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Chronic kidney disease, also known as chronic kidney failure, is characterized by a progressive loss of kidney function. Wastes and excess fluids in your blood are filtered by your kidneys and excreted in your urine. Advanced chronic kidney disease can result in dangerously high levels of fluid, electrolytes, and wastes in your body.
You may have few signs or symptoms in the early stages of chronic kidney disease. You might not realize you have kidney disease until it is too late.
Chronic kidney disease treatment focuses on slowing the progression of kidney damage, usually by addressing the underlying cause. However, even if the cause is controlled, kidney damage may progress. Chronic kidney disease can lead to end-stage kidney failure, which is fatal in the absence of artificial filtering (dialysis) or a kidney transplant.
WHAT ARE THE SYMPTOMS OF CHRONIC KIDNEY DISEASE?
If kidney damage progresses slowly, signs and symptoms of chronic kidney disease develop over time. A loss of kidney function can result in a buildup of fluid or body waste, as well as electrolyte imbalances. Depending on the severity, kidney function loss can result in:
- Nausea
- Vomiting
- Appetite loss
- Weakness and fatigue
- Sleep issues
- More or less urinating
- Reduced mental acuity
- Cramps in the muscles
- Foot and ankle swelling
- Itchy, dry skin
- Hypertension (high blood pressure) that is difficult to control
- Shortness of breath if fluid accumulates in the lungs
- If fluid accumulates around the heart's lining, it can cause chest pain.
The signs and symptoms of kidney disease are frequently vague. As a result, they can be caused by other illnesses as well. Because your kidneys can compensate for lost function, you may not notice any symptoms until irreversible damage has occurred.
WHAT ARE THE CAUSES OF CHRONIC KIDNEY DISEASE?
Chronic kidney disease develops when a disease or condition impairs kidney function, causing kidney damage to worsen over a period of months or years.
Chronic kidney disease is caused by a variety of diseases and conditions, including:
- Diabetes type 1 or diabetes type 2
- High blood pressure
- Glomerulonephritis, which is an inflammation of the filtering units of the kidney (glomeruli)
- Interstitial nephritis, which is an inflammation of the tubules and surrounding structures of the kidney.
- Other inherited kidney diseases, such as polycystic kidney disease
- Prolonged urinary tract obstruction caused by conditions such as an enlarged prostate, kidney stones, and some cancers
- Vesicoureteral reflux, which is a condition in which urine backs up into the kidneys.
- Repeated kidney infection, also known as pyelonephritis
WHAT ARE THE RISK FACTORS OF CHRONIC KIDNEY DISEASE?
The following factors can increase your risk of chronic kidney disease:
- Diabetes
- High blood pressure
- Heart disease (cardiovascular disease)
- Smoking
- Obesity
- Being African American, Native American, or Asian American
- Kidney disease in the family
- An abnormal kidney structure
- Older age
- Use of medications that can harm the kidneys on a regular basis
WHAT ARE THE COMPLICATIONS OF CHRONIC KIDNEY DISEASE?
Chronic kidney disease can have an impact on almost every organ in your body. Complications that could arise include:
- Fluid retention, which can cause swelling in your arms and legs, high blood pressure, and fluid in your lungs (pulmonary edema)
- A sudden increase in potassium levels in your blood (hyperkalemia), which can impair heart function and be fatal.
- Anemia
- Reduced immune response, making you more susceptible to infection
- Pericarditis is an inflammation of the sac-like membrane that surrounds the heart (pericardium)
- Complications of pregnancy pose risks to both the mother and the developing fetus.
- End-stage kidney disease causes irreversible kidney damage, necessitating dialysis or a kidney transplant for survival.
- Cardiovascular disease
- Weak bones and a higher risk of fractures
- Reduced sex drive, erectile dysfunction, or infertility
- Damage to your central nervous system, which can result in difficulty concentrating, personality changes, or seizures.
HOW IS CHRONIC KIDNEY DISEASE DIAGNOSED?
Your doctor will ask you about your personal and family history as a first step toward a diagnosis of kidney disease. Your doctor may inquire about whether you've been diagnosed with high blood pressure, whether you've taken a medication that could impair kidney function, whether you've noticed changes in your urinary habits, and whether you have family members with kidney disease.
