Chronic kidney disease

What is CKD?

Chronic kidney disease refers to an irreversible loss of the functions of the kidneys which typically develops over a period of years (chronic). It may also be called chronic renal failure or chronic renal insufficiency. Renal means kidney.

The kidneys are two bean-shaped organs located just below the ribs near the middle of the back, with one on either side of the midline. One of their major functions is filtering the blood to get rid of wastes and extra fluid, which are passed out as urine.

Chronic kidney disease occurs when something goes wrong with this function. Wastes and fluids start to build up, and this, together with the subsequent loss of its other functions, causes a whole lot of problems in the body.

A number of things could cause this to happen. Topping the list are diabetes and hypertension, in that order. Other less frequent causes include blockage in the renal arteries, inherited kidney problems and those that develop in the womb, prolonged stay around toxic substances like leaded paint and soldering materials.

 In people with diabetes, the excess glucose (sugar) in their blood can over time damage the tiny blood vessels that filter wastes in the kidneys. In hypertension, the high pressure of blood damages these same vessels over a period of time.

What are the symptoms?

The great majority of people with slowly deteriorating disease have no symptoms until during the late stages of the condition when there has been sufficient damage to the kidneys. Increased urination especially at night (nocturia) can be an early symptom. Others include:

  • Malaise, loss of energy
  • Loss of appetite
  • Sleeping difficulties
  • Itching
  • Nausea, vomiting and diarrhoea
  • Tingly feeling on hands and feet
  • Overwhelming need to frequently change position of the legs (this usually occurs in people getting dialysis for CKD)
  • Bone pain
  • Swelling usually of the legs and hands

However, many of the symptoms can also be caused by other conditions. So it becomes necessary to see a doctor when you start noticing some of these. They may have to carry out some blood and urine tests, take a look at your kidneys using an ultrasound, and possibly collect some samples from the kidney to be viewed under a microscope. These will confirm if you have CKD.

What treatments are available?Image result for dialysis in africa

Referral to a specialist is most appropriate for people with potentially treatable underlying disease or those who are likely to progress to the end-stage of CKD.

There is no cure for chronic kidney disease. However, with the appropriate treatments, the rate of deterioration can be slowed down, the symptoms improved, and the adverse effects of kidney damage limited.

Slowing the progression

  • Controlling the blood pressure, blood sugar, or any other identified cause of CKD.
  • Reducing the amount of protein being passed in urine.
  • Diet and lifestyle modification, by reducing protein intake and quitting smoking as well as doing more exercise and losing weight.

Treating problems caused by kidney failure

  • Accumulated fluid causing body swelling can be removed as urine with the help of drugs called diuretics. The amount of salt and fluid intake per day may also be checked.
  • Anaemia often occurs in people with CKD because their kidneys do not produce enough erythropoietin (EPO), a substance that helps make red blood cells. Hence there is shortage of red blood cells, and the individual feels very tired and becomes breathless easily. This could be treated with injections containing a drug similar to EPO.
  • Heart diseases may also occur in people with CKD because of a number of factors which ultimately lead to excess cholesterol and other “bad fat”. These effects may be checked using drugs called statins.
  • The bones may become weak in people with CKD as the kidneys are involved in the production of Vitamin D, phosphate, and calcium essential for strong bones. The doctor may recommend calcium and vitamin D supplements, as well as limiting the amount of phosphate in diet.
  • There is increased susceptibility to infections, and this is the second mmost common cause of death in CKD patients receiving dialysis, after heart disease. Appropriate antibiotics should be given promptly.
  • There is also an increased bleeding tendency in these individuals. Adequate dialysis can partially correct this in some cases.
  • Problems with the digestive system are common in people with CKD. These include nausea, vomiting, loss of appetite and peptic ulcer disease. These are taken care of by the appropriate drugs.
  • Finally, as the individual approaches or is on dialysis, depression could set in. This requires support for both them and their relatives.

Treating end-stage kidney disease

At end-stage, less than 15 percent of the normal kidney function is left, and the kidneys can no longer cope with the work of removing wastes and excess fluids from the body. Hence, a “kidney replacement” is needed. This may be done using either dialysis or a kidney transplant. The two options will be discussed in detail with your doctor to find out the one most suitable for you.

What will happen to me?

Chronic kidney disease is a serious long-term condition. However, with early identification and adequate management, the outlook can be quite good and people can live for many years with it. Even people with advanced kidney disease can achieve a good quality of life by closely following their doctor’s advice and treatment plan.