Chronic Kidney Disease (CKD)

What is Chronic Kidney Disease (CKD)? CKD is described as the gradual progressive loss of kidney function. When your kidneys begin to lose this function, waste products begin to pile up in your body, which in the long run, can cause havoc to the system.  This condition is a long-term disease that becomes worse as you grow older, getting more severe if precautions to salvage the situation are not taken. It usually shows no sign at the earliest stages and can remain undetected until the kidney function drops to 25 percent. Eventually, the kidney may stop working which is called kidney failure or end-stage renal disease (ESRD). CKD is also referred to as “chronic renal disease”, “chronic renal failure”, or “chronic kidney failure” Chronic kidney disease develops in 5 stages, from mild damage to complete kidney failure or ESRD. Stages of Chronic Kidney Disease The stages of your CKD is measured by your glomerular filtration rate (GFR). GFR is the estimation of the level of your kidney function. This estimation is done by determining how much your nephrons filter waste materials through a creatinine level blood test. When the creatinine level is tested, it is calculated with your age, gender, body size, muscular composition, sometimes race (as the case may be) through an equation of your doctor’s choice. The result will show you what stage of CKD you are at. The stages include:

• Stage 1: 90% and above

Very mild level of kidney damage, with almost insignificant symptoms. This is considered the normal rate.

• Stage 2: 60% to 89%

Mild level of kidney damage, with slightly increased signs of damage.

• Stage 3: 30% to 59%

Moderate level of kidney damage. More symptoms show.

• Stage 4: 16% to 29%

Severe level of kidney damage. Signs become more intense and discomforting. You may need dialysis.

• Stage 5: 0 to 15%

End-stage damage of the kidney. Chronic or total loss of kidney function. Dialysis and if a possible kidney transplant is required. Diagnosis It is hard to detect CKD through symptoms in its early stage, so it is advisable to always test for the presence of the condition especially if you have a high tendency of being affected.  Also, conduct a test if any of the signs of CKD has become persistent. The earlier it is diagnosed and controlled, the better. The diagnostic tests include:

• Glomerular Filtration Rate (GFR)

This is the surest way of knowing how well your kidney is performed and at what stage the CKD is. The test involves calculating the level of your kidney function with an equation that comprises your creatinine level in your blood, your age, body size, weight, height, your muscular mass, gender, and sometimes, your race.

• Blood Test

This is used to check the creatinine (chemical waste products in the body) and the urea level in your system. If the level is high, you are most likely to be diagnosed with chronic kidney disease.

• Urine Test

This is used to find out if there is a presence of protein or blood in the urine.

• Imagery Tests

Scans such as MRI, CT, or ultrasound can be used to determine the shape and size of the kidney, because, in the advanced stages of CKD, the kidney tends to get smaller and look uneven. Scans can also be used to check blockages in the bladder or urinary tract. An X-ray can be used to check the chest for pulmonary edema.

• Biopsy

Performed by examining a small sample of kidney tissue for cell damage or any kidney disease.

• Blood Pressure Test

High blood pressure is a cause of CKD and CKD can also cause high blood pressure. So, it is most likely that when there is high blood pressure, there is a presence of chronic kidney disease. Treatment The treatment of CKD is not to cure it, but to prevent it from becoming more severe. This is often done by curbing the underlying cause and relieve the symptoms of the disease. The treatments include: Medications According to your doctor’s advice and prescription, you can take:

• Drugs such as metoclopramide or cyclizine to alleviate sickness and nausea.
• Drugs to relieve itchiness and rashes such as antihistamines.
• Drugs to control your cholesterol level and decrease your blood pressure.
• Iron supplements in form of tablets or injection to help kidney disease.

Avoid the intake of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and only taken with your doctor’s permission.  Patients with anemia might require a blood transfusion. Diet Adhere to the following:

• Reduce your phosphate intake, which is reducing the consumption of proteins such as dairy products, eggs, fish, red meat, etc.
• Reduce your sodium and potassium intake, which is cutting down on your intake of salt.
• Avoid food with a lot of fat, cholesterol, and calories.
• Take as much vitamin D as you can to keep your bones healthy and strong.
• Limit your fluid intake to reduce the level of fluid retention and buildup in the body.

Lifestyle

• Engage in activities to keep your brain alert and active.
• Exercise regularly.
• Reduce your intake of alcohol.
• Avoid the use of hard drugs or substances.
• Do not smoke.

Dialysis; either peritoneal dialysis or hemodialysis, used to remove waste products and excess fluid from the system. This is mostly done in the final 2 stages of CKD. Kidney Transplant, often done in end-stage renal disease, where the kidneys completely fail. Prevention Most people in the world today have CKD but are unaware of this because they are in the mildest stage. Somehow, you can not stop chronic CKD from starting, especially when you are exposed to a lot of toxins, diseases, and medicines, but you can slow the rate at which it progresses to other stages. The preventive measures include:

• Keeping your blood sugar and pressure under control especially for diabetic and hypertensive people.
• Follow your physician’s directive on certain medications.
• Keep to the instructions on the package of over-the-counter drugs such as ibuprofen, acetaminophen, aspirin, etc. Avoid abuse of these drugs and try not to take them regularly and consistently.
• Maintain a healthy weight because added weight can lead to lesser kidney function.
• Exercise regularly and always be active to burn off calories.
• Eat healthily; avoid cholesterol and calories. Keep up with a low-sugar, low-salt, and low-fat diet.
• Do not take hard drugs.
• Avoid the use of tobacco and nicotine products, such as cigarettes.
• Limit your intake of alcohol.
• Run regular checks with your physician.

