Chronic kidney disease or chronic kidney failure, is the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then expelled in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can accumulate in your body.
A person may have few signs or symptoms in the early stages of chronic kidney disease. Chronic kidney disease may not become obvious until your kidney function is significantly weakened.
Treatment for chronic kidney disease controls the underlying cause by focusing on slowing the progression of the kidney damage. Chronic kidney disease can progress to end-stage kidney failure, which is deadly without artificial filtering (dialysis) or a kidney transplant.
Symptoms of Kidney disease
Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Symptoms of kidney disease may include:
- Nausea and vomiting
- Swelling of feet and ankles
- Chest pain, if fluid accumulates around the lining of the heart
- Loss of appetite
- Shortness of breath, if fluid builds up in the lungs
- Fatigue and weakness
- Severe itching
- Changes in how much you urinate
- Decreased mental sharpness
- Muscle twitches and cramps
- High blood pressure (hypertension) that’s difficult to control
Signs and symptoms of kidney disease can also be caused by other illnesses. Symptoms may not appear until irreversible damage because your kidneys are highly adaptable and able to compensate for lost function.
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When to see a doctor
If you have a medical condition that increases your risk of kidney disease, your doctor is likely to monitor your blood pressure and kidney function with urine and blood tests during regular office visits.
Causes of Kidney disease
Chronic kidney disease occurs when a disease or condition harms kidney function, causing kidney damage to deteriorate over several months or years.
Diseases and conditions that cause chronic kidney disease include:
- Hypertension or High blood pressure
- Type 1 or type 2 diabetes
- Prolonged blockade of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
- Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)
- 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
- Vesicoureteral reflux, a condition that causes urine to back up into your kidneys
Factors that may increase your risk of chronic kidney disease include:
- High blood pressure
- Heart and blood vessel (cardiovascular) disease
- Being African-American, Native American or Asian-American
- Family history of kidney disease
- Older age
- Abnormal kidney structure
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Chronic kidney disease can affect almost every part of your body. Potential complications may include:
- Edema: Fluid retention, which could lead to swelling in your arms and legs
- A sudden rise in potassium levels in your blood (hyperkalemia), which could damage your heart’s ability to function
- Heart and blood vessel (cardiovascular) disease
- Weak bones and an increased risk of bone fractures
- Decreased sex drive, erectile dysfunction or reduced fertility
- 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 saclike membrane that envelops your heart (pericardium)
- Pregnancy complications that carry risks for the mother and the developing fetus
- Irreversible damage to your kidneys, eventually requiring either dialysis or a kidney transplant for survival
To reduce your risk of developing kidney disease:
- Maintain a healthy weight.Maintain it by being physically active most days of the week. If you need to lose weight, discuss with your doctor about strategies for healthy weight loss.
- Follow instructions on over-the-counter medications.When using nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others), follow the instructions on the package. Taking too many pain relievers could lead to kidney damage.
- Don’t smoke.Cigarette smoking can damage your kidneys and worsen existing kidney damage. If you’re a smoker, talk to your doctor about strategies for quitting smoking.
- Manage your medical conditions with your doctor’s help.If you have diseases or conditions that increase your risk of kidney disease, work with your doctor to control them.
Your doctor might ask questions about whether you’ve been diagnosed with high blood pressure, if you’ve taken a medication that might affect kidney function, if you’ve observed changes in your urinary habits, and whether you have any family members who have kidney disease.
Your doctor will also perform a physical exam, to check for signs of problems with your heart or blood vessels, and conducts a neurological exam.
For kidney disease diagnosis, you may also need certain 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.Examining a sample of your urine may reveal irregularities that point to chronic kidney failure and help identify the cause of chronic kidney disease.
- Imaging tests.Your doctor may use ultrasound to assess the structure and size of your kidneys. 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 for testing. Kidney biopsy is often performed under 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 examination.
Depending on the underlying cause, some types of kidney disease can be treated. Though there’s no cure for chronic kidney disease. Treatment consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you may need treatment for end-stage kidney disease.
Treating the cause
Your doctor will work to slow or control the cause of your kidney disease. 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.
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Kidney disease complications can be controlled to make you more comfortable. Treatments may include:
- High blood pressure medications.People with kidney disease 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 need frequent blood tests to monitor your condition. Your doctor will likely also recommend a water pill (diuretic) and a low-salt diet.
- Medications to lower cholesterol levels.Your doctor may recommend medications called statins to lower your cholesterol. People with chronic kidney disease often experience high levels of bad cholesterol, which can increase the risk of heart disease.
- Medications to treat anemia. Your doctor may recommend supplements of the hormone erythropoietin, sometimes with added iron. Erythropoietin supplements assist in production of more red blood cells, which may relieve fatigue and weakness associated with anemia.
- Medications to relieve swelling.People with chronic kidney disease may retain fluids, causing swelling in the legs and high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.
- Medications to protect your bones. Calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture may be prescribed by your doctor. You may also take a phosphate binder to lower the amount of phosphate in your blood, and protect your blood vessels from damage by calcium deposits (calcification).
- 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 perform, you may consume 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, you need dialysis or a kidney transplant.
- Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. In peritoneal dialysis, a thin tube (catheter) inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a period of time, the dialysis solution drains from your body, carrying the waste with it.
- Kidney transplant.A kidney transplant surgically places a healthy kidney from a donor into your body. Transplanted kidneys can come from 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.
For some who choose not to have dialysis or a kidney transplant, a third option is to treat kidney failure with conservative measures. However, once you have complete kidney failure, your life expectancy would be only a few months.
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