Chronic Kidney Disease
Chronic kidney disease leads to the gradual loss of kidney function. Kidneys filter waste, toxins, and excess fluids from your blood. These waste products are then excreted in your urine. With chronic kidney failure, the filter system weakens or fails, causing dangerous levels of fluid, electrolytes, and wastes to build up in your body. The result can be fatal. Left untreated, kidney disease can lead to kidney failure (end-stage kidney disease). At this point, the kidney will need dialysis (artificial filtering) or an organ transplant.
Kidneys Have Many Jobs
Your body has two kidneys, organs that are bean-shaped and located on either side of your spine, towards your back, just beneath your rib cage. Each kidney is about the size of your fist.
While kidneys have many jobs, their main job is to filter your blood of wastes (toxins) and excess salt and water as urine. If your kidneys are damaged, waste can build up in your blood and make you sick.
Your kidneys also balance the amount of minerals in your body, keep your bones strong, make hormones that control blood pressure, and make red blood cells.
Risks for Chronic Kidney Disease
There are approximately 37 million people in the United States with chronic kidney disease.
You are more at risk if you:
- Have a family history of kidney disease
- Have diabetes
- Have high blood pressure
- Have heart disease
- Have abnormal kidney structure
- Are African-American, Hispanic, Native American, or Asian
- Are over 60 years of age
- Have a long history of taking painkillers, including over-the-counter products such as ibuprofen and aspirin
The Causes of Kidney Disease
Kidney diseases occur when your kidneys are damaged and cannot filter your blood. Damage can result from a sudden injury or sudden toxins, or damage can occur over months or years.
High blood pressure and diabetes are the two most common causes of chronic kidney disease.
Other conditions that affect kidney function and can lead to chronic kidney disease include:
- Glomerulonephritis is a type of kidney disease involving the filtering units inside your kidneys (glomeruli)
- Polycystic kidney disease is a genetic disorder that causes many fluid-filled cysts to grow in your kidneys
- Hypertensive nephrosclerosis is kidney damage caused by chronic, poorly controlled hypertension
- Membranous nephropathy is a disorder in which your body’s immune system attacks the waste-filtering membranes in your kidney
- Obstructions of the urinary tract can occur from kidney stones, cancer, or an enlarged prostate
- Vesicourethral reflux is a condition in which urine flows backward, back up the ureters to the kidneys
- Nephrotic syndrome is a collection of symptoms that indicate kidney damage
- Recurrent kidney infections can lead to chronic disease
- Diabetic nephropathy is damage or dysfunction of one or more nerves which typically results in numbness, tingling, muscle weakness, and pain in the affected area which can lead to liver disease
- Lupus and other immune system diseases can cause kidney problems including polyarteritis nodosa, sarcoidosis, and Goodpasture syndrome
Symptoms of Chronic Kidney Disease
Unfortunately, symptoms of kidney disease are often nonspecific (they can also be caused by other illnesses). Also, kidneys are highly adaptable and can often compensate for lost function. Therefore, symptoms may not appear until irreversible damage has occurred.
However, as the disease worsens, symptoms can include:
- A need to pee (urinate) more often
- Tiredness, weakness, low energy level
- Loss of appetite
- Swelling of your hands, feet and ankles
- Shortness of breath
- Blood in your urine or foamy urine
- Puffy eyes
- Dry and itchy skin
- Trouble concentrating
- Trouble sleeping
- Nausea or vomiting
- Muscle cramps
- High blood pressure
- Darkening of your skin
Complications of Kidney Disease
Some of the complications of chronic kidney disease include:
- Anemia (low red blood cell count)
- Weak and brittle bones
- Metabolic acidosis, a chemical imbalance
- High blood pressure
- Heart disease, including increased risk of stroke and heart attack
- High potassium which affects your heart’s ability to function correctly
- High phosphorus
- Fluid build up in feet, ankles and hands; fluid in your lungs
- Fertility problems and erectile dysfunction
- Decreased immune response, increasing your risk of infection
Diagnosing Kidney Disease
Your healthcare provider will order blood tests that will check:
- Your glomerulofiltration rate (GFR) which describes how efficiently your kidneys are filtering blood.
- Your serum creatinine level, which tells how well your kidneys are removing this waste product from muscle metabolism
A urine protein test will look for the presence of protein (albumin) and blood. Well-functioning kidneys indicate no blood or protein in your urine.
Other tests might include imaging tests such as an ultrasound, magnetic resonance imaging (MRI), or a computerized tomography (CT) scan to look for problems with the structure or size of your kidneys.
Your provider may also order a kidney biopsy to check for a specific type of kidney disease or level of damage.
Five Stages of Chronic Kidney Disease
There are five stages of kidney disease. The stages are based on how well your kidneys can filter waste and extra fluid from your blood. The stages range from very mild (stage 1) to kidney failure (stage 5).
Your healthcare provider will determine the stage of your kidney function according to the glomerular filtration range, a number based on the amount of creatinine (a waste product) found in your blood, along with other factors, including your age, race, and gender.
The chart below from the Cleveland Clinic outlines the different stages of chronic kidney disease.
Stages of Chronic Kidney Disease
What it Means
|Stage 1||90 and higher||Your kidneys are working well but you have signs of mild kidney damage.|
|Stage 2||60 to 89||Your kidneys are working well but you have more signs of mild kidney damage|
|Stage 3||30 to 59||Your kidneys aren’t working as well as they should and you have moderately decreased kidney function. This is the most common stage. You may notice symptoms at this stage.|
|Stage 4||15 to 29||You have poor kidney function; your kidneys are moderately to severely damaged.|
|Stage 5||Less than 15||Your kidneys are very close to failing or have failed. You need kidney dialysis or a kidney transplant.|
*GFR = glomerular filtration rate
Treatment for Chronic Kidney Disease
There is no cure for chronic kidney disease (CKD), but steps can be taken early on to preserve a higher level of kidney function for as long as possible.
If you have reduced kidney function:
- Make and keep your regular healthcare provider/nephrologist (kidney specialist) check-ups
- Keep your blood sugars under control if you are diabetic
- Avoid taking painkillers and other drugs that can worsen your kidney disease
- Keep blood pressure levels under control
- Consult a dietitian for helpful diet changes such as limiting protein, eating foods that can reduce blood cholesterol levels, and limiting sodium and potassium
- Treat anemia if present
- Don’t smoke
- Maintain a healthy weight
Medications for People with Chronic Kidney Disease
Depending on the cause of your kidney disease, your nephrologist might prescribe some of the following medications:
- An angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to lower blood pressure
- A diuretic to help eliminate extra fluid
- Medicines to lower cholesterol levels
- Erythropoietin, to build red blood cells if you are anemic
- Vitamin D and calcitriol to prevent bone loss
- Phosphate binder if your kidneys cannot eliminate phosphate
If chronic kidney disease progresses to end-stage kidney failure, artificial filtering (dialysis) or a kidney transplant becomes imperative.
Call us at Catawba Valley Healthcare for any of your primary care health needs or concerns at (828) 695-5900.