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Chronic Kidney Disease and Failure

What Is Chronic Kidney Disease and Failure?

Kidneys are responsible for cleaning waste from the blood. When they don’t function properly, a condition called chronic kidney disease (CKD) can develop. The disease is called “chronic” because the damage to the kidneys happens slowly over time. There are 5 stages of kidney disease, beginning with mild disease in stage one and progressing to the complete kidney failure that identifies stage five. People diagnosed with CKD typically have ongoing blood and urine tests to see how the disease is progressing.

When kidney function drops below 15% of what is considered normal, kidney failure is present. The waste the kidneys are supposed to eliminate builds up in the bloodstream, and the body retains excess water.

The main health problems that can lead to CKD and kidney failure include:

  • Diabetes: One of the most common causes of kidney damage and CKD. When glucose builds up in the blood, it can decrease the kidneys’ filtration ability, leading to the presence of proteins, such as albumin, in the urine.
  • High blood pressure: Also known as hypertension, this is another common cause of CKD. When blood pressure is elevated for prolonged periods, it damages the blood vessels in the kidneys. As a result, kidneys don’t filter waste as well, which causes the body to retain fluid. Excess fluid raises blood pressure, continuing the cycle.
  • IgA nephropathy: Also known as Berger’s disease, this condition causes buildup of immunoglobulin A (IgA) and inflammation in the kidneys.
  • Lead or other heavy metal poisoning: High levels of metal in the body can damage the kidneys.
  • Polycystic kidney disease: This genetic disorder causes cysts to grow in the kidneys.
  • Infections, medications and autoimmune conditions, such as lupus and various other disorders, can also damage the kidneys and lead to CKD.

Symptoms

Kidney disease often doesn’t cause symptoms unless it is in the late stages, when the kidneys are already failing. Being tested is the only way to know for sure if kidney disease is present. A doctor will check the urine for the presence of albumin, a protein that can build up due to decreased kidney function. He or she may also do a blood test to check glomerular filtration rate. This determines how well the kidneys are filtering waste from the blood by measuring creatinine levels.

Patients should talk to their doctor if they experience any of the symptoms listed below.

  • Blood in urine: In addition to filtering waste from the blood, healthy kidneys typically also filter out blood cells. When that filtration ability declines, patients may notice blood in their urine, which can also be a symptom of other concerning conditions such as infection and kidney stones, so patients should notify their doctor right away.
  • Decreased appetite: While decreased appetite can be a symptom of many conditions, waste buildup in the bloodstream often causes patients to feel less hungry.
  • Difficulty sleeping: Increased waste levels in the blood can make it more difficult to sleep. Sleep apnea is also more common in individuals with CKD.
  • Foamy urine: When protein isn’t filtered out of the urine, it can make urine look foamy and full of bubbles. Sometimes patients may even need to flush several times for the bubbles to go away. Patients should talk to their doctor if they notice this, as excessive protein in urine is a key sign of kidney disease.
  • Increased urge to urinate: A need to urinate more frequently can be a symptom of kidney disease, especially if this increased urge occurs more often at night. For men, increased urination can also be a sign of other conditions, such as enlarged prostate, so patients should talk to their doctor to determine the cause.
  • Itchy, dry skin: Removing waste from the blood helps the body maintain its necessary balance of minerals and nutrients. When accompanied by other symptoms, skin that is dry and itchy can indicate a mineral and bone disease that sometimes comes with advanced kidney disease.
  • Muscle cramps: If the kidneys aren’t filtering properly, the blood may not have the correct electrolyte levels. This can cause muscle cramps.
  • Puffy eyes: Protein in the urine, caused by decreased kidney function, can cause the eyes to appear puffy.
  • Swollen feet and ankles: Swelling can be a symptom of many things, including heart disease, so patients should alert their doctor if they notice sudden swelling of their lower extremities. One cause could be impaired kidney function, which can cause excess sodium levels.
  • Unexplained fatigue and difficulty concentrating: Anemia goes hand-in-hand with kidney disease and can cause unexplained fatigue and feelings of weakness. Increased waste levels in the blood can also make it difficult to concentrate and make patients feel constantly tired.

Treatment Options

Some people can preserve kidney function by treating their CKD with medication and lifestyle changes. Steps include:

  • Maintaining good blood sugar control
  • Maintaining healthy blood pressure levels
  • Quitting smoking
  • Seeing a kidney specialist, also known as a nephrologist, regularly
  • Taking steps to treat anemia
  • Working with a dietitian to limit sodium and protein intake, and reduce cholesterol levels

End-Stage Renal Disease Treatment Options

People with end-stage renal disease (ESRD) must consider further treatment. Options include:

  • Hemodialysis: When the kidneys can no longer filter toxins out of the blood, a doctor may recommend dialysis. Hemodialysis is one kind of dialysis and involves the use of a special filter called an artificial kidney, or a dialyzer, and a dialysis machine. Prior to beginning hemodialysis, a patient will have minor surgery to their arm to create access to the blood vessels by the dialyzer. From there, the patient will visit either the hospital or a dialysis center to receive treatment. Blood is pumped out of the body to the dialyzer, which cleans excess fluid and waste products such as creatinine, potassium and urea from the blood. Treatment is usually done three times a week and takes approximately four hours.
  • Peritoneal dialysis: In this type of dialysis, the lining of the abdomen is used as a filter rather than the dialyzer. A few weeks before starting peritoneal dialysis, a minor surgery is performed where a surgeon places a catheter in the patient’s abdomen. Cleansing fluid, called dialysate, enters the patient’s body through the catheter and absorbs waste. After the filtering process is through, the fluid exits the patient’s body again through the catheter. There are two types of peritoneal dialysis — automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). APD is typically done as the patient sleeps and a machine delivers and drains the cleansing fluid. CAPD is continuous, machine-free and is done as the patients go about their day. The patient places the cleansing fluid in the body through a tube via a plastic bag and later drains it. This process is done between three and five times per day. An important thing to keep in mind, however, is that dialysis can only replace part of a patient’s kidney function.
  • Kidney transplantUsing a kidney from either a living or deceased individual, a kidney transplant eases the burden on a damaged kidney by replacing it with a healthy, functioning kidney. A surgeon will connect the new kidney to an artery and a vein in the patient’s groin, as well as to the ureter so that urine can flow into the bladder from the new kidney. As with any transplant surgery, if a patient receives a kidney transplant, he or she will require immunosuppressant drugs to keep the immune system from attacking the donor kidney. Successful transplants typically reduce diet restrictions and eliminate the need for dialysis, leaving patients feeling better than they have in a long time.

When to Seek a Specialist

If patients have significant risk factors for kidney disease, including family history, high blood pressure or diabetes, doctors may recommend annual testing. Kidney disease often requires long-term care and monitoring. For that reason, primary care providers may refer to a nephrologist, a doctor who specializes in kidney disorders. A nephrologist will help determine the best way to maintain kidney function and, if necessary, guide toward treatment options such as dialysis or a transplant.

Why Temple Health?

Temple nephrologists provide the highest level of care for kidney patients. Patients have access to a range of treatment options, including an inpatient acute dialysis facility, three outpatient hemodialysis centers and a peritoneal dialysis unit.

The Temple Kidney Transplant Program provides transplant patients with a wide range of options. The team includes transplant nephrologists, surgeons, transplant coordinators, a doctor of pharmacy, a social worker and financial counselor. Temple’s multidisciplinary approach opens doors for even the most complex patients.

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