Definition and Overview

Chronic kidney disease is a condition wherein the kidneys have not been functioning properly for an extended period of time. This is to distinguish it from an acute kidney problem, which comes on more suddenly. Some patients believe that their kidney problem occurred suddenly, but the condition may have been silently and gradually developing without their knowledge. Nevertheless, a chronic kidney disease is just as dangerous and should be given immediate medical attention.

The kidneys are responsible for filtering the blood that circulates all over the body. In the process, they collect all the waste products and unwanted fluids from the blood and flush them from the body in the form of urine. So if the kidneys fail to work properly, the waste products in the blood will not be filtered out and will thus build up inside the body and cause negative symptoms.

Causes

A chronic kidney disease is linked to other diseases or health problems that damage the blood vessels in the kidneys. The two diseases most often blamed for a chronic kidney disease and, eventually, kidney failure, are:

  • Diabetes – Diabetes causes raised blood sugar levels that can damage the blood vessels in the kidneys in the long run. This damage can gradually affect the proper functioning of the kidneys.

  • Hypertension – Also known as high blood pressure, the excessive pressure in the blood vessels can damage them, and this, in turn, can damage the kidneys.

Other factors that can damage the kidneys include blockages in the renal artery, which is the artery that transmits blood to the kidneys, and continuous use of certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs).

According to some studies, certain factors also raise a person’s risk of developing a chronic kidney disease. These factors include:

  • Age – Studies show that the kidneys begin to reduce in size as a person gets older, making them more vulnerable.

  • Gender – Some studies found that men’s risk for chronic kidney disease is higher than that of women’s.

  • Family history – Existing evidence suggests that a chronic kidney disease can be passed from one generation to the next simply because its two major causes – diabetes and hypertension – are both often inherited.

Key Symptoms

A chronic kidney disease develops gradually and progresses silently, so it is possible that patients may not be aware that they have the disease until it has progressed enough to cause symptoms. Symptoms only become noticeable as the kidneys become less capable of doing their job. The key symptoms of a weakening kidney include:

  • Drastic weight gain or unexplained weight loss
  • Edema (This occurs when fluid that is unable to exit the body builds up in the tissues instead.)
  • Infrequent urination
  • Tiredness
  • Appetite loss
  • Nausea
  • Vomiting
  • Extreme sleepiness or insomnia
  • Headaches
  • Confusion
  • Metallic taste in the mouth
  • Severe itching

A chronic kidney disease can also cause several other health complications, such as:

  • Anemia – Characterized by general weakness, pale skin, and chronic tiredness, anemia occurs when the kidney is no longer able to produce adequate amounts of erythropoietin, the hormone that is necessary for the production of new red blood cells.

  • Electrolyte imbalance – Once the kidney starts malfunctioning, it will be unable to filter out unwanted substances from the blood, causing some chemicals to get stuck in the blood. These may include certain acids, potassium, and phosphate, which can cause muscle weakness and irregular heart rates.

  • Uremic Syndrome – When some substances are not filtered out from the blood and reached a certain level, they have the tendency to become poisonous. The uremic syndrome can have negative effects on the nerves, intestines, and heart.

  • Bone disease – If the kidneys are unable to filter out calcium, vitamin D, and phosphate, these substances can easily accumulate in unhealthy amounts, which can result in bone diseases.

  • Atherosclerosis – A heart condition characterized by blockages or narrowing of the arteries in the heart, atherosclerosis can develop and progress faster in patients with a chronic kidney disease.

When the kidney’s ability to function falls below a certain level, it will then be classified as a failing kidney. Kidney failure can have serious effects on the heart, brain, and bones.

Types of Treatments Available

When caught early, treatment for a chronic kidney disease is focused on stopping or slowing the progression of the disease to prevent further damage to the kidneys. If the patient is also suffering from diabetes or high blood pressure, it is all the more important for him to receive treatment for both conditions and to effectively manage his symptoms in order to avoid worsening the state of his kidneys.

For chronic kidney disease that is diagnosed early, the main treatment options are:

  • Medications – Medications to manage the symptoms of hypertension or diabetes, if these are needed, may be combined with medications that help reduce the protein levels in the urine. Some medications used to manage the symptoms of a chronic kidney disease and prevent its complications include erythropoietin therapy, iron replacement therapy for anemia, diuretics to counter abnormal fluid buildup, ARBs, and ace inhibitors.

  • Lifestyle changes – People with chronic kidney disease should make changes in their lifestyle and consciously decide to become healthier. Exercising regularly can greatly help in maintaining overall well-being. Smoking and drinking alcohol can also cause further harm to the kidneys and should thus be stopped immediately. Stressful work or situations should also be avoided, since it is important to keep blood pressure levels below 130/80 to prevent further damage to the blood vessels in the kidneys. Likewise, patients suffering from diabetes should maintain an optimum blood sugar level.

  • Dietary changes – People with chronic kidney disease should follow a diet plan customized to keep the kidneys healthy. A nutritionist or dietitian can tailor fit a meal plan based on the correct amounts of fluids, protein, and salt that a person with a chronic kidney disease can take without worsening his condition.

For severe cases of chronic kidney disease where kidney failure has already occurred, the only remaining treatment options are:

  • Dialysis
  • Kidney transplant

A kidney transplant is the best option for patients with kidney failure, but it can be a challenge to obtain donated kidneys that are a good match with the recipient in terms of blood type and tissue structure.

Specialty: Nephrology

The diagnosis and treatment of kidney disease fall under the sub-specialty called nephrology. Health professionals who specialize in this sub-specialty are called nephrologists.

When to See A Nephrologist?

Schedule an appointment with a nephrologist if you experience the key symptoms of chronic kidney disease or uremic syndrome, which include unexplained tiredness, swollen arms and feet, and bruise easily.

Also, seek medical attention if you experience the following symptoms:

  • Your heart rate slows down to less than 50 beats per minute or speeds up to over 120 beats per minute.
  • Chest pain
  • Shortness of breath
  • Severe muscle weakness
  • Nausea
  • Vomiting
  • Bloody stools
  • Fatigue

Aside from nephrologists, patients suffering from a chronic kidney disease can also seek help from family physicians, internists, pediatricians, and nurse’s assistants.

References:

  • Thomas R, Kanso A, Sedor J. “Primary Care: Chronic Kidney Disease” and its Complications
  • Advances in Chronic Kidney Disease
  • Tonelli M, Wiebe N, Culleton B. “Chronic kidney disease and mortality risk: A systematic review.” Journal of the American Society of Nephrology.
  • Barry JM. (2007). “Renal Transplantation.” PC Walsh et al, Campbell Walsh Urology.
  • Curhan GC, Mitch WE. (2008). “Diet and Kidney Disease.”
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