Chronic Kidney Disease

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and reabsorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body’s salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

• remove waste products from the body
• remove drugs form the body
• balance the body’s fluids
• release hormones that regulate blood pressure
• produce an active form of vitamin D that promotes strong, healthy bones
• control the production of red blood cells

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

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Kidney disease occurs when kidneys can no longer perform their functions to full capacity. These functions include: removing extra water and wastes, helping control blood pressure, keeping body chemicals in balance, maintaining strong bones and telling your body to make red blood cells. Kidney disease can happen all of a sudden – within 2 to 3 months- or slowly, over 30 to 40 years. The severity of chronic kidney disease depends on how well the kidneys filter wastes from the blood (glomerular filtration rate).

In chronic kidney disease, the kidneys have not stopped working altogether but are not working as well as they should. You can live normally with kidneys that are not functioning at 100% or with only one functioning kidney. Dialysis or kidney transplantation is required when kidney function drops to about 15% of normal.

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Chronic kidney disease is defined as having some type of kidney abnormality or “marker” such as protein in the urine, and having decreased kidney function for three months or longer.

There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited.

Others are congenital; that is, individuals may be born with an abnormality that can affect their kidneys.

The following are some of the most common types and causes of kidney damage that lead to chronic kidney disease.

• Diabetes is the number one cause of kidney disease, responsible for about 40% of all kidney failure.
• High blood pressure is the second cause, responsible for about 25%.
• Glomerulonephritis is the third most common cause of chronic kidney disease. Gomerulonephritis, a general term for many types of kidney inflammation.
• Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and “street” drugs such as heroin and crack can also cause kidney damage.

Other causes include:

• Infection and obstruction of the kidneys.
• Inherited genetic diseases, such as polycystic kidney disease.

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Knowing the symptoms of kidney disease can help people detect it early enough to get treatment. Symptoms can include:

• Changes in urination -making more or less urine than usual, feeling pressure when urinating, changes in the color of urine, foamy or bubbly urine, or having to get up at night to urinate.
• Swelling of the feet, ankles, hands, or face -fluid the kidneys can't remove may stay in the tissues.
• Fatigue or weakness -a build-up of wastes or a shortage of red blood cells (anemia) can cause these problems when the kidneys begin to fail.
• Shortness of breath -kidney failure is sometimes confused with asthma or heart failure, because fluid can build up in the lungs.
• Ammonia breath or an ammonia or metal taste in the mouth -waste build-up in the body can cause bad breath, changes in taste, or an aversion to protein foods like meat.
• Back or flank pain -the kidneys are located on either side of the spine in the back.
• Itching -waste build-up in the body can cause severe itching, especially of the legs.
• Loss of appetite
  Nausea and vomiting
• More hypoglycemic episodes, if diabetic.

If you believe you have any of these symptoms, talk to your doctor about your concerns. This is especially important if you have a close family member who has kidney disease, or if you have diabetes or high blood pressure, which are the main causes of kidney failure.

Also it is important to member some people with chronic kidney disease do not have any symptoms. Stephanie Starks Hope Foundation Healthy Vision promotes yearly physicals that can help diagnose undetected health issues that go undiagnosed. Since chronic kidney disease may not cause symptoms, your health professional may screen you for it if you are at high risk because you have another condition, such as diabetes or high blood pressure. Screening may be the only way to know whether you have chronic kidney disease.

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Kidney disease can be found through lab tests or by symptoms. Your health professional will use blood and urine test to measure changing levels of chemicals in the bloodstream to help determine how well the kidneys are working. Levels of certain chemicals, such as urea and creatinine, begin to increase as kidney functions declines.
High blood levels of creatinine and urea nitrogen (BUN) or high levels of protein in your urine suggests kidney disease.

Diabetics should have a yearly urine test for microalbumin, small amounts of protein that don't show up on standard urine protein test.

If you are in the high-risk group because you have diabetes or high blood pressure, screening for chronic kidney disease is recommended.

