Published on Jul 18, 2018 and last reviewed on Apr 10, 2020 - 5 min read
Chronic kidney disease, also known as a chronic renal disease is a slow and progressive loss of renal function. This article talks about the signs, symptoms, and risks associated with the condition as well as the causes and complications including end-stage renal disease.
Kidneys are organs whose primary function is to filter waste and excess fluids from the blood. In chronic kidney disease, there is a gradual loss of the function of filtering the blood and so there is an accumulation of more fluid and waste in the body. In very severe cases, the build-up can reach dangerous levels. But, initially, there are no to few symptoms felt by the patient. Therefore, many do not realize they have a problem until kidney function has deteriorated to a great extent.
Long-standing uncontrolled diabetes.
Kidney damage due to high blood pressure.
Obstruction of urine flow due to a kidney stone.
Vesicoureteral reflux, a condition that causes the urine to move back to the kidneys.
Recurrent infections such as pyelonephritis.
Prostate enlargement or a tumor.
Abuse of over-the-counter medications and illegal substances.
Exposure to lead and other toxic chemicals.
Nausea and vomiting.
Loss of appetite.
High blood pressure.
Decreased urinary output.
Decreased mental sharpness.
Blood in the urine.
Dryness of skin.
Reduced mental clarity.
Muscle twitches and cramps.
Swelling of feet and hands.
Proteinuria, a condition where a large amount of protein is excreted in the blood.
Increased frequency of urination at night.
A family history of kidney diseases.
Age over 60 years.
Urine output measurement.
Albumin and serum creatinine.
CT or Ultrasound scan of kidneys.
Sometimes, a biopsy may be ordered.
GFR test (Glomerular Filtration Rate).
Glomerular Filtration Rate (GFR) is the calculative value to find out how well the blood is purified by kidneys. When kidneys aren't working well, important substances that should remain in the body, for example, protein, are filtered out, and wastes that should be removed build up in the blood. A normal GFR value is more than or equal to 90 mL/min. The value of GFR tends to decrease due to aging. So having a GFR value between 60 mL/min and 89 mL/min is considered normal for elderly people.
The stages of CKD are:
Stage 1 - normal or high GFR of more than 90 mL/min.
Stage 2 - mild CKD with GFR value between 60 and 89 mL/min.
Stage 3A - moderate CKD with GFR value between 45 and 59 mL/min.
Stage 3B - moderate CKD with GFR value between 30 and 44 mL/min.
Stage 4 - severe CKD with GFR value between 15 and 29 mL/min.
Stage 5 - end-stage CKD with GFR of less than 15 mL/min.
Swelling in your arms and legs due to fluid retention. Accumulation of fluid in the feet is known as pedal edema.
Pulmonary hypertension and edema (high blood pressure and fluid in the lungs).
Increased potassium levels in the blood (hyperkalemia). This might affect the functioning of the heart and result in life-threatening complications.
Brittle bones increase the risk of bone fractures.
Decreased sex drive.
Loss of fertility.
Difficulty in concentration or seizures because of damage to the central nervous system.
Increased risk of infection as the immune response is affected.
In a span of 10 to 15 years, CKD can progress to kidney failure or end-stage renal disease (ESRD). Usually, kidneys are highly adaptable organs and make up their loss of function by various compensatory mechanisms. That is the reason there are no obvious symptoms initially. Later, as they fail, there is a need for an artificial filtering process known as dialysis or in some cases, a renal transplant may be required for survival. In both cases, the chance of success is good. While without treatment, the survival rate is only a few months, with recent advancements and treatment modalities, the life expectancy goes up to many years.
When the GFR has come down to 15 mL/min, It means that the kidney has come to the end-stage kidney. The kidney helps in removing waste, salt, and extra water to prevent them from building up in the body. It helps in keeping a safe level of certain chemicals in your blood, such as potassium, sodium, and bicarbonate.
In hemodialysis, an artificial kidney called hemodialyzer is used to remove wastes. Extra chemicals and fluid from your blood will also be removed. In order to get the blood into the artificial kidney, the doctor makes an opening into the blood vessels. This can be achieved by minor surgery to your arm or leg. In certain cases, it may be necessary to make it a bigger vessel by joining an artery and vein.
