially decrease kidney function and the change of the levels of electrolytes, so you may need frequent blood tests to monitor your condition. Your doctor may also recommend a water pill (diuretic) and a low-salt diet.
  • Medications to relieve the swelling. People with chronic kidney disease often retain fluids. This can lead to swelling in the legs, as well as high blood pressure. Medications called diuretics can help to maintain the balance of fluids in your body.
  • Medications to treat the anemia. The supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with the addition of iron, help to produce more red blood cells. This can relieve the fatigue and weakness associated with anemia.
  • Medications to lower cholesterol levels. Your doctor may recommend medications called statins to lower cholesterol. People with chronic kidney disease often have high levels of bad cholesterol, which can increase the risk of heart disease.
  • Medications to protect their bones. Calcium and vitamin D supplements can help prevent weak bones and reduce the risk of fracture. You can also take the medication known as a phosphate binder to reduce the amount of phosphate in the blood and protect the blood vessels from damages caused by deposits of calcium (calcification).
  • A lower protein content of the diet to minimize the waste products in the blood. As the body processes food proteins, it creates waste products that the kidneys need to filter the blood. To reduce the amount of work they have to do the kidneys, your doctor may recommend a lower consumption of protein. A registered dietitian can suggest ways to reduce your protein intake while still eating a healthy diet.

High blood pressure medications. People with kidney disease may have worsening of high blood pressure. Your doctor may recommend medication to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers and to preserve kidney function.

High blood pressure medications can initially decrease kidney function and the change of the levels of electrolytes, so you may need frequent blood tests to monitor your condition. Your doctor may also recommend a water pill (diuretic) and a low-salt diet.

Your doctor may recommend regular follow-up tests to see if your kidney disease remains stable or progresses.

The treatment for end-stage renal disease

If your kidneys can't keep up with the waste and the liquid of free space on their own and develop the complete or almost complete renal failure, you have end-stage renal disease. At that point, you need dialysis or a kidney transplant.

  • The dialysis.Artificial dialysis removes waste products and excess fluid from the blood when the kidneys are not able to do so. In hemodialysis, a machine filters wastes and excess fluid from the blood. In peritoneal dialysis, a thin tube that is inserted into the abdomen fills the abdominal cavity with a dialysis solution that absorbs wastes and excess fluids. After a time, the dialysis solution is drained from your body, taking the trash with him.
  • Kidney transplant.A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys from deceased or living donors. After a transplant, you will have to take medicines for the rest of your life to prevent your body from rejecting the new organ. You do not need to be on dialysis for a kidney transplant.

The dialysis. Artificial dialysis removes waste products and excess fluid from the blood when the kidneys are not able to do so. In hemodialysis, a machine filters wastes and excess fluid from the blood.

In peritoneal dialysis, a thin tube that is inserted into the abdomen fills the abdominal cavity with a dialysis solution that absorbs wastes and excess fluids. After a time, the dialysis solution is drained from your body, taking the trash with him.

Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys from deceased or living donors.

After a transplant, you will have to take medicines for the rest of your life to prevent your body from rejecting the new organ. You do not need to be on dialysis for a kidney transplant.

For some who choose not to have dialysis or a kidney transplant, a third option is the treatment of renal failure with conservative measures. Conservative measures likely to include symptom management, advance care planning and attention to keep you comfortable (palliative care).

Lifestyle and home remedies

As part of your treatment for chronic kidney disease, your doctor may recommend a special diet to help support the kidneys and limit the work they do. Ask your doctor for a referral to a registered dietitian that can analyze your diet and suggest ways to make your diet easier on the kidneys.

Depending on your situation, the kidney function and health in general, the dietary recommendations may include the following:

  • Avoid products with added salt. Reduce the amount of sodium you consume each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups, and fast foods. Other foods with added salt, which include salty snacks, canned vegetables, and processed meats and cheeses.
  • Choose lower potassium foods. Foods rich in potassium include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, carrots, cabbage, carrots, green beans, grapes, and strawberries. Be aware that many salt substitutes that contain potassium, so in general you should avoid if you have kidney failure.
  • Limit the amount of protein you eat. Your registered dietitian can calculate how many grams of protein you need each day, and make recommendations based on that amount. Foods rich in protein include lean meats, eggs, milk, cheese, and beans. Low-protein foods are vegetables, fruits, breads and cereals.

Coping and support

To receive a diagnosis of chronic kidney disease can be troubling. To help you deal with your feelings, consider the possibility of:

  • Connect with other people who have kidney disease. They can understand what they are feeling and offer support only. Ask your doctor about support groups in your area. 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.
  • The maintenance of your normal routine, when possible. Try to keep doing the activities you enjoy and continue to work, if their condition allows it. This can help you to deal with feelings of sadness or loss that you may have.
  • Be active on most days of the week. With the advice of your doctor, try to do at least 30 minutes of physical activity most days of the week. This can help you to deal with stress and fatigue.
  • Speak with someone you trust. You can have a friend or family member who is a good listener. Or you may find it helpful to speak to a religious leader or someone else you trust. Ask your doctor for a referral to a social worker or a counselor.

Preparing for your appointment

It is likely to start by seeing your primary care physician. If the laboratory tests reveal that you have kidney damage, you may be referred to a doctor who specializes in problems of the kidneys (nephrologist).

What you can do

To prepare for your appointment, ask if there is something that you need to make ahead of time, such as the limit of its diet. Then, make a list of:

  • Your symptoms, including any that seem unrelated to your kidneys or urinary function, and when they began
  • Of all your medications, vitamins, or other supplements you are taking, including dose
  • Other medical conditions you may have, and family members with kidney disease
  • Questions about your condition

Have a friend or family member, if possible, to help you remember the information that you receive. Or the use of a tape recorder during your visit.

For chronic kidney disease, some basic questions to ask include:

  • What is the level of damage to the kidneys?
  • It is my worsening of renal function?
  • I need more tests?
  • What is the cause of my condition?
  • Can kidney damage be reversed?
  • What are my treatment options?
  • What are the possible side effects of each treatment?
  • I have these other health conditions. How can I best manage them together?
  • What should I eat a special diet?
  • Can you give me the name of a dietitian who can help me plan my meals?
  • Are there brochures or other printed material I can have? What sites do you recommend?
  • How frequently do I need to have my kidney function tested?

Do not hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor may ask you questions, such as:

  • How long have you had symptoms?
  • Have you been diagnosed or treated for high blood pressure?
  • Have you noticed changes in your eating habits urinals?
Symptoms and treatment of Chronic kidney disease