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Diabetes is a risk factor for kidney disease, but this does not mean your kidneys will fail. You can care for your kidneys by controlling your blood sugar and getting regular microalbumin urine tests to see if you are spilling even tiny amounts of protein. Even if you develop diabetic kidney disease, you can work with your doctor to keep your kidneys working as long as possible.

If I have signs of kidney disease, what should I do?
After you have basic screening tests done, if you have signs of kidney disease, you should ask for a referral to a nephrologist, a specialist in treating kidney disease. A nephrologist will perform an evaluation then suggest medications or lifestyle changes to help slow the progression of kidney disease.

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There are four main risk factors for the development of chronic kidney disease

Risk factors you cannot control

• Age. The kidney begins to get smaller at about age 35. By age 80 most people have lost about 30% of their kidney mass.

• Race. Both African-Americans and Native Americans are more likely to develop chronic kidney disease.

• Gender. Men have a higher risk for developing chronic kidney disease than women.

• Family history. Family history is a factor in the development of both diabetes and high blood pressure, the major causes of chronic kidney disease. Polycystic kidney disease is one of several inherited diseases that cause kidney failure.

Risk Factors You May Be Able To Control

If you have already been diagnosed with chronic kidney disease, you can control some risk factors that can lead to CKD, slow the progression of the disease, and prevent or delay the development of end-stage renal disease (ESRD). These risk factors include:

• High blood pressure.

• Diabetes.

• Dietary intake of protein and fats.

• Other medication use.

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Since another condition usually causes chronic kidney disease, the most effective way to treat kidney disease is to treat and manage the disease that caused your kidney damage. Work with your health professional to:

• Develop a plan to aggressively treat and control your diabetes or high blood pressure.to slow additional damage to your kidneys.
• Prevent diseases or avoid situations, such as medication use, that can cause kidney damage.

Your health professional will use blood and urine tests to regularly monitor your condition. These tests will determine how your kidneys are functioning and whether changes to your treatment plan are needed. Kidney dialysis or kidney transplant may be needed if end-stage renal disease (ESRD) develops.

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Chronic kidney disease is often progressive. If the disease progresses, your symptoms may occur more frequently or become more severe. Work with your health professional to develop a treatment plan to control these symptoms.

Depending on your stage of chronic kidney disease, you may need to make dietary changes to help slow its progression. You may be asked to limit your use of salt or watch how much potassium or phosphorus is in your diet.

In the early stages of this disease, only a small part of the kidney is involved. Some people have destruction of the glomerulus (glomerulonephritis ) or renal tubules. Early kidney disease can cause scarring, which interferes with the blood flow to a portion of the kidney (nephrosclerosis ).

Over time, if chronic kidney disease is not treated, end-stage renal disease (ESRD) develops. When this occurs the kidneys have been severely damaged and are often replaced with nonfunctional scar tissue.

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According to the American Kidney Fund more than 10 million Americans have severe health problems with their kidneys, including kidney infections, kidney stones, cancer of the kidney, polycystic kidney disease, bladder disorder or acute urinary conditions. Another 13 million citizens suffer from urinary incontinence.

According to the National Institutes of Health, about 100,000 Americans are diagnosed with total and permanent kidney failure or end-stage renal disease (ESRD) and must go on dialysis or undergo a transplant of a healthy kidney in order to live.

Partially due to our aging population, kidney disease has become the ninth leading cause of death and one of the most expensive chronic diseases to treat. Approximately 75 million Americans are at risk due to a number of factors, including diabetes, high blood pressure, inherited and congenital kidney diseases or other factors:

• About 1 out every 12 people in America suffers from kidney and urinary tract diseases.
• Untreated hypertension (high blood pressure), strep throat and exposure to toxins are the major preventable causes of kidney disease.
• Diabetes is the leading cause of kidney failure (42% of new diagnoses)
• Currently, almost 400,000 citizens suffer from kidney failure are being kept alive through dialysis or as a recipient of a transplant of a healthy kidney.
• About 45,000 patients are waiting for a kidney transplant, but only about 12,000 will have the opportunity to receive a healthy kidney this year.
• Almost 60,000 ESRD patients die each year, making kidney disease America's ninth leading cause of death.

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* Text Resources: The Mayo Clinic Staff