Overview
Chronic kidney disease (CKD) is a gradual loss of kidney function, where the kidneys are unable to filter waste and excess fluids from the blood effectively. CKD can lead to a buildup of fluids, electrolytes, and waste in the body, which can cause numerous health complications. In its early stages, CKD may not display any symptoms, making it difficult to detect until the condition advances. Treatment for CKD focuses on controlling the underlying cause to slow the progression of kidney damage. However, even with proper treatment, kidney damage may continue to worsen, potentially resulting in end-stage kidney failure, which requires either dialysis or a kidney transplant to survive. Risk factors for CKD include diabetes, high blood pressure, heart disease, smoking, obesity, certain ethnic backgrounds, family history, and older age.
Understanding the disease
Symptoms
The symptoms of chronic kidney disease can include: nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, urinating more or less, decreased mental sharpness, muscle cramps, swelling of feet and ankles, dry, itchy skin, high blood pressure (hypertension) that's difficult to control, and shortness of breath or chest pain if fluid builds up in the lungs or around the lining of the heart. In the advanced stages, kidney failure symptoms may include rashes, itchy skin, muscle cramps, upset stomach, vomiting, less appetite, and confusion.
Risk Factors
Risk factors for developing chronic kidney disease include: diabetes, high blood pressure, heart (cardiovascular) disease, smoking, obesity, being Black, Native American, or Asian American, family history of kidney disease, abnormal kidney structure, older age, and frequent use of medications that can damage the kidneys.
Development
Chronic kidney disease develops when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. Some of the diseases and conditions that cause chronic kidney disease include:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis, an inflammation of the kidney's filtering units (glomeruli)
- Interstitial nephritis, an inflammation of the kidney's tubules and surrounding structures
- Polycystic kidney disease or other inherited kidney diseases
- 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 These conditions can damage the kidneys gradually, leading to a decline in kidney function over time. In the early stages of chronic kidney disease, there might be few signs or symptoms, making it important to be proactive with regular check-ups, especially if you have a medical condition that increases your risk of kidney disease.
Assessment and Diagnosis
Triage
You should see a doctor if you have signs or symptoms of chronic kidney disease or if you have a medical condition that increases your risk of kidney disease. Early detection might help prevent kidney disease from progressing to kidney failure. If you have any of the symptoms listed, such as nausea, vomiting, fatigue, swelling, or high blood pressure that is difficult to control, you should make an appointment with your doctor. Your doctor may perform urine and blood tests to check your kidney function and help determine if you have chronic kidney disease. It's important to manage any underlying conditions and work with your doctor to slow the progression of kidney damage.
Diagnosis
To diagnose chronic kidney disease, your doctor will typically start by discussing your personal and family history, performing a physical exam, and conducting a neurological exam. Additional tests and procedures may include blood tests, urine tests, imaging tests, and a kidney biopsy. Blood tests can assess kidney function by measuring waste products in your blood, while urine tests can identify abnormalities indicating chronic kidney failure. Imaging tests, such as ultrasound or CT scans, can evaluate kidney structure and size. A kidney biopsy involves removing a sample of kidney tissue for laboratory analysis to determine the cause of kidney problems.
Management and Treatment
Complications
Potential complications of chronic kidney disease include fluid retention, hyperkalemia, anemia, heart disease, weak bones and increased risk of bone fractures, decreased sex drive and fertility, damage to the central nervous system, decreased immune response, pericarditis, and pregnancy complications.
Prevention
Chronic kidney disease can be prevented to some extent by adopting a healthy lifestyle. Maintaining a healthy lifestyle can help prevent atherosclerosis, which can cause chronic kidney disease. The following measures can be taken to reduce the risk of kidney disease:
- Quit smoking.
- Eat healthy foods.
- Exercise regularly.
- Maintain a healthy weight.
- Check and maintain a healthy blood pressure.
- Check and maintain healthy cholesterol and blood sugar levels. While these steps might not entirely prevent chronic kidney disease, they can help slow its progression. In cases where the disease is caused by polycystic kidney disease, genetic counseling and managing blood pressure can help prevent complications.
Treatment
Treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the cause. However, even controlling the cause might not keep kidney damage from progressing. In advanced cases, chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant. In addition to managing underlying medical conditions, some general lifestyle changes that can help protect kidney health include:
- Managing blood pressure through medications and a low-salt, healthy diet.
- Maintaining a healthy weight.
- Engaging in regular physical activity.
- Limiting alcohol consumption.
- Avoiding smoking and exposure to toxic substances. It is important to consult with a healthcare professional for personalized advice on managing chronic kidney disease.
Preparing for medical consultation
Preparing for an appointment for chronic kidney disease involves several steps. First, make an appointment with your primary care provider or a doctor who specializes in kidney health (nephrologist). Before the appointment, ask if there's anything you need to do in advance, such as fasting before a specific test. Make a list of the following information:
- Your symptoms, including any that seem unrelated to your kidneys or urinary function, and when they began
- All medications, vitamins, or other supplements you take, including doses
- Your and your family's medical history, particularly kidney diseases
- Any questions you have about your condition, treatment options, potential side effects, or managing other health conditions Consider bringing a family member or friend along to help you remember the information you receive. Also, ask your doctor for a referral to a dietitian who can help you plan your meals. Regular physical activity, talking with someone you trust, and seeking support from a social worker or counselor may also be beneficial. Remember to prepare for your appointment by taking care of your overall health and well-being, including managing stress and maintaining a balanced diet.