Kidney Disease

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Introduction

What is kidney disease?

Kidney disease is a general term that includes any disease, disorder or condition of the kidneys. The kidneys are vital internal organs located in the upper abdomen. Normally people have two bean-shaped kidneys, which form a part of the urinary tract in the genitourinary system.

Healthy kidneys function continuously, and the body’s total blood supply passes through the kidneys several times each minute. The healthy body can continue to function with only one good kidney, as happens when someone volunteers to be a living kidney donor.

Kidney disease is due to a variety of conditions that lead to kidney damage and deterioration of kidney function. Kidney disease can make it difficult or impossible for the kidneys to perform functions that are critical to life and your overall health including:

  • Filtering waste products and excess water and salts from the blood, which are then eliminated from the body through the ureters, bladder and urethra in the form of urine

  • Producing certain hormones, such as renin, which helps regulate blood pressure

  • Producing the active form of vitamin D (calcitrol)

  • Regulating electrolytes and other vital substances, such as sodium, calcium and potassium

  • Regulating the level and quality of fluid in the body

  • Stimulating red blood cell production

There are two general types of serious kidney disease:

  • Acute renal failure is a condition in which there is damage and deterioration of kidney function that occurs suddenly, generally over a period of days. Acute renal failure can be caused by such conditions as shock, acute pyelonephritis, urinary tract obstruction, or ingestion of certain toxic substances. In some cases, acute renal failure can be totally reversible without long-term consequences.

  • Chronic kidney disease is a condition in which there is damage and deterioration of kidney function that occurs over a long period of time, from months to years. Chronic kidney disease is generally caused by long-term diseases, such as diabetes and hypertension (high blood pressure).

Rapid diagnosis and treatment of many underlying causes of kidney disease may prevent or slow the progression of serious kidney damage that leads to chronic kidney disease or acute renal failure.

Kidney disease can be a serious or life-threatening condition because it can progress quickly and critically affect the ability of the kidneys to function normally. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of impaired kidney function, such as severe shortness of breath, bloody stools or urine, decrease in urinating or lack of urinating, or a change in consciousness or alertness. Seek immediate medical care (call 911) if you, or someone you are with, have overdosed on a drug or ingested a toxic substance.

Symptoms

What are the symptoms of kidney disease?

Symptoms of kidney disease vary according to the underlying causes. General symptoms can include:

  • Cloudy or discolored urine

  • Difficulty urinating

  • Dizziness upon attempted standing

Serious symptoms that might indicate a life-threatening condition

Kidney disease can be caused by or progress to serious or life-threatening conditions, such as kidney stones or renal failure (kidney failure). Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious or life-threatening symptoms including:

  • Blood clots in urine or bloody urine (hematuria)

  • Bloody stools or black, tarry stools

  • Confusion and disorientation

  • Confusion or change in consciousness or mental status

  • Decrease in urination or lack of urination

  • Flank pain that moves or radiates to the lower abdomen, groin, labia or testicles

  • High fever (higher than 101 degrees Fahrenheit) or chills

  • Moderate to severe edema (swelling)

  • Seizure

  • Severe shortness of breath or difficulty breathing

Seek immediate medical care (call 911) if you, or someone you are with, have overdosed on a drug or ingested a toxic substance.

Causes

What causes kidney disease?

Kidney disease can be caused by a wide variety of underlying diseases, disorders or conditions that lead to kidney damage, such as obstruction, infection, malignancy, inflammation, deformity, toxic ingestion, or a reduced blood supply to the kidneys. Underlying causes include:

  • Diabetes, which can damage the kidneys over time

  • Diseases that cause inflammation and damage to the kidney, such as nephritis and glomerulonephritis

  • Heart failure

  • Hypertension (high blood pressure)

  • Infections, such as repeated bladder infections, pyelonephritis (kidney infection), or septicemia (blood infection)

  • Intravenous (IV) drug abuse

  • Kidney cancer

  • Liver failure

  • Overdose of certain drugs, or long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDS include ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn).

  • Polycystic kidney disease (inherited disease that causes formation of large cysts in the kidneys that damage kidney tissue)

  • Reduced blood flow to the kidneys due to shock or renal artery stenosis (narrowing of the renal arteries)

  • Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues) and other autoimmune diseases that can attack the kidneys

  • Toxic exposure to poisonous substances

  • Trauma or injury to the kidney or arteries that supply blood to the kidneys

  • Urinary tract obstruction, which can be caused by a kidney stone, tumor, congenital deformity, or enlarged prostate gland

What are the risk factors for kidney disease?

