Chronic Kidney Disease

Chronic Kidney Disease is diagnosed and treated by the Urology Division of Premier Medical Group.

What is chronic kidney disease?

Chronic kidney disease or chronic kidney failure is a condition that occurs when your kidney loses its function over time. Kidneys are an essential organ that help filter your blood to maintain the right levels of substances in your bloodstream. When the kidneys begin to fail as a result of chronic kidney disease, your body can become exposed to dangerous buildups if the kidneys are not filtering properly. In the United States, chronic kidney disease has become more common, affecting around 15% of adults.

Chronic kidney disease can remain undetected or display some symptoms that make it hard to detect early. The disease and its effects occur in stages, making the disease a progressive illness. There are treatments for the disease to help slow the progression; however, chronic kidney disease likely will continue to worsen, resulting in serious end-stage kidney failure. Chronic kidney disease in turn affects major bodily functions and can create high blood pressure, poor bone health, and low blood cell counts.

What causes chronic kidney disease?

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Chronic kidney disease results from damage to the kidneys from a variety of other conditions. The two most common causes of chronic kidney disease are diabetes and high blood pressure. Diabetes can cause damage to the kidneys because if the amount of glucose starts to accumulate in the bloodstream, the extra sugar can damage the kidneys as the organ attempts to filter the glucose. When the kidney filter functions become damaged by the glucose, the kidney cannot regulate other waste and excess fluid from the blood. 

High blood pressure also can cause chronic kidney disease as a result of damage to the blood vessels in the kidneys. This damage strains how well the kidneys can move blood in and out of the filtering system to return to the bloodstream, often resulting in even higher blood pressure as a result of the extra fluid in the bloodstream that the kidneys could not effectively manage. 

While diabetes and high blood pressure are the two most common causes of chronic kidney disease, there are other causes, including:

  • Infection
  • Lupus 
  • Polycystic kidney disease 
  • Glomerulonephritis 
  • IgA vasculitis 
  • Vesicoureteral reflux 
  • Membranous nephropathy

What are symptoms of chronic kidney disease?

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There are not many noticeable symptoms of chronic kidney disease until the functioning of your kidneys become impaired. A person can be in the early stages of kidney disease and not experience any signs of the condition. Some people may be able to detect the condition early through lab tests, but the condition does not often make itself known. 

Chronic kidney disease shares symptoms with other common conditions, so be sure to communicate with your healthcare team once you notice new or worsening symptoms. Once chronic kidney disease has progressed, you may notice the following symptoms:

  • Foamy urine
  • Muscle cramps
  • Nausea
  • Vomiting
  • Trouble sleeping
  • A change in urination frequency (i.e.: more frequently or less frequently)
  • Fatigue and mental fog
  • Loss of appetite or weakness 
  • Swollen ankles and feet 
  • Itchy, dry skin 
  • Chest pain 
  • Trouble breathing 
  • Numbness in the limbs 
  • Metallic taste in mouth or breath that smells like ammonia 

Many of these symptoms will only show during advanced stages of the condition, so it is important to communicate these symptoms to your doctor as soon as you notice them to start getting treated as soon as possible. 

What are the stages of chronic kidney disease?

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Doctors rely on two lab tests to track a person’s chronic kidney disease progression. One blood test uses creatinine levels in a person’s blood to determine a person’s glomerular filtration rate (GFR). The GFR establishes the stage of kidney disease and measures how well the kidneys are filtering out the creatine waste in the blood. Another urine test called the urine albumin-creatinine ratio (uACR) measures the amount of protein in the urine, which indicates potential kidney damage. 

There are 5 stages to chronic kidney disease. Each stage is associated with a set GFR measurement and symptoms. 

Stage 1:

  • GFR of 90 or higher 

  • uACR of 30 or higher for 3 or more months 

  • Possible that no symptoms appear. 

Stage 2

  • GFR of 60-89 

  • uACR of 30 or higher for 3 or more months 

  • Possible symptoms: foamy urine, high blood pressure, and urinary tract infections. 

Stage 3a

  • GFR of 45-59 for 3 or more months 

  • Mild kidney dysfunction 

  • Possible symptoms: swelling in feet and hands, frequent urination, back pain, and high blood pressure. 

