CHRONIC KIDNEY DISEASE
Also called chronic kidney failure chronic kidney disease, describes the gradual loss of kidney function. The kidneys filter wastes and excess fluids from the blood, which are then expelled in urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid and electrolytes as well as wastes can build up in the body.
One may have few signs or symptoms in the early stages of chronic kidney disease. Thus chronic kidney disease may not become apparent until the functions of the kidney is significantly impaired.
Treatment for chronic kidney disease normally focuses on slowing down the progression of the kidney damage, which is usually by controlling the underlying cause. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.
Facts about Chronic Kidney Disease (CKD)
- At increased risk are African Americans, Hispanics, Pacific Islanders, American Indians and the elderly.
- For most people with CKD, heart disease is the major cause of death.
- The early detection can help prevent the progression of kidney disease to kidney failure.
- The best estimate of kidney function is Glomerular filtration rate (GFR).
- Hypertension causes CKD and vice versa.
- Persistent protein in the urine (proteinuria) indicates the presence of CKD.
- Those with diabetes, hypertension and family history of kidney failure are in the high risk group.
- blood pressure, urine albumin and serum creatinine are Simple tests that can detect CKD
CAUSES
Kidneys carry out a very complex system of filtration in the human body, it filters excess waste and fluid material from the blood. These are removed and excreted from the body through urine.
In most cases, kidneys can eliminate most waste materials that the body produces. However, if blood flow to the kidneys is affected, if the kidneys are not working properly because of damage or disease, or if urine outflow is obstructed, problems are likely to occur.
In majority of the cases, progressive kidney damage is the result of a chronic (long-term) disease, such as:
- Obstructed urine
If its flow is blocked, urine can back up into the kidney from the bladder (a.k.a. vesicoureteral reflux). Blocked urine flow will naturally increase pressure on the kidneys and will undermine its function. Possible causes of this will include an enlarged prostate, kidney stones, or a tumor.
- Kidney artery stenosis
When the renal artery narrows or is blocked before it joining the kidney.
- Diabetes
Chronic kidney disease is linked to both types 1 and 2 diabetes. If the person's diabetes is not well controlled, glucose (excess sugar) can accumulate in the blood. Kidney disease is not common during the first 10 years of diabetes; it mostly occurs 15-25 years after the diagnosis of diabetes.
- Hypertension (high blood pressure)
Blood pressure, if it is consistently high can damage the parts of the kidney involved in filtering waste products (glomeruli).
- Kidney diseases
Polycystic kidney disease, Pyelonephritis, or Glomerulonephritis etc.
Certain toxins
Fuels, carbon tetrachloride, and lead and lead-based paint, pipes, and soldering materials. Some types of jewelry also have toxins, which can lead to chronic kidney failure.
- Some medications overuse :, for example, too much use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.
- Problem with fetal developmental
When the kidneys do not develop properly while the unborn baby is developing in the womb.
- Systemic lupus erythematosus
An autoimmune disease in which the body's own immune system attacks the kidneys as though they were foreign tissue.
- Malaria and yellow fever : Both known to cause impaired kidney function.
- Illicit substance abuse : such as use of heroin or cocaine.
- Injury : A sharp blow or physical injury to the kidney(s).
SYMPTOMS
One may notice one or more of the following symptoms if the kidneys are beginning to fail:
- Itching - An irritating sensation that makes one want to scratch the skin
- Muscle cramps - Overuse of a muscle, dehydration, muscle strain or simply the effect of holding a position for a prolonged period
- Too much urine or dearth of it - Frequent urination, or lack of same could be a sign of diabetes. It can also be a sign of kidney or ureter problems, urinary bladder problems, or other medical conditions, such as pregnancy, or prostate gland problems
- Trouble sleeping - Difficulty falling asleep at night. Waking up during the night. Waking up too early. Not feeling well-rested after a night's sleep
- Nausea and vomiting - Vomiting is an uncontrollable reflex that expels the contents of the stomach through the mouth. Nausea is a term that describes the feeling that one might vomit, but aren't actually vomiting.
- Not feeling hungry - Loss of appetite is also known as anorexia, which can have a medical or psychological cause.
- Swelling in the feet and ankles - When the muscles are inactive, they can't pump body fluids back up toward the heart. The retention of water and blood can cause swelling in the legs.
- Trouble with breathing - Shortness of breath, or dyspnea, is an uncomfortable condition that makes it difficult to fully get air into the lungs.
If the kidneys suddenly stop working (acute kidney failure), the following symptoms may be noticed;
- Rash - A rash is a noticeable change in the texture or color of the skin.
- Back pain - An ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs
- Vomiting - Vomiting is an uncontrollable reflex that expels the contents of the stomach through the mouth
- Diarrhea : When faeces are discharged from the bowels frequently and in a liquid form
- Abdominal pain - Pain that one feels anywhere between the chest and groin
- Fever - A body temperature that is higher than normal.
