Chronic Kidney Disease & Kidney Failure

Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.

What Causes CKD?

Unlike acute renal failure, with its sudden reversible failure of kidney function, chronic renal failure is slowly progressive. It most often results from any disease that causes gradual loss of kidney function. It can range from mild dysfunction to severe kidney failure. Progression may continue to End-Stage Renal Disease (ESRD).

How Does CKD Develop?

Chronic kidney disease usually occurs over a number of years as the internal structures of the kidney are slowly damaged. In the early stages, there may be no symptoms. In fact, progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.

How Many People Are Affected By CKD?

Chronic kidney disease and ESRD affect more than 2 out of 1,000 people in the United States. Diabetes and hypertension are the two most common causes and account for approximately two thirds of the cases of chronic kidney disease and ESRD. Other major causes include the following:

• Glomerulonephritis of any type (one of the most common causes)
• Polycystic kidney disease
• Alport syndrome
• Reflux nephropathy
• Obstructive uropathy
• Kidney stones and infection
• Analgesic nephropathy

How Does CKD Occur?

Chronic kidney disease results in the accumulation of fluid and waste products in the body, causing azotemia and uremia. Azotemia is the buildup of nitrogen waste products in the blood. It may occur without symptoms. Uremia is the state of ill health resulting from renal failure. Most body systems are affected by chronic renal failure. Fluid retention and uremia can cause many complications.

What Are The Symptoms Of CKD?

Initial symptoms may include the following:

• Unintentional weight loss
• Nausea, vomiting
• General ill feeling
• Fatigue
• Headache
• Frequent hiccups
• Generalized itching (pruritus)

Later Symptoms May Include The Following:

• Increased or decreased urine output
• Need to urinate at night
• Easy bruising or bleeding
• Blood in the vomit or in stools
• Decreased alertnes
• Drowsiness, somnolence, lethargy
• Confusion, delirium
• Coma
• Muscle twitching or cramps
• Seizures
• Uremic frost -- deposits of white crystals in and on the skin
• Decreased sensation in the hands, feet, or other areas

Additional Symptoms That May Be Associated With This Disease:

• Excessive nighttime urination
• Excessive thirst
• Abnormally dark or light skin
• Paleness
• Nail abnormalities
• Breath odor
• High blood pressure
• Loss of appetite
• Agitation

What tests are needed to detect Chronic Kidney Disease?

Blood pressure may be high. A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.

A urinalysis may show protein or other abnormalities:

• Creatinine levels progressively increase
• BUN is progressively increased
• Creatinine clearance progressively decreases
• Potassium test may show elevated levels
• Arterial blood gas and blood chemistry analysis may show metabolic acidosis

An abnormal urinalysis may occur 6 to 10 months or more before other symptoms appear.

Changes that indicate chronic renal failure, including both kidneys being smaller than normal, may be seen on:

• Renal or abdominal X-ray
• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound

CKD may also alter the results of the following tests:

• Urinary casts
• Renal scan
• PTH
• Serum magnesium - test
• Erythropoietin

What Treatments Are Available For CKD?

Treatment focuses on controlling the symptoms, minimizing complications, and slowing the progression of the disease.

Associated diseases that cause or result from chronic kidney disease must be controlled. Hypertension, congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated as appropriate.

Blood transfusions or medications such as iron and erythropoietin supplements may be needed to control anemia.

Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dietary protein restriction may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Salt, potassium, phosphorus, and other electrolytes may be restricted.

Dialysis or Kidney Transplant may be required eventually.

What Should I Expect If I’m Diagnosed With CKD?

There is no cure for chronic renal failure. Untreated, it usually progresses to end-stage renal disease. Lifelong treatment may control the symptoms of chronic renal failure.

What Are Some Complications Of CKD?

• End-stage renal disease
• Pericarditis
• Cardiac tamponade
• Congestive heart failure
• Hypertension
• Platelet dysfunction
• Loss of blood from the gastrointestinal tract
• Ulcers
• Hemorrhage
• Anemia
• Hepatitis B, Hepatitis C, liver failure
• Decreased functioning of white blood cells
• Decreased immune response
• Increased incidence of infection
• Peripheral neuropathy
• Seizures
• Encephalopathy, nerve damage, dementia
• Weakening of the bones
• Fractures
• Joint disorders
• Changes in glucose metabolism
• Electrolyte abnormalities including hyperkalemia
• Decreased libido, impotence
• Miscarriage, menstrual irregularities, infertility
• Skin dryness, itching/scratching with resultant skin infection

Call your health care provider, immediately, if nausea or vomiting persists for more than 2 weeks, if decreased urine output occurs or other symptoms of chronic renal failure occur.

