Chronic Kidney Disease

Chronic kidney disease (CKD) is a condition in which the kidneys gradually lose their ability to filter waste products and excess fluid from the blood. The kidneys are vital organs that help maintain the body's chemical balance, regulate blood pressure, and produce hormones.

CKD develops slowly over months or years and often has no symptoms in early stages. Early detection and treatment can slow progression and prevent complications. In advanced stages, dialysis or kidney transplant may be needed.

Early stages often have no symptoms. As kidney function declines, symptoms may include:

Common Symptoms:

• Fatigue: Feeling tired and weak
• Swelling: In feet, ankles, or around eyes
• Changes in urination:
  • More or less frequent
  • Foamy or bubbly urine
  • Blood in urine
  • Difficulty urinating
• Nausea and vomiting: Loss of appetite
• Muscle cramps: Especially at night
• Dry, itchy skin: Persistent itching
• Shortness of breath: Fluid buildup in lungs
• High blood pressure: Difficult to control
• Sleep problems: Difficulty sleeping
• Difficulty concentrating: Mental fog

Symptoms may be mild or severe and worsen as disease progresses.

Seek emergency care if:

• Severe shortness of breath
• Chest pain
• Severe confusion
• Seizures
• Severe nausea and vomiting
• Signs of severe fluid overload

Managing CKD involves:

1. Control Underlying Conditions:

   • Diabetes: Keep blood sugar controlled
   • High blood pressure: Take medications as prescribed
   • Heart disease: Follow treatment plan
   • Managing these slows progression

2. Take Medications as Prescribed:

   • Blood pressure medications
   • Medications to protect kidneys
   • Phosphate binders (if needed)
   • Don't skip doses
   • Report side effects

3. Dietary Changes (as recommended):

   • Limit protein: May need to reduce
   • Limit sodium: Reduce salt intake
   • Limit potassium: If levels high
   • Limit phosphorus: If levels high
   • Fluid restriction: If advanced disease
   • Work with dietitian

4. Monitor Blood Pressure:

   • Check regularly at home
   • Keep log
   • Target: Usually <130/80 mmHg
   • Follow doctor's recommendations

5. Avoid Medications That Harm Kidneys:

   • Some NSAIDs (check with doctor)
   • Some antibiotics
   • Contrast dyes (for imaging)
   • Always check with doctor before new medications

6. Stay Active (as able):

   • Regular exercise as approved
   • Helps control blood pressure and weight
   • Don't overexert

7. Quit Smoking:

   • Smoking worsens kidney disease
   • Increases cardiovascular risk
   • Get support to quit

8. Regular Monitoring:

   • Follow-up appointments
   • Blood and urine tests
   • Monitor kidney function
   • Track symptoms

• Severe shortness of breath
• Chest pain
• Severe confusion
• Seizures
• Signs of severe fluid overload

• New or worsening symptoms
• Changes in urination
• Swelling that's getting worse
• Blood pressure difficult to control
• Questions about diet or medications
• Need to adjust treatment
• Planning for dialysis or transplant

• Symptoms stable
• Following treatment plan
• Regular monitoring scheduled
• No new concerns

Diagnosing CKD involves:

1. Blood Tests:

   • Creatinine: Waste product (higher = worse function)
   • eGFR (estimated glomerular filtration rate): Measures kidney function
   • BUN (blood urea nitrogen): Another waste product
   • Electrolytes: Sodium, potassium, phosphorus
   • Hemoglobin: May be low (anemia)

2. Urine Tests:

   • Albumin: Protein in urine (shouldn't be there)
   • Creatinine clearance: Measures filtering ability
   • Urinalysis: Checks for blood, protein, infection

3. Imaging Tests:

   • Ultrasound: Shows kidney size and structure
   • CT or MRI: More detailed images
   • May show cause of kidney disease

4. Kidney Biopsy (if needed):

   • Small sample of kidney tissue
   • Helps determine cause
   • Guides treatment

Stages of CKD (based on eGFR):

