Chronic Kidney Disease (CKD)

Overview

Chronic kidney disease, referred to as CKD or chronic renal disease, is a progressive condition where the kidneys experience a gradual decline in function. It encompasses various conditions that cause damage to the kidneys, leading to a diminished ability to effectively filter waste products and excess fluids from the blood, which are normally eliminated through urine. As kidney disease progresses, the accumulation of waste substances in the bloodstream can reach elevated levels and result in feelings of illness and discomfort.

Symptoms

Signs and symptoms of chronic kidney disease gradually emerge as the condition advances and causes a slow deterioration of kidney function. The appearance of symptoms can vary depending on the extent of kidney damage and may encompass the following:

Nausea or vomiting
Loss of appetite
Fatigue and weakness
Trouble sleeping
Urinating more often, especially at night
Difficulty in concentrating
Muscle cramps
Swollen feet and ankles
Dry, itchy skin
Puffy eyes
High blood pressure (hypertension)
Shortness of breath
Chest pain
Skin darkening

Causes

Chronic kidney disease occurs when the function of the kidneys is impaired due to the effects of an underlying disease or condition. This leads to a gradual deterioration of kidney function over a span of months or even years. The primary contributors to chronic kidney disease are diabetes and hypertension (high blood pressure), which together account for approximately two-thirds of all cases. Additionally, there are various other diseases and conditions that can result in chronic kidney disease which includes:

Diabetic nephropathy, which develops as a result of either type 1 or type 2 diabetes.
Hypertensive nephrosclerosis, caused by high blood pressure.
Glomerulonephritis, characterized by inflammation of the kidney’s filtering units called glomeruli.
Interstitial nephritis, an inflammation affecting the kidney’s tubules and surrounding structures.
Membranous nephropathy, a disorder wherein the immune system mistakenly attacks the kidney’s waste-filtering membranes.
Polycystic kidney disease, a genetic disorder that causes several fluid-filled cysts to grow in kidneys, and reduces the ability of kidneys to function
Prolonged obstruction of the urinary tract, which can occur due to conditions like enlarged prostate, kidney stones, or certain cancers.
Vesicoureteral reflux, a condition in which urine flows backward from the bladder into the kidneys.
Recurrent kidney infection, also called pyelonephritis
Other inherited kidney diseases

Risk Factors

There are some factors that can put you at high risk of developing chronic kidney disease. Those may include:

Diabetes
High blood pressure
Heart (cardiovascular) disease
Smoking
Obesity
If you are an Africa-American, Hispanic, Native American, Asian Pacific Islanders, or American Indians
Family history of kidney disease
Abnormal kidney structure
Older age (over 60 years)
Frequent use of medications that can damage the kidneys (such as aspirins and ibuprofen)

Complications

Chronic kidney disease can affect nearly all parts of your body. Several potential complications can arise from chronic kidney disease, including:

Fluid retention, which could lead to swelling in arms and legs, or fluid in lungs (pulmonary edema)
High blood pressure

Gout
Anemia

Increased risk of heart disease, stroke, and heart attacks.
Weakened bones and elevated risk of bone fractures.
Elevation of potassium levels in the blood (hyperkalemia), impacting the heart’s function and potentially posing life-threatening consequences.
Reduced sex drive, erectile dysfunction, or diminished fertility.
Impairment of the central nervous system, resulting in difficulties with concentration, personality changes, or seizures.
Diminished immune response, heightening the risk of infections.
Pregnancy complications

Permanent damage to your kidneys (end-stage kidney disease), leading to either dialysis or a kidney transplant for survival

Diagnosis and Tests

To determine whether you have kidney disease or not, your provide reviews the medical history of you and your family with you. In addition to other things, your provider might inquire about whether you have been diagnosed with high blood pressure, if you have taken any medication that might impair kidney function, or if you have observed fluctuations in your urinary habits and whether you have family members who are diagnosed with kidney disease.

To identify the severity of your kidney disease, your healthcare provider may run some blood tests, a urine test and check your blood pressure. Tests might include:

Blood tests: Tests are conducted to evaluate kidney function by measuring levels of waste products like creatinine and urea in the bloodstream.
Urine tests: Examination of a urine sample helps identify abnormalities that indicate chronic kidney failure and aids in determining the underlying cause of the disease.
Glomerular filtration rate (GFR): GFR assessment gauges the efficiency of kidney filtration, measuring the volume of blood filtered by the kidneys per minute. The GFR value is used to determine the stage of kidney disease.
Imaging tests: Your healthcare provider may employ ultrasound to examine the structure and size of your kidneys. In certain cases, additional imaging methods like MRI or CT scans may be used.
Kidney biopsy: If necessary, your doctor may recommend a kidney biopsy procedure, involving the extraction of a small sample of kidney tissue. This procedure typically utilizes local anesthesia and a thin needle inserted through the skin into the kidney. The biopsy sample is sent to a lab for examination and to help determine the cause of your kidney problem.

Treatment and Medication

The treatment approach for chronic kidney disease aims to mitigate the advancement of kidney damage, typically by managing the underlying cause. While certain types of kidney disease can be treated effectively, chronic kidney disease itself does not currently have a cure. In some cases, even when the underlying cause is controlled, it may not be possible to prevent the progression of kidney damage. Unfortunately, chronic kidney disease can eventually reach a stage known as end-stage kidney failure, which is a life-threatening condition requiring interventions such as dialysis (artificial filtering) or a kidney transplant for survival.

Depending on the specific cause of your kidney disease, your healthcare provider may prescribe various medications as part of your treatment regimen. The medications can consist of:

Antihypertensive medications: To address high blood pressure, your healthcare provider may prescribe an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB).
Diuretic medications: These medications assist in reducing swelling by promoting the elimination of excess fluid from your body.
Cholesterol-lowering medications: If necessary, your doctor may recommend statins to help lower your cholesterol levels.
Anemia treatment medications: In cases of anemia, supplements of the hormone erythropoietin may be prescribed to stimulate red blood cell production. • Bone protection medications: To safeguard your bones and reduce the risk of fractures, your doctor might suggest vitamin D and calcium supplements (calcitriol).
Phosphate binder. If your kidneys can’t eliminate phosphate.

Your provider might encourage your for regular follow-up testing and check-ups to keep a track on your kidney condition to determine whether its stable or progresses.

Prevention

Maintaining regular check-ups with your healthcare provider throughout your lifetime is a proactive approach to preventing kidney disease and promoting overall health. In the United States, one out of every three individuals faces the risk of developing kidney disease. By implementing certain lifestyle modifications, you can actively reduce the likelihood of developing this condition. Some preventive measures include:

Manage your blood sugar levels if you have diabetes.
Refrain from using painkillers and other medications that can negatively impact your kidney condition.
Control your blood pressure levels.
Seek guidance from a registered dietitian to make healthy dietary adjustments, such as limiting protein, sodium (salt), and potassium intake, while incorporating cholesterol-reducing foods.
Refrain from smoking.
Address any existing anemia.
Engage in daily exercise and embrace an active lifestyle.
Try to keep a healthy weight.

Prognosis

It is possible to maintain a fulfilling home and work life while enjoying quality time with your loved ones even if you are diagnosed with kidney disease. Your active involvement in your treatment team is crucial to achieving the best possible outcome.

Detecting the disease early and receiving appropriate treatment are vital in slowing its progression, aiming to prevent or delay kidney failure. It is essential to prioritize regular medical appointments, adhere to medication instructions, follow a nutritious diet, monitor blood pressure, and keep track of blood sugar levels.