Chronic Kidney Disease

 Chronic Kidney Disease

is a condition characterized by a gradual loss of kidney function over time. CKD is also known as chronic renal disease. Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. Treatment for chronic kidney failure focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney failure can progress to end-stage kidney disease, which is fatal without artificial filtering (dialysis) or a kidney transplant.

What causes Chronic Kidney Disease?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are:

• Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease.


• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.


• Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.


• Lupus and other diseases that affect the body's immune system.


• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.


• Repeated urinary infections.

What are the symptoms of Chronic Kidney Disease?

Signs and symptoms of kidney failure develop slowly over time if kidney damage progresses slowly. Signs and symptoms of kidney failure may include:

• Nausea


• Vomiting


• Loss of appetite


• Fatigue and weakness ( feel more tired and have less energy )


• Sleep problems ( have trouble sleeping )


• Changes in urine output (need to urinate more often, especially at night   )


• Decreased mental sharpness


• Muscle twitches and cramps (have muscle cramping at night )


• Hiccups


• puffiness around eyes, especially in the morning


• Swelling of the feet and ankles


• Persistent itching ( have dry, itchy skin )


• Chest pain, if fluid accumulates around the lining of the heart


• Shortness of breath, if fluid accumulates in the lungs


• High blood pressure (hypertension) that's difficult to control

Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:

• have diabetes


• have high blood pressure


• have Heart disease


• have High cholesterol


• are obese


• are Smoking


• have a family history of kidney failure


• are 65 or older


• belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.

Signs and symptoms of kidney failure are often nonspecific, meaning they can also be caused by other illnesses. In addition, because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms of kidney failure may not appear until irreversible damage has occurred.

Causes:

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

Diseases and conditions that commonly cause chronic kidney failure include:

• Type 1 or type 2 diabetes


• High blood pressure


• Glomerulonephritis (gloe-mer-u-lo-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli)


• Polycystic kidney disease


• Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers


• Vesicoureteral  reflux, a condition that causes urine to back up into your kidneys


• Recurrent kidney infection, also called pyelonephritis

Complications:

Chronic kidney failure can affect almost every part of your body. Potential complications may include:

• Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)


• A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening


• Heart and blood vessel disease (cardiovascular disease)


• Weak bones and an increased risk of bone fractures


• Anemia


• Decreased sex drive or impotence


• Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures


• Decreased immune response, which makes you more vulnerable to infection


• Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium)


• Pregnancy complications that carry risks for the mother and the developing fetus


• Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

Tests and Diagnosis

To determine whether you have chronic kidney failure, you may need tests and procedures such as:

• Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.


• Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.


• Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure, size and degree to which they reflect sound waves (echogenicity). Other imaging tests may be used in some cases.


• Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problems.

Treatments and Drugs

Depending on the underlying cause, some types of chronic kidney failure can be treated. Often, though, chronic kidney failure has no cure. Treatment consists of measures to help control signs and symptoms of chronic kidney failure, reduce complications, and slow the progress of the disease. If your kidneys become severely damaged, you may need treatments for end-stage kidney disease.

Treating the cause of kidney failure

Your doctor will work to slow or control the disease or condition that's causing your kidney failure. Treatment options vary, depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled.

Treating complications of kidney failure Kidney failure complications can be controlled to make you more comfortable. Treatments may include:

• High blood pressure medications. People with chronic kidney failure may experience worsening high blood pressure. Your doctor may 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 may have frequent blood tests to monitor your condition. Your doctor will likely also recommend a low-salt diet.


• Medications to lower cholesterol levels. Your doctor may recommend medications, called statins, to lower your cholesterol. People with chronic kidney failure often experience high levels of bad cholesterol, which can increase the risk of heart disease.


• Medications to relieve anemia. In certain situations, your doctor may recommend supplements of the hormone erythropoietin (uh-rith-row-POY-uh-tin), sometimes with added iron. Erythropoietin supplements can induce production of more red blood cells, which may relieve fatigue and weakness associated with anemia.