When Kidneys Fail

What Is Kidney Failure?

Kidney failure is a condition where the kidneys are incapable of performing their normal functions. Substances, which should have been excreted, such as urea and creatinine are accumulated in the body. These levels, if high enough, cause symptoms such as tiredness, weakness, loss of appetite and vomiting. Creatinine is the breakdown product of muscles. Doctors often use the blood creatinine level as a measure for the degree of kidney failure. Generally, when the creatinine level in the blood reaches a level of 10 mg/dL the patient should start on dialysis.

The volume of water in the body increases and swelling of the tissues results. Excess salt and water retention may cause high blood pressure, swelling of the legs, face and abdomen and breathlessness. The kidneys fail to excrete phosphate, causing the blood phosphate level to increase and the calcium level to fall. This results in bone disease and may predispose the patient to fractures of the bones. The bone problem is also worsened by the lack of active Vitamin D. Inadequate production of erythropoeitin leads to anemia.

What are the causes of kidney failure?

The common causes of kidney failure are glomerulonephritis (inflammation of the kidney) and diabetes mellitus. Some of the other causes include kidney stones, polycystic kidneys, systemic lupus erythematosus and uncontrolled hypertension.

What are the symptoms of kidney failure?

In mild kidney failure, no symptoms are present although kidney tests show some abnormalities. As kidney failure worsens, the patient may experience the following:

• Hypertension
• Lower back pain
• Swollen hands and feet
• Puffy Eyes
• Discolored or frothy urine
• Painful urination
• Frequent urination, especially at night
• Pale and sallow complexion
• Fatigue
• Shortness of breath
• Body itch
• Poor appetite, sometimes accompanied with nausea and vomiting
• Passing little urine

Are there measures that can be taken to prevent kidney failure?

Control of Blood Pressure

Strict control of blood pressure is necessary as high blood pressure damages the kidney. This requires observation of a low salt diet and regularly taking high blood pressure medications.

Diet Restrictions

You should seek the counseling of a license dietician who will assess your needs and make recommendations accordingly.

Protein - Reducing the intake of protein, such as poultry, seafood and soy products, helps to reduce the level of protein waste products in the body. However, one must be cautious not to reduce this too low or malnutrition will occur. A dietician should usually be consulted and advise the patient on the appropriate proportion of protein to take.

Salt -Beware of the salt content in sauces and seasonings as well. Too much salt makes you feel thirsty, and drinking too much fluid can cause swelling of the face, legs and abdomen, as well as, increase blood pressure. 

Fluid - If you have a significant amount of swelling, your doctor will instruct you to reduce your fluid intake. Fluid allowance for the day depends on the fluid status of the patient. It may be restricted to a range of 300 ml to 500 ml a day.

Potassium - Potassium affects the contraction of heart muscles; too much or too little potassium can harm the heart. Therefore, intake of high potassium foods has to be restricted. Leafy vegetables, fruits and fruit juices are high in potassium.

Phosphate - Beans, peas, mushrooms, nuts, milk, soy products, and legumes are examples of foods that contain phosphates and should be avoided. Phosphate is retained in the blood due to the inability of the kidneys to excrete waste and toxins. As a result, the body is unable to maintain a balance between calcium and phosphate, which may lead to bone problems.

Medications

Your doctor may prescribe medications or supplements such as:

• Anti Hypertensives
• Multivitamins
• Calcium supplements
• Phosphate binders

Follow his orders and take all medication as prescribed.

Some General Advice

• Avoid eating sweet and oily food
• Avoid drinking alcohol
• Drink more water
• Prevent or treat diabetes and high blood pressure
• Eat well-balanced diet
• Control any infection
• Go for routine check-ups

If you want to stay healthy, you have to look after yourself.

Remember

• Kidney failure may not be accompanied by symptoms.
• Dietary restriction and blood pressure control are important to retard the progression of kidney failure.
• All appointments with your doctors must be kept.
• Your doctor will inform you in advance if dialysis is necessary.

In the advanced stages of kidney failure, your kidney/s can deteriorate very rapidly so beware of the signs and symptoms and get to a doctor.

If you have any questions, call Kidney Foundation of Greater Cincinnati at 513.961.8105.