Chronic kidney disease (CKD) is the permanent and gradual destruction of the kidneys or loss of renal function. Your kidneys are important components of your body. (1)
They are responsible for a variety of functions, including:
- help keep your body’s minerals and electrolytes, such as calcium, sodium and potassium, in balance.
- play an important role in producing red blood cells.
- maintain a delicate acid-basic (pH) balance in your blood.
- excrete water-soluble waste out of your body.
Damaged kidneys are no longer able to perform these functions. (2)
Some of the diseases and conditions responsible for chronic kidney disease are:
- High blood pressure
- type 1 diabetes
- type 2 diabetes
- Polycystic kidney disease
- pyelonephritis also known as Recurrent kidney infection
Each kidney contains approximately one million tiny filtration units, known as nephron. Any condition that hurts or scars the kidneys nephron can cause kidney disease. Both diabetes and hypertension can harm your kidneys nephron. (3)
High blood pressure can damage the blood vessels in your kidneys, heart and brain, too. The kidneys are very vascularised, which means they contain many blood vessels. This means that diseases of the blood vessels are usually dangerous for your kidneys.
Auto-immune diseases like lupus can damage blood vessels and produce antibodies to kidney tissue.
There are a variety of other reasons for CKD. For example, polycystic kidney disease is an hereditary reason of CKD. Glomerulonephritis may be because of lupus. It may also occur after streptococcus infection.
The risk of CKD is increasing for persons over 65. The condition exists among families as well. This is most likely to occur among African Americans, Indians and Asian Americans.
The following factors may increase your chance of developing chronic kidney disease:
- older age
- kidney cancer
- bladder cancer
- kidney stones
- kidney infection
- cigarette smoking
- high cholesterol
- diabetes (types 1 and 2)
- autoimmune disease
- obstructive kidney disease
- cirrhosis and liver failure
- systemic lupus erythematosus
- vesicoureteral reflux
CKD causes no symptoms until almost all of your kidney is destroyed. When the kidney is seriously damaged, symptoms of CKD may include:
- sleep apnea
- periorbital edema
- pedal edema
- shortness of breath
- vomiting, mostly in the morning and after eating
- bone pain
- uremic frost
- mental cloudiness
- numbness in your hands and feet
- restless leg syndrome
- brittle hair and nails
- weight loss
- loss of muscle mass
- muscle twitching and cramps
- easy bruising and bleeding
- blood in your stools
- excessive thirst
- Interest in sex has declined
You can also experience symptoms of any illness that contribute to your kidney problems.
How is chronic kidney disease diagnosed?
CKD diagnosis starts with a family medical history background. Family history of kidney disease, high blood pressure and diabetes can alert your physician. However, more tests are needed to verify that you have CKD, such as:
Complete blood count
A complete blood count may point to anemia. Your kidneys produce a hormone called erythropoietin. This hormonal agent stimulates your bone marrow to produce red blood cells. When your kidneys are badly damaged, your ability to produce erythropoietin goes down. This leads to the reduction of red blood cells, or anemia.
Electrolyte level test
CKD is capable of affecting your electrolyte levels. Potassium can be elevated and bicarbonate concentrations can be low if you have a CKD. There can also be increased levels of acidity in the blood.
Blood urea nitrogen test
The level of urea nitrogen in the bloodstream can increase as your kidneys start to fail. Your kidneys usually remove protein-degrading products from your blood. After kidney damage, the by-products accumulate. Urea is a by-product of protein decomposition and that is what gives urine its odour. Your physician can check for accumulation.
When renal function goes down, your creatinine goes up. This protein is also associated with muscular tissue mass.
Parathyroid hormone (PTH) test
Both kidney and parathyroid glands interact by regulating calcium and phosphorus. There is a change in renal function that affects PTH release. This affects the levels of calcium in the whole body.
When your kidney progresses to the terminal stage of kidney disease, it does not excrete enough phosphorus and interferes with vitamin D synthesis. Your bones are capable of releasing calcium, too. As a result, your bones grow weak over time.
Renal flow and scan
A renal exam is an imaging investigation of kidney function.
This non-invasive test provides images to help your physician identify any obstructions.
Extra tests for CKD include:
- abdominal CT scan
- abdominal MRI
- kidney biopsy
- bone density test
Treatment and complications
CKD is a chronic, irreversible condition. This means that treatment focuses on improving the underlying disease. Treatment may also prevent and manage CKD complications, including:
- brittle bones
- fluid overload
- congestive heart failure
- weight loss
- electrolyte imbalance
Controlling underlying issues, such as high blood pressure and diabetes, may slow the progression of kidney damage.
End-stage renal disease (ESRD) happens when the kidneys clearly start to stop. When your kidney function is reduced to 10 per cent or less, you may require dialysis or kidney transplantation.
Treatment for CKD and ESRD includes:
You must reduce fat, salt, protein and potassium in your food. The reduction in salt and fluid consumption can help control blood pressure and prevent fluid overload. Make sure you always have enough calories to keep your weight. If you are diabetic, limit the amount of carbohydrates you eat.
Make sure that you get appropriate exercise. Stopping smoking if you smoke can help too.
Supplements and medication
Treatment can include the following:
- iron and vitamin supplementation for managing anemia.
- calcium & vitamin D supplements.
- erythropoietin injections to boost red blood cell production.
- phosphate binders
- antihistamines for itching
You could use dialysis to cleanse your blood. In some instances, a kidney transplant may be required. You should also talk to your physician to check your blood glucose and diabetes, if you have them.
You may be at increased risk for infection if you have CKD or ESRD. Physicians recommend the following vaccines:
- hepatitis B vaccine
- influenza vaccine
- pneumococcal vaccine
- H1N1 (swine flu) vaccine
It’s not always preventable. However, control conditions such as hypertension and diabetes may be helpful. You should do routine screening for CKDs if you are at high risk. An early diagnosis of CKD may help to slow the progression of disease.