Following that, your doctor will perform a physical exam to look for signs of heart or blood vessel problems, as well as a neurological exam.
Certain tests and procedures may be required for kidney disease diagnosis in order to determine the severity of your kidney disease (stage). Among the possible tests are:
- Blood tests: Kidney function tests measure the amount of waste products in your blood, such as creatinine and urea.
- Urine tests: A urine sample can be analyzed to detect abnormalities that indicate chronic kidney failure and to help determine the cause of chronic kidney disease.
- Imaging tests: Ultrasound may be used by your doctor to evaluate the structure and size of your kidneys. In some cases, other imaging tests may be used.
- Taking a kidney tissue sample for testing: A kidney biopsy, which involves removing a sample of kidney tissue, may be recommended by your doctor. A long, thin needle is inserted through your skin and into your kidney during a kidney biopsy, which is usually performed under local anesthesia. The biopsy sample is sent to a lab for testing to help determine the source of your kidney problem.
WHAT ARE THE TREATMENTS FOR CHRONIC KIDNEY DISEASE?
Some types of kidney disease can be treated, depending on the underlying cause. Chronic kidney disease, on the other hand, is frequently incurable.
Treatment typically consists of measures to control signs and symptoms, reduce complications, and slow disease progression. If your kidneys are severely damaged, you may require end-stage kidney disease treatment.
Treating the cause
Your doctor will attempt to slow or control the underlying cause of your kidney disease. Treatment options differ depending on the underlying cause. However, even if an underlying condition, such as diabetes mellitus or high blood pressure, is under control, kidney damage can worsen.
Treating complications
Complications of kidney disease can be managed to make you more comfortable. Treatment options may include:
- Medication for high blood pressure: High blood pressure can worsen in people with kidney disease. Your doctor may prescribe medications to lower your blood pressure and preserve kidney function, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers.
Because high blood pressure medications can temporarily impair kidney function and alter electrolyte levels, you may require frequent blood tests to monitor your condition. Your doctor may also advise you to take a water pill (diuretic) and follow a low-salt diet.
- Medications to relieve swelling: Fluid retention is common in people with chronic kidney disease. This can result in leg swelling as well as high blood pressure. Diuretics are medications that can help keep your body's fluid balance in check.
- Medications to treat anemia: Erythropoietin supplements, sometimes combined with iron, aid in the production of red blood cells. This may alleviate anemia-related fatigue and weakness.
- Cholesterol-lowering medications: To lower your cholesterol, your doctor may advise you to take statin medications. Chronic kidney disease patients frequently 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 bone weakness and reduce your risk of fracture. You may also be prescribed a phosphate binder to reduce the amount of phosphate in your blood and protect your blood vessels from damage caused by calcium deposits (calcification).
- A low-protein diet to reduce waste products in the blood: Your body generates waste products as it processes protein from foods, which your kidneys must filter from your blood. Your doctor may advise you to eat less protein to reduce the amount of work your kidneys must do. A registered dietitian can advise you on how to reduce your protein intake while maintaining a healthy diet.
Your doctor may advise you to undergo regular follow-up testing to determine whether your kidney disease is stable or progressing.
End-stage kidney disease treatment
End-stage kidney disease occurs when your kidneys are unable to keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure. You'll need dialysis or a kidney transplant at that point.
- Dialysis: When your kidneys are unable to remove waste products and extra fluid from your blood, dialysis is used to do so. A machine filters waste and excess fluids from your blood during hemodialysis.
A thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids during peritoneal dialysis. The dialysis solution eventually drains from your body, carrying the waste with it.
- Kidney transplant: A kidney transplant is the surgical placement of a healthy kidney from a donor into your body. Transplanted kidneys can be obtained from either deceased or living donors.
You'll need to take medications for the rest of your life to keep your body from rejecting the new organ after a transplant. A kidney transplant does not require that you be on dialysis.
If you do not want to have dialysis or a kidney transplant, you have a third option: treat your kidney failure with conservative measures. Conservative measures will most likely include symptom management, advance care planning, and comfort care (palliative care).