Chronic Kidney Disease (CKD)

The kidneys are two fist-sized organs located on either side of you spinal column protected by your rib cage.  Your kidneys filter extra water and wastes out of your blood and make urine.  Your kidneys control the amount of water and salt in your body, control the levels of important minerals in your body such as potassium, help control blood pressure, assist in making red blood cells, make and control hormones that keep your bones healthy, and filter certain medications and waste from your body.

Kidney disease means that the kidneys are damaged and can’t work as effectively as they normally should.  This damage can cause wastes to build up in the body. It can also cause other problems that can harm your health.

Chronic Kidney Disease (CKD) for most people occurs slowly over many years and is often due to diabetes or hypertension.  However CKD can be caused by other underlying chronic diseases or from severe acute kidney injury.  CKD is a growing problem. More than 20 million Americans may have CKD and many more are at risk.  CKD becomes more common as you age.  The major risk factors for CKD are diabetes, high blood pressure, cardiovascular (heart and blood vessel) disease, and a family history of kidney disease.  However there are numerous other conditions or causes of CKD which include taking some medications.

CKD has been staged into 5 different levels.

CKD stage 1 and 2:  These are early stages of CKD and the kidney may still be functioning normally.  At this stage you may have no symptoms and if you control your blood pressure and or blood sugar (if you have diabetes) you may never develop further decline in kidney function.

CKD Stage 3:  At this stage your kidney function is decreasing and waste products can start to build up in the body.  You will most likely have no symptoms at this stage.  It is important to have kidney function monitored regularly and to take steps to help prevent further damage of the kidneys.  This includes:

1. Control of blood pressure and diabetes (if you have it) and be on the appropriate types of medications such as ACE-inhibitors or Angiotensin Receptor Blockers.
2. Avoiding medications that can harm the kidneys such as NSAIDs (Motrin, Aleve, Advil, Ibuprofen, Naproxen, Celebrex as examples)
3. Avoid phosphate containing solutions
4. Avoid if able IV contrast used in CT scans or heart catherizations
5. Smoking cessation, losing weight (if overweigtht), controlling cholesterol

If you are able to take good care of yourself you may be able to prevent progression of CKD in to later stages of disease.

CKD Stage 4 and 5:  These are advanced stages of kidney disease and at these stages waste products can build up to high levels that can make you feel sick or make your blood pressure difficult to control.  At this stage you will need to be followed closely by a kidney specialist (nephrologist).  At this stage there is a high risk of progression of kidney disease to End-Stage Kidney Disease.  You will need to discuss with your nephrologist the appropriate types of medications and diet.  You will also start discussions about dialysis and kidney transplant.  Symptoms to recognize at these stages include:

1. Increased fatigue or weakness
2. Nausea or vomiting
3. Loss of appetite or metallic taste in your mouth
4. Trouble concentrating
5. Swelling or Shortness of breath
6. Itchiness
7. Change in Urination    

End-Stage Kidney Disease (Dialysis)

Info here.

Hypertension

Hypertension is the condition of high blood pressure.  Blood pressure is the force of blood against the walls of your blood vessels which enables blood to pump throughout your body.  When blood pressure is too high it is called hypertension.  Over time untreated hypertension can damage blood vessels and damage organs such as the kidneys and lead to chronic kidney disease.

Kidney Transplant

Info here.

Electrolyte Disturbances (Potassium, Magnesium, Sodium)

Info here.

Anemia of Chronic Kidney Disease

Kidney disease often leads to anemia.  Anemia is a below normal level of hemoglobin in the blood.  Hemoglobin is the protein in red blood cells that carry oxygen to tissue in your body.  Anemia means your body is not making enough red blood cells.  Anemia can occur at any stage of kidney disease but your risk of developing anemia increases as kidney disease worsens.  This occurs because the kidney normally secrete a glycoprotein called erythropoietin.  Erythropoietin stimulates cells to form into red blood cells.  In the setting of kidney disease the kidney may not produce enough erythropoietin which leads to less red blood cell production and anemia.  Patients with mild anemia may have no symptoms or only mild symptoms.  More severe anemia can lead to fatigue (feeling tired), shortness or breath, headaches, or feeling cold.  Other factors that can lead to anemia in kidney disease include iron deficiency, vitamin deficiency, effects of poor nutrition or inflammation.  Depending on your level of anemia your kidney doctor may recommend medication (erythropoiesis-stimulating agents), iron supplements, vitamin supplements or iron-rich diet.

Polycystic Kidney Disease

Polycystic kidney disease (PKD) is most often an inherited disorder.  You are at high risk of PKD if either your mother or father has or had PKD.   It is a chronic condition that causes multiple cysts to grow in the kidneys and replace normal kidney tissue.   A cyst is a fluid filled pouch that can form in the kidney and continue to expand over time.  As the disorder progresses patients can develop hypertension, pain over the kidneys,  or kidney stones.  Once PKD progresses into its more severe form it can cause kidney failure.

The goals of treatment in PKD is to manage symptoms associated with PKD when they occur and manage kidney disease if it develops.  As of now there is no treatment to stop the progression of PKD but ongoing research continues.  In late stages of PKD dialysis or renal transplant may be needed as the kidney function continues to decline.

Kidney Stones (Nephrolithiasis)

Mineral and salts in the urine can sometimes precipitate and form very small solid rock-like objects called kidney stones.  Kidney stones are a common problem.  They can cause pain if the stones causes a blockage of urine flow from the kidney or as the stone passed from the kidney to the bladder and out of the body.  If a kidney stone causes an obstruction you may need to see a urologist to help remove or break up the stone into smaller pieces.  If you develop multiple stones a nephrologist can evaluate any underlying conditions that could cause higher risk of kidney stone formation and suggests treatments that can help reduce the risk of future kidney stone formation.

Blood in the urine (Hematuria)

Info here.

Protein in the urine: Proteinuria

Proteinuria is a when a large amount of circulating protein (protein that should remain in the blood) is found in the urine.  Under normal circumstances there should be no or very tiny amount of protein in the urine.  When protein is found in the urine this suggests that there is some underlying damage in the kidney causing protein to “spill” into the urine.  Another term to describe unusually high levels of protein in the urine is albuminuria.

The two most common health conditions that damage the kidneys and are associated with proteinuria are high blood pressure and diabetes.  However there are multiple other health conditions that can cause proteinuria that your kidney doctor may need to rule out.

Some common symptoms when patient have very large amounts of protein in their urine include swelling of the body especially around the feet, hands, and face.  Some patient may notice foamy or bubbly urine.  However you may still have protein in your urine without these symptoms.

If the kidney disease that is causing the proteinuria is left untreated there is a high risk that the kidney disease could continue to progress end-stage kidney disease.