Chronic kidney disease
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Chronic kidney disease, commonly known as chronic kidney failure, is a condition in which the kidneys progressively losses its ability to function. When the kidneys are damaged, it cannot remove the waste product and extra fluid from the blood through the urine. The body may accumulate hazardous amounts of fluid, electrolytes, and wastes which typically happens when someone have an advanced chronic kidney disease.
Patient may not have many signs and symptoms during the first stages or when the chronic kidney disease is still developing. It is possible that the condition goes unnoticed until it is already advanced.
The goal of chronic kidney disease treatment is to slow the development of kidney damage, usually by addressing the underlying cause. However, even managing the cause of kidney disease might not stop the damage from getting worse. Kidney disease can lead to kidney failure, also known as the end-stage kidney disease, which will require dialysis or a kidney transplant to improve chances of survival.
Symptoms
Patients with chronic kidney disease may not immediately notice the signs and symptoms until the disease is advanced. Excess fluid, body waste and electrolyte may accumulate when the kidneys stop working. As the disease progresses, symptoms may include:
- Swelling of the feet and ankles
- Puffy eyes
- Frequent urination
- Nausea and vomiting
- Having poor appetite
- Confusion
- Difficulty in sleeping
- Fatigue or weakness
- Shortness of breath
- Chest pain
- Muscle cramps
- Hypertension
The signs and symptoms of chronic kidney disease are usually nonspecific as other illness may cause them. You might not experience symptoms until permanent damage has occurred since your kidneys can compensate for reduced function.
If the patient experiences any of these symptoms or signs, schedule an appointment with the doctor. Early detection of kidney disease can help preventing the disease’s progression and complications.
During checkups, the doctor may check the blood pressure and kidney function using urine and blood tests, especially if the patient has a medical condition that raises the risk of kidney disease. The doctor can confirm which tests are needed for the diagnosis.
Causes
Chronic kidney disease is usually caused by other conditions or illnesses that affects kidney function. The underlying condition puts a strain on the kidneys which causes kidney damage and can progress overtime. Chronic kidney disease can be caused by:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis an inflammation of the kidney’s filtering units.
- Interstitial nephritis a disorder in which the portion of your kidneys’ filters, known as tubules, become swollen.
- Polycystic kidney disease or other inherited kidney diseases
- Blockage in the flow of urine, from conditions such as enlarged prostate, kidney stones and some cancers
- Vesicoureteral reflux, a condition in which the urine flows back into your kidneys
- Recurrent kidney infection, also called pyelonephritis
Risk factors
Several factors can contribute to the risk of chronic kidney disease. This includes:
- History: Member of the family has history of kidney disease
- Age: The risk increases when the person gets older
- Other diseases: Having pre-existing disease could increase the risk of kidney disease such as high blood pressure, diabetes, heart diseases,
- Body Mass Index: Above normal body mass index or overweight person are at high risk.
- Medication: Prolong use of certain medicines increase the risk of kidney disease.
- Smoking
- Abnormal kidney structure
Diagnosis
The doctor will initially talk with you about the personal and family medical history to help diagnose kidney disease. The doctor may inquire about the family history of kidney disease, history of high blood pressure, prolonged medications, changes in the urination patterns, and more. After which, a physical and neurological examination may be necessary. The doctor will also evaluate for signs of cardiac or blood vessel problems.
The doctor may request for several laboratory tests and procedures to confirm the diagnosis and verify the severity of the kidney disease. Common tests include:
- Blood tests: The doctor will test your blood for waste products called creatinine and urea.
- Urine tests: This test will determine if there are protein (albumin) or blood in the urine. The presence of any of the two can be an indicator of chronic kidney disease. It can help in knowing the underlying cause of the kidney disease.
- Imaging tests: To evaluate the structure and size of the kidneys, ultrasound, magnetic resonance imaging (MRI) and/or computerized tomography (CT) scans will be recommended.
- Removing a sample of kidney tissue for testing: A kidney biopsy, which includes taking a sample of kidney tissue, may be advised by the doctor. Using a needle, a small sample is extracted, and the cells are examined in the lab to assist diagnose the kidney. A kidney biopsy procedure is done under local anesthesia.
Treatment
The chances on which the kidney disease can be treated depends on the underlying cause. However, in most cases chronic kidney disease is incurable.
The treatment provided can only help to manage the signs and symptoms, lessen complications, and delay the disease’s progression. Patient may need treatment for end-stage renal disease if the kidneys suffer substantial damage.
Treating the cause
The doctor will focus on effectively managing the cause of the kidney disease to prevent it from progressing. The cause of the kidney disease will determine the appropriate type of treatment. However, even if an underlying illness, such as diabetes mellitus or high blood pressure, has been managed, kidney damage might still progress.
Treating complications
Managing the complications related to kidney disease can improve the comfort of patients. Possible treatments include:
- High blood pressure medications: High blood pressure can get worse in kidney disease patients. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers are frequently prescribed by doctors to decrease blood pressure and protect kidney function.
Patient may require frequent blood tests to track the status of waste product because high blood pressure drugs have the potential to affect electrolyte levels and initially reduce kidney function. A low-salt diet and a diuretic may also be recommended.
- Treatments to relieve swelling: Fluid retention is common to people with chronic kidney disease. High blood pressure and limb edema may result from this. The correct volume of fluid in the body can be preserved with the aid of drugs referred to as diuretics.
- Medications to treat anemia: Increasing red blood cell production can help improve kidney function. Erythropoietin hormone and iron acts this role. This could lessen the anemia-related weakness and fatigue.
- Treatments to lower cholesterol levels: High levels of bad cholesterol are common in people with chronic kidney disease, which can raise their risk of heart disease. To reduce the cholesterol, they may be recommended to take drugs called statins.
- Treatments to protect your bones: Vitamin D and calcium supplements can improve bone health. To reduce the amount of phosphate in the blood and shield the blood vessels from harm by calcium deposits, you may also take a drug referred to as a phosphate binder.
- A lower protein diet to minimize waste products in your blood: Kidneys must remove waste product from the blood as the body breaks down protein from diet. The doctor may advise consuming less protein to lessen the strain on the kidneys’s workload. A licensed dietitian can offer advice on how to consume less protein while maintaining a balanced diet.
Regular check-ups with the doctor are necessary to ensure that the treatment is working to slow down the damage of the kidney.
Treatment for end-stage kidney disease
End-stage kidney disease, sometimes called irreversible kidney failure, means unable to remove waste and fluid on their own. With this stage, dialysis or a kidney transplant is necessary.
- Dialysis: When the kidneys are unable to filter out waste and excess fluid from the blood, dialysis could help the patient. A machine separates waste and extra fluid from the blood during hemodialysis.
During peritoneal dialysis, a narrow tube is placed into the abdomen and fills it with a dialysis solution. The dialysis solution absorbs the waste and extra fluid. After a while, the dialysis solution including the waste absorbed is drained out of your belly.
- Kidney transplant: is a surgical procedure which will transplant the kidney either from living or recently pass away donor into the recipient.
Patient may require lifelong medication after a transplant to prevent the body to reject the new organ. A kidney transplant is not required for those who are not on dialysis.
A third option is to manage kidney failure with conservative methods if you decide against dialysis or a kidney transplant. Symptom control, advance care planning, and comfort care will likely be among the conservative methods (palliative care).