• Medications to relieve swelling. People with chronic kidney failure may retain fluids. This can lead to swelling in the arms and legs, as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.


• Medications to protect your bones. Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture. You may also take medication to lower the amount of phosphate in your blood, which increases the amount of calcium available for your bones.


• 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 may recommend eating less protein. Your doctor may also ask you to meet with a dietitian who can suggest ways to lower your protein intake while still eating a healthy diet.

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, dialysis or a kidney transplant is needed.

• Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys aren't able to perform these functions. In hemodialysis, a machine filters waste and excess fluids from your blood. In peritoneal dialysis, you use a catheter to fill your abdominal cavity with a dialysis solution that absorbs waste and excess fluids — then this solution drains out of your body and is replaced with fresh solution.


• Kidney transplant. If you have no life-threatening medical conditions other than kidney failure, a kidney transplant may be an option for you. Kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased donors or from living donors.

If you're unwilling to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. However, your life expectancy generally would be only a few weeks in the case of complete kidney failure.

Chronic Kidney Disease Medical Treatment

There is no cure for chronic kidney disease. The four goals of therapy are to:

1.  slow the progression of disease;


2.  treat underlying causes and contributing factors;


3.  treat complications of disease; and


4.  replace lost kidney function.

Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:

• Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.


• Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep blood pressure below 130/80 mm Hg if one has kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.


• Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with a health care practitioner and a dietitian. For some general guidelines, see the Chronic Kidney Disease Self-Care at Home section of this article.

The complications of chronic kidney disease may require medical treatment.

• Fluid retention is common in kidney disease and manifests with swelling. In late phases, fluid may build up in the lungs and cause shortness of breath.


• Anemia is common with CKD. The two most common causes of anemia with kidney disease are iron deficiency and the lack of erythropoietin. If one is anemic, the doctor will run tests to determine if the anemia is secondary to kidney disease or due to alternative causes.


• Bone disease develops in kidney disease. The kidneys are responsible for excreting phosphorus from the body and processing Vitamin D into its active form. High phosphorus levels and lack of vitamin D cause blood levels of calcium to decrease, causing activation of theparathyroid hormone (PTH). These and several complex changes cause the development of metabolic bone disease. Treatment of metabolic bone disease is aimed at managing serum levels of calcium, phosphorus, and parathyroid hormone.


• Metabolic acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation, and bone disease. If the acidosis is significant, the doctor may use drugs such as sodium bicarbonate (baking soda) to correct the problem.

Chronic Kidney Disease Self-Care at Home

Chronic kidney disease is a disease that must be managed in close consultation with a health care practitioner. Self-treatment is not appropriate.

• There are, however, several important dietary rules one can follow to help slow the progression of kidney disease and decrease the likelihood of complications.


• This is a complex process and must be individualized, generally with the help of a health care practitioner and a registered dietician. 

The following are general dietary guidelines: 

• Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietician can help one determine the appropriate amount of protein.


• Salt restriction: Limit to 2 to 4grams a day to avoid fluid retention and help control high blood pressure.


• Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, the doctor may recommend restriction of water intake.


• Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, avocados, and potatoes.


• Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.

Other important measures that a patient can take include:

• carefully follow prescribed regimens to control blood pressure and/or diabetes;


• stop smoking; and


• lose excess weight.

In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:

• Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])


• Fleets or Phospho-Soda enemas because of their high content of phosphorus


• Laxatives and antacids containing magnesium and aluminum such asmagnesium hydroxide (Milk of Magnesia) and magnesium and aluminum hydroxide (Mylanta)


• Ulcer medication H2-receptor antagonists: cimetidine (Tagamet) and ranitidine(Zantac) (decreased dosage with kidney disease)


• Decongestants such as pseudoephedrine (Sudafed) and phenylpropanolamine (Rhindecon) especially if the patient has high blood pressure


• Alka Seltzer, since this contains large amounts of sodium


• Herbal medications

If a patient has a condition such as diabetes, high blood pressure, or high cholesterol underlying chronic kidney disease, they should take all medications as directed and see their health care practitioner as recommended for follow-up and monitoring.