- Nosebleeds - Simply bleeding from the blood vessels in the nose.
Having one or more of any of the symptoms above may be a sign of serious kidney problems.
Symptoms of advanced CKD
- Nausea
- Vomiting
- Loss of appetite
- Chest pain
- Dry skin
- Itching or numbness
- Feeling tired
- Headaches
- Increased or decreased urination
- Muscle cramps
- Shortness of breath
- Sleep problems
- Trouble concentrating
- Weight loss
- Anemia
- Bone disease, and
- Malnutrition
STAGES
Changes in the GFR rate can assess how advanced the kidney disease is. In many countries, kidney disease stages are classified as follows:
Stage 1 : GFR rate is normal. However, evidence of kidney disease has been detected.
Stage 2 : GFR rate is lower than 90 milliliters, and evidence of kidney disease has been detected.
Stage 3 : GFR rate is lower than 60 milliliters, regardless of whether evidence of kidney disease has been detected.
Stage 4 : GRF rate is lower than 30 milliliters, regardless of whether evidence of kidney disease has been detected.
Stage 5 : GFR rate is lower than 15 milliliters. Renal failure has occurred.
The majority of patients with chronic kidney disease rarely progress beyond Stage 2. It is therefore important for kidney disease to be diagnosed and treated early in order to prevent serious damage.
Patients with diabetes should have an annual test, which measures small amounts of protein (micro albuminuria) in urine.
WHEN TO SEE A DOCTOR
People must make appointment with their doctors if they have any signs or symptoms of kidney disease.
The doctor is likely to monitor blood pressure and kidney function with urine and blood tests, if they have medical condition that increases the risk of kidney disease.
RISK FACTORS
Factors that may increase a person's risk of chronic kidney disease include:
- Family history of kidney disease
- Old age
- Obesity - A complex disease involving an excessive amount of body fat
- Diabetes - A metabolic disease that causes high blood sugar
- High blood pressure - a common condition in which the long-term force of the blood against the artery walls is high enough that it may eventually cause health problems, such as heart disease.
- Heart and blood vessel (cardiovascular) disease - a general term for conditions affecting the heart or blood vessels.
- Smoking - A practice in which a substance is burned and the resulting smoke is breathed in to be tasted and absorbed into the bloodstream.
- Being African-American, Native American or Asian-American
- Abnormal kidney structure - All types of structural problems (solitary kidney, hydronephrosis, renal hypoplasia, duplex kidney, posterior urethral valves, etc.)
COMPLICATIONS
Chronic kidney disease can affect almost every part of the body. Potential complications may include:
- Weak bones and an increased risk of bone fractures - Osteoporosis causes bones to become weak and brittle, so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture.
- Anemia - A condition in which one lacks enough healthy red blood cells to carry adequate oxygen to the body's tissues
- Fluid retention, which could lead to swelling in the arms and legs, high blood pressure, or fluid in the lungs (pulmonary edema)
- A rise in potassium levels in the blood (hyperkalemia), which could impair the heart's ability to function. This could be life threatening.
- Heart and blood vessel (cardiovascular) disease - A general term for conditions affecting the heart or blood vessels.
- Decreased sex drive, erectile dysfunction or reduced fertility - Loss of libido (sex drive) is a common problem that affects many men and women at some point in their life. Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. Fertility is the natural capability to re-produce or produce offspring.
- Damage to the central nervous system - Disorders of the nervous system include stroke, infections, such as meningitis, carpal tunnel syndrome
- Decreased immune response - Occur when the body's immune response is reduced or absent which makes one more vulnerable to infections
- Pericarditis - Refers to inflammation of the pericardium, two thin layers of a sac-like tissue that surround the heart, hold it in place and help it work.
- Pregnancy complications - Health problems that occur during pregnancy
- Irreversible damage to the kidneys - End-stage kidney disease eventually requiring either dialysis or a kidney transplant for survival.
DIAGNOSIS
A doctor will check for signs and ask the patient about symptoms. The following tests may also be ordered:
- Blood test
A blood test to determine whether waste substances are being adequately filtered out may be ordered. If persistently high levels of urea and creatinine are found, the doctor will most likely diagnose end-stage kidney disease.
- Urine test
A urine test to find out whether there is either blood or protein in the urine.
- Kidney scans
Kidney scans may include a magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or an ultrasound scan. The aim would be to determine whether there are any blockages in the urine flow. In advanced stages of kidney disease the kidneys are smaller and have an uneven shape. The scans can also reveal the size and shape of the kidneys therefore would assist greatly in the diagnosis.
- Kidney biopsy
A sample of kidney tissue would be extracted and examined for cell damage. An analysis of kidney tissue makes it easier to make a precise diagnosis of kidney disease.
- Chest X-ray
The aim of this test would be to check for pulmonary edema (fluid retained in the lungs).