• Stage 1: eGFR ≥90 (mild damage, normal function)
• Stage 2: eGFR 60-89 (mild decrease)
• Stage 3: eGFR 30-59 (moderate decrease)
• Stage 4: eGFR 15-29 (severe decrease)
• Stage 5: eGFR <15 (kidney failure, need dialysis/transplant)

Treatment aims to slow progression and manage complications:

1. Treat Underlying Causes:

   • Control diabetes
   • Control high blood pressure
   • Treat infections
   • Address other causes

2. Medications:

   • ACE inhibitors or ARBs: Protect kidneys, lower blood pressure
   • Blood pressure medications: Keep pressure controlled
   • Phosphate binders: If phosphorus high
   • Erythropoietin: If anemia present
   • Other medications as needed

3. Dietary Management:

   • Work with renal dietitian
   • May need to limit protein, sodium, potassium, phosphorus
   • Maintain adequate nutrition
   • May need fluid restriction

4. Lifestyle Modifications:

   • Quit smoking
   • Regular exercise
   • Weight management
   • Stress management

5. Dialysis (if kidney function very low):

   • Hemodialysis: Machine filters blood
   • Peritoneal dialysis: Uses abdominal lining
   • Needed when eGFR <15 or symptoms severe

6. Kidney Transplant (option for some):

   • Replaces failed kidneys
   • Requires evaluation
   • Long-term medication needed

7. Manage Complications:

   • Anemia treatment
   • Bone disease prevention
   • Cardiovascular disease prevention
   • Infection prevention

Prevent CKD by:

• Control Diabetes: Keep blood sugar controlled
• Control Blood Pressure: Take medications as prescribed
• Don't Smoke: Smoking damages kidneys
• Maintain Healthy Weight: Obesity increases risk
• Exercise Regularly: Helps control blood pressure and weight
• Eat Healthy Diet: Limit sodium, processed foods
• Limit NSAIDs: Overuse can damage kidneys
• Stay Hydrated: Adequate fluids (unless restricted)
• Get Regular Check-ups: Early detection important
• Treat Infections Promptly: Especially urinary tract infections

In CKD:

1. Kidney Damage: Kidneys become damaged (various causes)
2. Reduced Filtration: Kidneys filter less effectively
3. Waste Buildup: Waste products accumulate in blood
4. Fluid Imbalance: Body can't regulate fluid properly
5. Hormone Problems: Kidneys produce less hormones
6. Complications: Anemia, bone disease, cardiovascular disease

Causes:

• Diabetes: Leading cause
• High blood pressure: Second leading cause
• Glomerulonephritis: Inflammation of kidney filters
• Polycystic kidney disease: Genetic condition
• Kidney infections: Repeated infections
• Obstructions: Blockages in urinary tract
• Autoimmune diseases: Lupus, etc.
• Medications: Some can damage kidneys

• More common with age
• May have multiple health conditions
• Higher risk of complications
• May progress faster

• Diabetes is leading cause
• Tight blood sugar control crucial
• Regular monitoring important
• May progress faster if not controlled

• High blood pressure is second leading cause
• Blood pressure control crucial
• May need multiple medications
• Regular monitoring important

Early stages may be stabilized, but damage usually can't be reversed. Treatment focuses on slowing progression and preventing complications.

Not everyone needs dialysis. It depends on how advanced the disease is and how well other treatments work. Dialysis is needed when kidney function is very low (usually eGFR <15).

Many cases can be prevented or progression slowed by controlling diabetes and high blood pressure, not smoking, maintaining healthy weight, and avoiding medications that harm kidneys.

Many people live for many years with CKD, especially with proper treatment. Life expectancy depends on stage, underlying causes, and how well complications are managed.

Yes, exercise is generally beneficial. It helps control blood pressure and weight, which can slow progression. Check with your doctor about appropriate activities, especially in advanced stages.