What you need to know about chronic kidney disease

A diagnosis of chronic kidney disease may seem scary for patients.

But with proper treatment, progression of the disease can be slowed, complications can be reduced and patients can be more comfortable.

The major function of kidneys is to remove waste products and excess fluids from the body. It regulates blood pressure and keeps your bone stronger by producing active vitamin D. It also controls the red blood cell production.

In addition, the kidneys play a critical role in electrolyte ( like sodium, potassium, calcium, phosphorous) and acid regulation.

That’s why with known kidney disease, it is important to control blood pressure, acidosis, anemia and bone-mineral abnormality.

What is chronic kidney disease?

Chronic kidney disease is a condition characterized by kidney damage and/or a decrease in kidney function. Persistence of this condition or damage  for more than three months makes this condition chronic.

Physicians can determine if the kidney has damage by doing a biopsy or using imaging to see the kidneys. They can also detect damage if more protein is being excreted in the urine.

Physicians can tell whether the kidneys have decreased function by examining the glomerular filtration rate (GRF) — the unit of kidney function measure. It is calculated based on your blood test called creatinine.  When kidney function is compromised, waste products start accumulating in the blood and make one feel sick.  Fluid in the body starts building up and the person feel short of breath.

Other complications of kidney damage include high blood pressure, low blood cell count  (called anemia), weakness in bones and poor nutritional status.

What causes kidney disease?

The two main causes of CKD are diabetes mellitus and hypertension.  High blood sugar from the diabetes can cause damage to your heart, eyes, nerves, blood vessels and your kidneys. High blood pressure (hypertension) can lead to stroke, heart attacks and chronic kidney disease.

Some other important conditions which can cause kidney damage include:

  • Glomerulonephritis:
    This is a condition characterized by the inflammation in kidney filtering units.
  • Inherited diseases, like polycystic kidney disease or Alport syndrome.
  • Obstruction: secondary to prostate enlargement, kidney stone or tumors.
  • Recurrent /repeated urinary tract infections
  • Congenital disease
    This happens to the baby when he or she is in mother’s womb. The most common is reflux disease — an abnormal valve between ureter and bladder.

If chronic kidney disease is so serious, why don’t I feel sick?

In the early stages of kidney disease, the signs and symptoms of kidney disease are subtle and most of those will be detected by health professionals. The gradual decline in kidney function in the early stages is asymptomatic.

When kidney problems advance, the patient experiences multiple symptoms. As toxins build excessively, a person develops loss of appetite, nausea, vomiting, lethargy, confusion, seizures and can even die. Because of fluid imbalance, individuals can experience increased swelling, become short of breath (from fluid accumulation in lungs),  and see a life-threatening electrolyte imbalance.

If I have chronic kidney disease, will I ultimately need dialysis or a transplant?

Not all individuals with kidney disease have same rate of progression.  In some people, the rate of progression is very rapid. In some, it remains steady for a long period of time. It depends on various factors like the underlying cause of kidney disease, other medical conditions, treatments, socioeconomic status, individual genes, ethnicity, etc.

However, as the disease advances, patients will have to initiate dialysis or undergo a kidney transplant. Early diagnosis and adequate preparation for dialysis decreases hospitalizations, complications and perhaps death due to kidney disease. This also helps to make sure the evaluation of a transplant is done in timely fashion, along with a great chance of recruiting a donor.

Different dialysis modality options are available, like in-center hemodialysis,  home hemodialysis or home peritoneal dialysis. Kidney transplantation can be a living donor transplant or cadaveric kidney transplantation.

The choice between home dialysis versus in-center dialysis is influenced by various factors, including availability, convenience, other medical conditions, home situation, age, gender, and family involvement.

What should I do to avoid more damage to my kidneys?

For any medical health condition an individual has, patient and family involvement is very important for improvement and stability of the disease.

If you are diagnosed with kidney disease, you should take following steps:

  1. Know what your kidney function is.
  2. Control your blood pressure.
  3. Know your medication dosage or that some medications may need to be changed.
  4. Avoid exposure to contrast dyes whenever possible.
  5. Avoid over the counter pain medications, like non-steroidal anti-inflammatories.
  6. Talk to a dietitian if needed.
  7. Control you cholesterol levels.
  8. Stop smoking.
  9. Be sure to get your annual flu vaccination.
  10. Visit your kidney specialist regularly.
  11. Learn different treatment options for kidney disease.
  12. Get prepared for dialysis and transplantation when and if needed.

How effective are lifestyle changes in treating the condition?

Diabetes and hypertension are the most important causes of kidney disease.  Heart disease is also very common in patients with kidney disease.

Smoking slows the blood circulation to the kidney and can worsen the existing kidney disease. It also can interfere with blood pressure medicines and can worsen blood pressure which has adverse effects on the kidneys.

Lifestyle modifications can play vital role in preventing and halting the progression of the kidney disease. These include:

    • Weight reduction
    • Regular exercise
    • Dietary modifications
    • Low salt diet, moderate protein intake, low carb, low fat
    • Smoking cessation
    • Routine check of blood test, urine tests and blood pressure check
    • Know your family medical history
    • Control cholesterol, blood sugar and blood pressure

If I have chronic kidney disease, do I need to take medications as well?

Kidney disease can be avoided and treated and/or the progression can be slowed. Attempts should be made to make specific diagnosis which includes blood test, urine test, kidney ultrasound and kidney biopsy. Once presumed or definite diagnosis is made all attempts should be made to treat it. If the damage is irreversible, every steps is taken to avoid further damage and avoid further complications.

The proper treatment of underlying problems which includes

    1. Proper management for strict diabetes control
    2. Medications for blood pressure control
    3. Cholesterol medications
    4. Medications for glomerulonephritis ( inflammatory kidney disease) which includes steroid and chemotheraupetic agents
    5. Treatment for different complications of kidney disease which includes medications to keep bone strong, to keep your blood count normal.
Sonali Birewar, MD, ADC Nephrology About the Author

Dr. Sonali Birewar is a nephrologist specializing in the diagnosis and treatment of chronic kidney disease, hypertension and dialysis. She sees patients at ADC's Main Clinic and Cedar Park satellite location. Read more about her in her biography here.