Kidney disease can affect people of any age and any race or cultural background. However, a number of factors increase the risk of developing kidney disease. Risk factors include:

  • Age older than 65 years

  • African American, Native American, Hispanic American, Asian, or Pacific Islander ethnicity

  • Diabetes

  • Exposure to radiographic contrast material

  • Family history of kidney disease

  • Heart disease

  • High cholesterol, atherosclerosis (buildup of plaque on the walls of the arteries), and peripheral artery disease (PAD)

  • Hypertension (high blood pressure)

  • Intravenous (IV) drug abuse

  • Liver disease

  • Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)

  • Obesity

  • Recent major surgery or serious or life-threatening illnesses, such as shock and septicemia (blood infection)

  • Smoking

    Reducing your risk of kidney disease

    Not all people who are at risk of kidney disease will develop the condition. However, you can lower your risk of developing kidney disease by:

    • Following your physician’s recommendation for using medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)

    • Maintaining a healthy weight

    • Not smoking

    • Not using recreational and IV drugs

    • Seeking regular medical care and following your treatment plan for chronic diseases and conditions, such as diabetes, hypertension, obesity, high cholesterol, and heart disease

    Treatments

    How is kidney disease treated?

    Treatment of kidney disease varies depending on the underlying disease, disorder or condition. The goals of treatment are to cure the underlying condition, prevent excessive fluid and waste from accumulating in the body, and stop or slow the progression of damage to the kidneys. Treatment also aims to minimize complications of kidney disease.

    General treatment of kidney disease

    For all types and causes of kidney disease, treatment plans generally include:

    • Low salt diet

    • Monitoring and control of blood pressure

    • Not smoking or quitting smoking

    • Prompt treatment of bladder infections

    • Regular medical care

    • Weight loss as needed and maintenance of a healthy weight

    Other treatments that may be used for kidney disease

    Certain types of kidney disease may require one of more of the following treatments:

    • Diets that limit fluids and protein

    • Diuretic medications to help damaged kidneys eliminate fluid

    • Kidney dialysis, which filters waste products from the blood, is used in advanced kidney disease that has lead to kidney failure.

    • Kidney transplant may be an option for some people who have end-stage kidney failure. This major surgical procedure involves using a healthy donor kidney to replace severely damaged kidneys.

    • Medications to balance electrolytes in the body or ensure adequate vitamin levels, especially vitamin D

    • Reduction or elimination of certain medications that can be harmful to the kidneys

    Treatment of specific types and causes of kidney disease

    Treatment plans also include a multifaceted approach tailored to the specific type and cause of kidney disease and your medical history. For example:

    • Autoimmune disorders, such as systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues), are treated with medication.

    • Diabetes treatment includes control of blood sugar levels through diet, exercise, medication, and weight reduction as needed.

    • Hypertension (high blood pressure) is treated with a low sodium diet, medication, and weight reduction as needed.

    • Intravenous (IV) drugabuse treatment includes abstaining from drugs and participation in a drug rehabilitation treatment program.

    • Kidney cancer is generally treated with removal of part or all of the kidney, and possibly certain medications. Radiation therapy and chemotherapy may be an option in some cases.

    • Kidney stones are treated with fluids, pain medications, and, if necessary, certain medical procedures, such as extracorporeal shock wave lithotripsy.

    • Pyelonephritis (kidney infection) and septicemia (blood infection) are treated with antibiotics and hospitalization. Treatment of less severe infections that can lead to kidney disease, such as uncomplicated urinary tract infections or impetigo, generally includes antibiotics but not hospitalization.

    • Shock and septicemia (blood infection) are treated with hospitalization, IV fluids and medications, and possibly life support measures.

    What are the possible complications of kidney disease?

    Kidney diseases and their underlying causes can be serious and even life threatening. You can reduce your risk of serious complications by seeking regular medical care and following the treatment plan your health care professional designs specifically for you.

    Complications of kidney disease can include:

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2018 Nov 15
    1. About Chronic Kidney Disease. National Kidney Foundation. http://www.kidney.org/kidneydisease/ckd/index.cfm.
    2. Acute Kidney Failure. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/#adam_000501.disease.treatment.
    3. Chronic Kidney Disease. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm.
    4. Kidney Disease. National Kidney Foundation. http://www.kidney.org/kidneydisease/.
    5. Kidney Disease. Lab Tests Online. http://www.labtestsonline.org/understanding/conditions/kidney-2.html
    6. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
    7. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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