Stage 3b

  • GFR of 30-44 for 3 or more months 

  • Moderate loss of kidney function 

  • Possible symptoms: swelling in feet and hands, frequent urination, back pain, and high blood pressure. 

Stage 4

  • GFR of 15-29 for 3 or more months

  • Severe loss of kidney function 

  • Possible symptoms: Back pain, anemia, bone disease, frequent urination, and swelling in the limbs. 

Stage 5 

 

  • GFR of 15 or less for 3 or more months 

  • Kidney failure 

  • Possible symptoms: muscle cramps, itching, nausea, vomiting, difficulty sleeping, difficulty breathing, and swelling in hands and feet. 

Are there any risk factors or groups for chronic kidney disease?

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There are risk factors that make a person more likely to develop chronic kidney disease. 

 

  1. Medical conditions: People with diabetes, high blood pressure, heart disease, and obesity are more likely to develop the condition. 

  2. Family history: Chronic kidney disease can run in families. 

  3. Lifestyle: Smoking or chewing tobacco can increase blood pressure and put you at a higher likelihood of the disease. 

  4. Demographics: Certain racial and ethnic groups, mainly African Americans, Hispanics, Native Americans, or Asian Americans, are at a higher risk. 

  5. Age: The condition is more likely to occur in adults aged 60 years or older.

  6. Medications: Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin converting enzyme inhibitors (ACEIs), can damage the kidneys, and frequent use of those medications can increase your risk.  

How is chronic kidney disease diagnosed?

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Chronic kidney disease is diagnosed by a healthcare professional with the use of a medical history review, physical examination of symptoms, and lab test to confirm the disease and its stage. Your doctor will use your medical history to assess your risk of the condition and any familial history of the condition. In addition, a review of your symptoms can help inform which next steps or tests may be necessary to confirm a diagnosis. 

The two main tests to confirm a chronic kidney disease diagnosis are the blood test glomerular filtration rate (GFR) and the urine test urine albumin-creatinine ratio (uACR). These tests detect the presence of key proteins and chemicals associated with normal kidney function to know at what level the kidneys are working. Since chronic kidney disease develops slowly, you will likely need to conduct follow up testing if you are at risk of the condition to track the progress of the condition and apply appropriate treatments. 

How is chronic kidney disease treated?

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Treating chronic kidney disease depends on the stage of the condition. There is no cure for the condition, and kidney damage is not always reversible. The goal of treatment is to manage symptoms and slow the progression of the disease. However, when the condition reaches end stages, treatment becomes more aggressive to preserve organ function. 

Early Stages Treatment:

  • Diet and lifestyle: A kidney-friendly diet helps lower cholesterol, sodium, and potassium levels. In addition, staying active can help maintain a healthy weight and lower blood pressure. Quitting smoking also can help treat the condition. 
  • Medication: Medications like ACE inhibitors, nsMRA, and statin all help slow down chronic kidney disease and help lower blood pressure and cholesterol levels. Those with chronic kidney disease should not take NSAIDs. 

End Stage Treatment: 

  • Dialysis: Dialysis mechanically removes waste using medical devices after the kidneys are no longer able to filter blood. 
  • Kidney transplant: Kidney transplant, if an available option, can be an alternative to dialysis that depends on blood types to identify a compatible match. Often, people receive a kidney donation from a family member. 

Should you see a doctor for chronic kidney disease?

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Chronic kidney disease is a serious condition if left untreated or undetected, so you should see a doctor as soon as you notice symptoms. Early detection can help establish a treatment plan to slow the progression of the disease. Those in end stage chronic kidney disease must follow their treatment plan very closely to ensure the risk of complications is understood and lowered. A doctor is the only one able to confirm a diagnosis and determine the best treatment plan. 

What is the outlook for people living with chronic kidney disease?

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Since chronic kidney disease has no cure, a person will have to continuously treat the condition for the rest of their life. The outlook of the condition can be more positive with early detection and successful treatment. Those with end stage chronic kidney disease need to take treatment very seriously and explore their dialysis and kidney transplant options. 

Kidney transplant can extend a person’s life with chronic kidney disease. In recent news, a man with end stage kidney disease received a successful kidney transplant of a pig kidney. Surgical news like this brings a new sense of hope to those living with chronic kidney disease that transplants might be more readily available for those in the later stages of the condition. 

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