- Glomerular filtration rate (GFR)
This is a test that compares the levels of waste products in the patient's blood and urine. GFR measures how many milliliters of waste the kidneys can filter per minute. The kidneys of healthy individuals can typically filter over 90 ml per minute.
TREATMENT
There is currently no cure for chronic kidney disease. However, some therapies can help control the signs and symptoms, reduce the risk of complications, and slow the progression of the disease.
Most patients with chronic kidney disease typically will need to take a large number of medications.
Treatments include:
- Anemia treatment
It is hemoglobin a substance in red blood cells that carries vital oxygen around the body. If hemoglobin levels are low, the patient is said to have anemia.
Some kidney disease patients with anemia will require blood transfusions. A patient with kidney disease will usually have to take iron supplements, either in the form of daily ferrous sulfate tablets, or occasionally in the form of injections.
- Phosphate balance
People with kidney disease will be advised to reduce their nutritional phosphate intake because they may not be able to eliminate phosphate from their body properly. This would mean reducing consumption of dairy products, red meat, eggs, and fish.
- High blood pressure
High blood pressure is common problem among patients with chronic kidney disease. It is critical to bring the blood pressure down to protect the kidneys, and subsequently slow down the progression of the disease.
- Skin itching
Antihistamines, may help alleviate symptoms of itching.
- Anti-sickness medications
If toxins build up in the body because the kidneys don't work properly, patients may feel sick (nausea). Medications such as cyclizine may help relieve sickness.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as ibuprofen should be avoided and only taken if a doctor recommends them.
- End-stage treatment
This is when the kidneys are functioning at less than 10-15 percent of normal capacity. The mitigating measures used so far (e.g. diet, medications, and treatments controlling underlying causes) are no longer enough.
The kidneys of patients with end-stage kidney disease cannot keep up with the waste and fluid elimination process on their own. At this stage, the patient will need dialysis or a kidney transplant in order to survive.
A lot of doctors will try to delay the need for dialysis or a kidney transplant for as long as possible because dialysis also carries the risk of potentially serious complications.
- Kidney dialysis
Peritoneal dialysis is a treatment option for chronic kidney disease.
There are two main types of kidney dialysis, with each type also having subtypes. The two main types are:
Hemodialysis: Blood is pumped out of the patient's body and goes through a dialyzer (an artificial kidney). The patient undergoes hemodialysis about three times per week. Each session lasts for at least 3 hours.
Peritoneal dialysis: The blood is filtered in the patient's own peritoneal cavity which contains a vast network of tiny blood vessels. A catheter is implanted into the abdomen, into which a dialysis solution is infused and drained out for as long as is necessary to remove waste and excess fluid.
- Kidney transplant
The kidney donor and recipient should have the same blood type, cell-surface proteins and antibodies, in order to minimize the risk of rejection of the new kidney. Usually, the most suitable donors are siblings or very close relatives. If a living donor is not possible, the search will begin for a cadaver (dead person) donor.
DIET
Following a proper diet is vital for effective treatment of kidney failure. Specifically, restricting the amount of protein in the diet may help slow down the progression of the disease.
Diet may also help alleviate symptoms of nausea.
- The intake of salt must be carefully regulated to control hypertension. Potassium and phosphorus consumption, over time, may also need to be restricted.
- Vitamin D - Patients with kidney disease typically have low levels of vitamin D. Vitamin D is essential for healthy bones. The vitamin D that is obtained from the sun or food has to be activated by the kidneys before the body can use it
- Fluid retention - People with chronic kidney disease need to be careful with their fluid intake. , the patient is much more susceptible to fluid build-up if the kidneys do not work properly. Most patients will be asked to restrict their fluid intake.
PREVENTION
To lower one's chances of getting kidney disease, one will actually want to focus on two other conditions: diabetes and high blood pressure. The two are the biggest threats to the kidneys. Many people have diabetes and/or high blood pressure and don't know it. So people must schedule checkups to ensure proper attention.
If the doctor diagnoses diabetes or hypertension, it will be important to work to bring it under control. That will spare the kidneys from the extra wear and tear that high blood sugar levels or high blood pressure cause over time.
Keep all healthy habits going strong. The things one does to take care of the heart and weight (e.g. Eating a healthy diet, not smoking, limiting alcohol, staying active, and taking any medicines the doctor prescribes), also are good for the kidneys.
Get Tested Regularly
If one has diabetes or high blood pressure, or if kidney problems run in the family, one may need to get regular tests to see how well the kidneys work.
- Urine tests will show if there is too much protein, glucose (sugar), or blood in the urine.
- Blood pressure readings check whether the blood pressure is elevated.
- Fasting blood glucose tests (taken after patient hasn't eaten for several hours) measure the blood sugar.
- Creatinine tests will measure the amount of waste from muscle activity because creatinine levels rise when the kidneys don't work properly.
These tests will not prevent kidney disease. But early detection or diagnosis of the problem when it's still in the early stages, could help prevent kidney failure.
