Chronic Kidney Disease

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Introduction

What is chronic kidney disease?

Chronic kidney disease is a disease in which the kidneys progressively stop working over time. This means that waste and excess water are not properly removed from the bloodstream. The disease commonly affects people with diabetes and high blood pressure, but can affect others as well. Two in every 1,000 people in the United States have chronic kidney disease (Source: NIH).

Chronic kidney disease is progressive, meaning that it worsens over time. You may not experience any symptoms in the early stages of chronic kidney disease. As the disease progresses, you may experience symptoms such as fatigue, general feelings of illness, headaches, unexplained weight loss, and nausea. Middle stage symptoms include pain, confusion, muscle twitching, numbness and tingling, bad breath, bruising, bleeding, unusual thirst, sleep disorders, edema (swelling), and vomiting. The last stage of chronic kidney disease is known as end stage renal disease, or kidney failure.

Treatment for chronic kidney disease includes medications, such as angiotensin receptor blockers (to lower blood pressure) or phosphate binders (medications that prevent dangerously high levels of phosphorus in the body). Iron supplements may be used to prevent anemia (low red blood cell count), and other supplements may be useful in boosting depleted vitamin levels. Once chronic kidney disease has progressed to its final stages, dialysis or even kidney transplant may be necessary.

While there is no cure, chronic kidney disease can be managed. If you suspect you may have chronic kidney disease, it is vitally important to seek prompt medical care to retard progression of the disease. Changes in your lifestyle, such as eating a healthy diet, exercising regularly, and avoiding smoking, may also help prevent or control chronic kidney disease.

Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms, such as confusion, easy bleeding or bruising, difficulty breathing, inability to urinate, or bloody stool.

Seek prompt medical care if you have persistent symptoms of chronic kidney disease or if, for any reason, you suspect you may have chronic kidney disease. Early diagnosis requires simple blood and urine tests, and is critical for ensuring a good outcome.

Symptoms

What are the symptoms of chronic kidney disease?

Symptoms of chronic kidney disease are related to the body’s inability to eliminate waste and excess water. Symptoms are progressive, meaning that they get worse over time. In fact, early stage chronic kidney disease may not manifest any symptoms. End stage chronic kidney disease, classified as end stage renal failure, involves symptoms that are very serious, even life threatening.

Early symptoms of chronic kidney disease

You may experience chronic kidney disease symptoms daily or just once in a while. At times, any of these symptoms can be severe:

  • Dry skin
  • Fatigue
  • General ill feeling
  • Headache
  • Itchy skin
  • Loss of appetite
  • Malaise or lethargy
  • Nausea with or without vomiting
  • Unexplained weight loss

Later symptoms of chronic kidney disease

As chronic kidney disease progresses, existing symptoms will worsen and new symptoms can appear. These symptoms include:

Serious symptoms that might indicate a life-threatening condition

In some cases, chronic kidney disease can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Blood-streaked stools
  • Bloody stool (blood may be red, black, or tarry in texture)
  • Confusion or loss of consciousness, even for a brief moment
  • Difficulty breathing or shortness of breath
  • Easy bleeding or bruising
Causes

What causes chronic kidney disease?

Chronic kidney disease is caused by damage to the kidneys over time. Usually, damage to the kidneys results from high blood pressure or poorly controlled diabetes. Damage to the kidneys may also result from problems with the circulatory system; kidney disorders, such as kidney stones; certain medications; environmental toxins; injury; or autoimmune disorders. The damaged kidneys become increasingly inefficient at filtering waste and excess water from the body, which can cause the disease to worsen.

Common causes of chronic kidney disease

Chronic kidney disease results from damage to the kidneys over time from a variety of conditions including:

  • Certain chemicals, toxins or medications

  • Diabetes (chronic disease that affects your body’s ability to convert sugar for energy)

  • High blood pressure

  • Infection

  • Kidney stones

  • Scleroderma (connective tissue disease characterized by skin and blood vessel changes)

  • Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)

Other causes of chronic kidney disease

Chronic kidney disease can also occur due to a variety of other conditions including:

  • Arterial defects

  • Birth defects

  • Glomerulonephritis (kidney inflammation)

  • Injury

  • Kidney disease (including any type of kidney problem, such as kidney stones, kidney failure, and kidney anomalies)

  • Polycystic kidney disease (condition characterized by multiple cysts within the kidneys)

  • Reflux nephropathy (damage to the kidneys due to backward flow of urine)

What are the risk factors for chronic kidney disease?

A number of factors are known to increase your risk of developing chronic kidney disease. Not all people with these risk factors will develop chronic kidney disease. Risk factors for chronic kidney disease include:

  • Family history of diabetes

  • Family history of kidney problems

  • High blood pressure

  • Personal medical history of autoimmune disorders

  • Recent injury

Reducing your risk of chronic kidney disease

Chronic kidney disease generally results from poorly controlled high blood pressure or diabetes. You can take basic precautions to help maintain a healthy blood pressure, thus minimizing your risk of chronic kidney disease. You may be able to lower your risk of chronic kidney disease by:

  • Avoiding smoking

  • Controlling high blood pressure

  • Controlling your blood sugar if you have diabetes

  • Eating a healthy diet low in fat, cholesterol and salt

  • Exercising regularly

Treatments

How is chronic kidney disease treated?

Chronic kidney disease can be treated with medications designed to slow and minimize damage to the kidneys. If chronic kidney disease progresses to end stage renal disease, dialysis or kidney transplant may be necessary to properly remove waste and excess water from the bloodstream.

Medications for chronic kidney disease

Chronic kidney disease medications seek to lower blood pressure and restore the proper balance of vitamins and minerals in the blood. Your health care provider may recommend medications for chronic kidney disease including:

  • Blood pressure regulators, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)

  • Calcium supplements

  • Iron supplements or erythropoietin to prevent anemia

  • Phosphate binders, to maintain proper phosphate levels in the blood

  • Vitamin D supplements

Other treatments for chronic kidney disease

In addition to medication, your doctor may recommend other treatments including:

What you can do to improve your chronic kidney disease

In addition to medication and other treatments, lifestyle modifications may help slow the progression of your chronic kidney disease. These modifications include:

  • Avoiding smoking

  • Changing your diet to limit fluids, protein, salt, potassium, phosphorous and electrolytes

  • Consuming enough calories to prevent excessive weight loss

  • Controlling your blood pressure

  • Controlling your blood sugar

  • Exercising regularly

  • Getting the appropriate vaccinations

  • Participating in a support group to cope with the stress of chronic kidney disease

What are the potential complications of chronic kidney disease?

Chronic kidney disease is a serious progressive illness. While you are unlikely to suffer complications with early stage chronic kidney disease, the risk of complications increases dramatically as the disease progresses. Complications of untreated or poorly controlled chronic kidney disease can be serious, even life threatening in some cases. You can take an active role in minimizing your risk of serious complications by following the treatment plan you and your health care provider design specifically for you. Complications of chronic kidney disease include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Chronic kidney disease. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm
  2. Chronic kidney disease and kidney failure. National Institutes of Health Research Online Reporting Tools (RePORT). http://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=34&key=C
  3. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3:5.
  4. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
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