Chronic kidney disease

What is chronic kidney disease?

Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don’t work right, wastes build up in your blood and make you sick.

Chronic kidney disease may seem to have come on suddenly. But it has been happening bit by bit for many years as a result of damage to your kidneys.

Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.

One way to measure how well your kidneys are working is to figure out your glomerular filtration rate (GFR). The GFR is usually calculated using results from your blood creatinine (say “kree-AT-uh-neen”) test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.

There are things you can do to slow or stop the damage to your kidneys. Taking medicines and making some lifestyle changes can help you manage your disease and feel better.

Chronic kidney disease is also called chronic renal failure or chronic renal insufficiency.

What causes chronic kidney disease?

Chronic kidney disease is caused by damage to the kidneys. The most common causes of this damage are:

• Uncontrolled high blood pressure over many years.
• High blood sugar over many years. This happens in uncontrolled type 1 or type 2 diabetes.

Other things that can lead to chronic kidney disease include:

• Kidney diseases and infections, such as polycystic kidney disease, pyelonephritis, and glomerulonephritis, or a kidney problem you were born with.
• A narrowed or blocked renal artery. A renal artery carries blood to the kidneys.
• Long-term use of medicines that can damage the kidneys. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), such as celecoxib and ibuprofen.

What are the symptoms?

You may start to have symptoms only a few months after your kidneys begin to fail. But most people don’t have symptoms early on. In fact, many don’t have symptoms for as long as 30 years or more. This is called the “silent” phase of the disease.

How well your kidneys work is called kidney function. As your kidney function gets worse, you may:

• Urinate less than normal.
• Have swelling and weight gain from fluid buildup in your tissues. This is called edema (say “ih-DEE-muh”).
• Feel very tired or sleepy.
• Not feel hungry, or you may lose weight without trying.
• Often feel sick to your stomach (nauseated) or vomit.
• Have trouble sleeping.
• Have headaches or trouble thinking clearly.

How is chronic kidney disease diagnosed?

Your doctor will do blood and urine tests to help find out how well your kidneys are working. These tests can show signs of kidney disease andanemia. (You can get anemia from having damaged kidneys.) You may have other tests to help rule out other problems that could cause your symptoms.

Your doctor will do tests that measure the amount of urea (BUN) andcreatinine in your blood. These tests can help measure how well your kidneys are filtering your blood. As your kidney function gets worse, the amount of nitrogen (shown by the BUN test) and creatinine in your blood increases. The level of creatinine in your blood is used to find out the glomerular filtration rate (GFR). The GFR is used to show how much kidney function you still have. The GFR is also used to find out the stage of your kidney disease and to guide decisions about treatment.

Your doctor will ask questions about any past kidney problems. He or she will also ask whether you have a family history of kidney disease and what medicines you take, both prescription and over-the-counter drugs.

You may have a test that lets your doctor look at a picture of your kidneys, such as an ultrasound or CT scan. These tests can help your doctor measure the size of your kidneys, estimate blood flow to the kidneys, and see if urine flow is blocked. In some cases, your doctor may take a tiny sample of kidney tissue (biopsy) to help find out what caused your kidney disease.

How is it treated?

Chronic kidney disease is usually caused by another condition. So the first step is to treat the disease that is causing kidney damage.

Diabetes and high blood pressure cause most cases of chronic kidney disease. If you keep your blood pressure and blood sugar in a target range, you may be able to slow or stop the damage to your kidneys. Losing weight and getting more exercise can help. You may also need to take medicines.

Kidney disease is a complex problem. You will probably need to take a number of medicines and have many tests. To stay as healthy as possible, work closely with your doctor. Go to all your appointments. And take your medicines just the way your doctor says to.

Lifestyle changes are an important part of your treatment. Taking these steps can help slow down kidney disease and reduce your symptoms. These steps may also help with high blood pressure, diabetes, and other problems that make kidney disease worse.

• Follow a diet that is easy on your kidneys. A dietitian can help you make an eating plan with the right amounts of salt (sodium) and protein. You may also need to watch how much fluid you drink each day.
• Make exercise a routine part of your life. Work with your doctor to design an exercise program that is right for you.
• Do not smoke or use tobacco.
• Do not drink alcohol.

Always talk to your doctor before you take any new medicine, including over-the-counter remedies, prescription drugs, vitamins, or herbs. Some of these can hurt your kidneys.

What happens if kidney disease gets worse?

When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body. It can cause serious heart, bone, and brain problems and make you feel very ill. Untreated kidney failure can be life-threatening.

When you have kidney failure, you will probably have two choices: startdialysis or get a new kidney (transplant). Both of these treatments have risks and benefits. Talk with your doctor to decide which would be best for you.

• Dialysis is a process that filters your blood when your kidneys no longer can. It is not a cure, but it can help you feel better and live longer.
• Kidney transplant may be the best choice if you are otherwise healthy. With a new kidney, you will feel much better and will be able to live a more normal life. But you may have to wait for a kidney that is a good match for your blood and tissue type. And you will have to take medicine for the rest of your life to keep your body fromrejecting the new kidney.

Making treatment decisions when you are very ill is hard. It is normal to be worried and afraid. Discuss your concerns with your loved ones and your doctor. It may help to visit a dialysis center or transplant center and talk to others who have made these choices.

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