Symptoms

Symptoms of Chronic Kidney Disease

The signs of chronic kidney disease are progressive, happening gradually. They do not show or are nearly insignificant in the early stages. Since the kidneys are two in number, one can fail, leaving the other to carry out the functions. If the condition that led to one kidney failing is not controlled, the kidney left begins to weaken too. The loss of function in both kidneys is what makes symptoms noticeable. Therefore, you should get a kidney is functioning as frequently as possible, especially when you are at risk of being prone to the disease. 

Unfortunately, there is no permanent cure to CKD and the effects are irreversible, but detecting the condition early will help you know how to keep it in check and prevent it from progressing faster. 

The symptoms often intensify as the condition progresses. Some of the signs are:

• Fatigue
• Itchiness and rashes 
• Abdominal pains
• Lack of appetite
• Urinary problems such as dark wine, blood in urine, protein in the urine, frequency in urinating, etc.
• Edema is swelling of the feet, hands, ankles, and face.
• Muscle pains, twitches, and cramps
• Nausea and vomiting
• Diarrhea
• Lack of sleep or insomnia.
• Anemia
• Eye puffiness
• Headaches
• Mental dullness, confusion, and lack of concentration.
• Nosebleeds
• Chest pains and shortness of breath.
• High blood pressure (Hypertension)
• Erectile dysfunction in men, etc.

Once you have such symptoms, consult with a doctor and undergo a test.

Causes

Causes & Risk Factors

Certain factors can contribute to this long-term disease, making some people more at risk of developing the condition faster than others. Mostly, these factors are diseases or conditions that causes the kidney to lose function and get damaged progressively.

The factors include:

• Diabetes
• Hypertension or high blood pressure.
• Kidney diseases such as polycystic kidney disease, glomerulonephritis, interstitial nephritis, pyelonephritis, etc.
• Kidney injury.
• Artery stenosis of the kidney.
• Urinary tract/bowel obstruction from kidney stones, tumors/cancers, an enlarged prostate in men, etc, and urinary infections.
• Pregnancy malformations
• Vesicoureteral reflex
• Autoimmune diseases such as lupus, sickle cell, etc.
• Heart diseases

Other factors that are risk include:

• A family history of kidney diseases
• Being over the age of 60.
• A race such as African, Asians, Hispanians, Pacific Islanders, American Indians, and African, Hispanic, and Asian Americans.
• Continuous contact with or inhalation of toxins such as lead, fuel, and solvents.
• Overuse of some medications such as NSAIDs like aspirin.
• Abuse of hard drugs.

Complications

If CKD is not well taken care of and advances, some risks, and complications may likely arise. They include:

• A weakened immune system
• Anemia
• Damage of the central nervous system
• Osteoporosis or osteomalacia; a bone disease that causes weakening and fracture of bones.
• Fluid retention and buildup in the body.
• Pulmonary edema, due to fluid mention in the lungs.
• Cardiovascular diseases
• Hyperkalemia; high potassium level in the blood.
• Pericarditis; inflammation of the sac-like membrane around the heart.
• Stomach ulcers
• Reduced sex drive.
• Erectile dysfunction. 
• Infertility
• Complications in pregnancy.
• Kidney failure; irreversible damages to the kidney.

FAQ

Which doctor do I consult for CKD?

Consult a nephrologist; a doctor who specializes in the treatment of kidney problems and related high blood pressure issues.

How is my diabetes control related to my kidney function?

Diabetes is one of the most common causes of CKD because a high sugar level in the blood damages the blood vessels and can affect the kidney's filtering ability.

Can I have CKD and have no symptoms?

Chronic kidney disease happens in stages which progresses. In the first two early stages, which are considered the mild loss of kidney function, the symptoms are not noticeable, or there may be no symptoms at all. So, you can feel great for a long time while you have the condition.

Can kidneys recover from CKD?

There is no cure for chronic kidney disease. Once your kidney is affected, it becomes damaged and losses some percentage of its function. The kidney keeps deteriorating if the cause of the disease is not targeted and controlled. In essence, your kidney cannot be healed from CKD, but the underlying causes and symptoms can be controlled to slow the progress of damage to the kidney.

What happens if my kidneys fail?

Kidney failure is called end-stage renal (kidney) disease. When your kidneys fail, your body will no longer be able to excrete waste products. This will cause the accumulation of excess fluids and chemical wastes in your body which will lead to severe health complications. A failed kidney is irreversible, however, there are treatments to salvage the situation. Dialysis can be used to remove waste products from your body through a machine and Kidney transplants can be done to give you a new and healthy kidney.