Cronic Kidney Disease
Kidney transplant physician in Navi Mumbai | Dr. Ravindra Nikalji
Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then removed in your urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes and wastes to build up in your body.
In the early stages of chronic kidney disease, you might have few signs or symptoms. You might not realize that you have kidney disease until the condition is advanced.
Treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the cause. But, even controlling the cause might not keep kidney damage from progressing. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.
Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or electrolyte problems. Depending on how severe it is, loss of kidney function can cause:
- Nausea
- Vomiting
- Loss of appetite
- Fatigue and weakness
- Sleep problems
- Urinating more or less
- Decreased mental sharpness
- Muscle cramps
- Swelling of feet and ankles
- Dry, itchy skin
- High blood pressure (hypertension) that’s 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
Signs and symptoms of kidney disease are often nonspecific. This means they can also be caused by other illnesses. Because your kidneys are able to make up for lost function, you might not develop signs and symptoms until irreversible damage has occurred.
Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.
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), is an inflammation of the kidney’s filtering units (glomeruli)
- Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), is an inflammation of the kidney’s tubules and surrounding structures
- Polycystic kidney disease or other inherited kidney diseases
- Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
- 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)
Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.
Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease.
Treating the cause
Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as diabetes mellitus or high blood pressure, has been controlled.
Treating complications
Kidney disease complications can be controlled to make you more comfortable. Treatments might include:
High blood pressure medications. People with kidney disease can have worsening high blood pressure. Your doctor might recommend medications 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 change electrolyte levels, so you might 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 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 maintain the balance of fluids in your body.
- Medications to treat anaemia. Supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron, help produce more red blood cells. This might relieve fatigue and weakness associated with anaemia.
- Medications to lower cholesterol levels. Your doctor might recommend medications called statins to lower your cholesterol. People with chronic kidney disease often have high levels of bad cholesterol, which can increase the risk of heart disease.
- Medications to protect your bones. Calcium and vitamin D supplements can help prevent weak bones and lower your risk of fracture. You might also take medication known as a phosphate binder to lower the amount of phosphate in your blood and protect your blood vessels from damage by calcium deposits (calcification).
- A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor might recommend eating less protein. A registered dietitian can suggest ways to lower your protein intake while still eating a healthy diet.
Your doctor might recommend regular follow-up testing to see whether your kidney disease remains stable or progresses.
Treatment for end-stage kidney disease
If your kidneys can’t keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.
Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood.
In peritoneal dialysis, a thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from your body, carrying the waste with it.
Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors.
After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant.
For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).