The duration of the treatment is 4 hours and has to be done three times a week.
Dialysis will not cure the underlying kidney disease. This will substitute for the functioning of a healthy kidney.
There is no permanent cure for CKD, but the treatment focuses on making lifestyle changes. Focus on controlling chronic conditions such as diabetes and hypertension, if present.
Take a low sodium and potassium diet.
Exercise regularly for at least 30 minutes a day.
Maintain your BMI (body mass index) in the ideal range.
Quit smoking, if you do.
Stop consuming alcohol.
Foods to be avoided: Banana, coconut, dates, lemon, white beans, black beans, orange, and tomatoes.
Food to be consumed: Papaya, apple, guava, olive oil, cardamom, carrot, garlic, ginger, turnip, radish, wheat, rice, and low-fat milk.
Renal artery stenosis.
Systemic lupus erythematosus.
It is difficult to predict the life expectancy of a person with chronic kidney failure. It totally depends on the age, other underlying health problems. Most people with early chronic kidney failure will never have end-stage renal failure. It is possible for patients to live for many years with dialysis and kidney transplants.
One of the ideal ways to test for chronic kidney disease is to perform a simple urine test. Identify the level of albumin using this test. This test will help you to assess the kidney damage. It is advised that you get help from a doctor. If you want to get help from home, you might get help from online platforms like iCliniq.
Eating a balanced diet and performing regular exercises are ideal habits for overall health, including kidney’s health. It is a great way to take control of your physical health. Inappropriate food habits can affect the health of the kidney. Avoid processed foods and junk foods. Always choose fresh fruits and vegetables. To maintain a normal GFR, the magic formula is to follow a low-salt diet.
There is a common misconception that you should drink a minimum of eight glasses of water each day. But the requirement of drinking water will be different for each individual. It is necessary that you maintain an appropriate level of hydration. If you have kidney failure, drinking too much water can increase the load on your kidney. This might reduce efficiency later. You should ask the doctor’s advice to maintain normal GFR.
When your kidneys stop working, your body begins to fill with additional water and waste products. This condition is known as uremia. You will feel very tired and weak. This is because the body needs to clean up the blood to function properly. The uremia which is left untreated may eventually lead to seizures or coma. This will lead to death in the long-run.
The procedure of dialysis itself does not cause any harm. In the procedure of hemodialysis, the needles might be pricking too much during the procedure. You can ask your doctor to provide anesthesia for numbing. In peritoneal dialysis, severe abdominal pain can be present.
Cranberry juice is the best choice. This will keep your urinary tract and kidney in perfect form. Wine can be good for your kidneys. Citric acid juices like lemon juices are known to cure kidney stones.
The foods to be avoided are canned foods, bananas, brown rice, dairy products, fruits like avocados and orange. Beverages like dark-colored colas should be totally avoided.
Patients with end-stage renal disease might require permanent dialysis. It is a mechanical filtration process that is used to remove toxins and wastes from our body. If this does not help, your doctor might advise for a kidney transplant.
When you are in the end-stage of kidney failure, you might need dialysis. Most of the time, before you start dialysis, 85 to 90 percent of your kidney function might be lost. The GFR rate would have been reduced to less than 15.
Query: Hi doctor, My mother is suffering from chronic kidney disease, and her creatinine level is 9.8 mg/dL. She has a history of diabetes for the past 25 years. She is taking Insulin from the beginning. She has hypertension for the past 35 years. Her hemoglobin is about 11.0 gm/dL. Her eyesight has been ... Read Full »
Query: Hello doctor, If a person with chronic kidney disease with a creatinine of 1.9 and a GFR of 40 receives Toradol 60 mg IM as a single dose, can that lead to acute renal failure? How soon would failure occur after the administration of the medication? Read Full »
Query: Hi doctor, I am 40 years old, and my weight is 97 kilograms. I am a diabetic patient, and my A1C test showed a result of 9 %. I am taking Sitaglu Met 500 mg. It has not helped me. When I take it, within five minutes, my sugar level gets increased to 250 mg/dL and comes down again to 180 mg/dL or 19... Read Full »
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