Chronic kidney disease (CKD, also called kidney failure or renal failure) is a condition in which the kidneys lose some of their ability to remove waste products and excess fluid from the bloodstream. As waste products and fluids build up in the body, other body systems are affected, which can be harmful to your health.
The most common causes of CKD are diabetes and high blood pressure. In the early stages of CKD, there are no symptoms. The disease can progress to complete kidney failure, also called end-stage kidney disease. This occurs when kidney function has worsened to the point that dialysis or kidney transplantation is required to maintain good health and even life, which is typically when kidney function is approximately 10 percent or less of the normal kidney function.
The main goal of treatment is to prevent progression of CKD to complete kidney failure. The best way to do this is to diagnose CKD early and control the underlying cause.
A number of factors can increase the risk of developing CKD, including:
Most people with CKD do not have symptoms until the kidney function is severely impaired. The problem is often discovered when blood or urine tests done for other reasons show abnormalities. The blood test that is most commonly used to check the level of kidney function is the creatinine concentration. As kidney function goes down, the creatinine concentration in the blood goes up. The most common urine tests are for protein or albumin in the urine.
Sometimes, people with CKD will develop swelling, most commonly around the feet and ankles, before any other symptoms appear. Even when kidney failure is advanced, most people still make a normal or near-normal amount of urine; this is sometimes confusing. Urine is being formed, but it does not contain sufficient amounts of the body’s waste products.
With advanced kidney disease, you may develop edema (swelling of the feet, ankles, or legs), loss of appetite, increased sleepiness, nausea, vomiting, confusion, and difficulty thinking. Patients often develop high blood pressure, blood chemistry (electrolyte) abnormalities such as a high potassium concentration, anemia (a decrease in red blood cells, which can cause fatigue and other symptoms), and bone disease.
People with advanced kidney failure may develop a group of symptoms referred to as uremia. The symptoms of uremia include loss of appetite, nausea, vomiting, a build-up of fluid around the heart, nerve problems, and changes in mental status, including drowsiness, seizures, or coma.
A health care provider may use several tests to diagnose CKD and determine if there is a treatable underlying cause.
Kidney function tests
The glomerular filtration rate (GFR) gives an approximate measure of the number of functioning nephrons. GFR is used to monitor the severity of kidney impairment. The most common way to estimate the GFR in adults is by measuring the creatinine level in the blood stream and then using this number to calculate an estimated GFR (eGFR) level.
The presence of albumin or protein in the urine (called albuminuria or proteinuria) is a marker of kidney disease. Even small amounts of albumin in the urine may be an early sign of CKD in some people, particularly those with diabetes and high blood pressure.
Imaging tests (such as a CT Scan or ultrasound) may be recommended to determine if there are any obstructions (blockages) of the urinary tract, kidney stones, or other abnormalities, such as many large cysts seen in a genetic disease called polycystic kidney disease.
With a kidney biopsy, a small piece of kidney tissue is removed and examined under a microscope. The biopsy helps to identify abnormalities in kidney tissue that may be the cause of kidney diseases.
The first step in the treatment of CKD is to determine the underlying cause. Treatment of reversible causes may prevent CKD from worsening.
Research has shown that management of CKD is best done with the assistance of a nephrologist, a doctor who specializes in kidney diseases, to decreases the chance of developing complications associated with CKD.
People in the early stages of CKD can take medicines to keep the disease from getting worse. For example, many people with CKD should take medicines known as “ACE inhibitors” or “angiotensin receptor blockers.” If your doctor prescribes these medicines, it is very important that you take them every day as directed. If they cause side effects or cost too much, speak to your doctor or nurse about it. He or she might have solutions to offer.
What happens if my kidneys stop working completely?
If your kidneys stop working completely, you will need a treatment to take over the job of your kidneys. The most common option in Belize at the moment is Hemodialysis.