Chronic kidney disease or CKD, is a long-term condition where a person’s kidneys don’t work properly.

Kidney disease is more common as people get older with around one in five men and one in four women aged 65 and 74 having some degree of chronic kidney disease.

Ethnicity affects a person’s risk of kidney disease. The risk of developing kidney disease is also greater in people of south Asian origin and black people.

What are the symptoms of kidney disease?

Early detection is the first step in treating chronic kidney disease. The early symptoms of kidney disease may include:

• Increased urination at night.
• Passing only small amounts of urine.
• Swelling, particularly of the hands and feet, and puffiness around the eyes.
• Unpleasant taste in the mouth and urine-like odour to the breath.
• Persistent fatigue or shortness of breath.
• Loss of appetite.
• Increasingly higher blood pressure.
• Pale skin.
• Excessively dry, itchy skin.
• In children: increased fatigue and sleepiness, decrease in appetite, and poor growth.

Seek medical advice if:

You experience any of these symptoms, which could be a warning sign of kidney disease.

Unfortunately, some people have no symptoms of chronic kidney disease until some of their kidney function is lost – which is why prevention is vital.

How do I know if I have kidney disease?

Blood and urine tests can help uncover signs of early kidney disease and monitor kidney disease. Common tests include:

Blood pressure monitoring. Detection and early treatment of high blood pressure is key to slowing or preventing kidney damage. Your doctor will advise a plan, which may include diet changes and medication, to keep your blood pressure as close to normal as possible. Normal blood pressure is generally considered to be less than 120/80.

Protein in the urine. Excess protein in the urine may be a sign of damage in the kidneys’ filters (the glomeruli).

GFR (glomerular filtration rate). This is a measure of how well your kidneys are filtering your blood. An estimate of your “filtering rate” is determined by a blood test called a blood creatinine test, which measures the amount of a waste product — creatinine — in your blood. This test, along with your age, body size, and gender, gives your doctor an estimate of your GFR. Your GFR, or “filtering rate,” helps confirm normal or low kidney function.

Your doctor may also refer you to a kidney specialist, called a nephrologist, for more specialised testing. A kidney biopsy may be advised, which removes a small amount of kidney tissue for microscopic examination to pinpoint the cause of kidney damage and plan treatment.

What are the treatments for kidney disease?

Medication, especially those that control diabetes and high blood pressure, can sometimes help slow the progress of chronic kidney disease. A sudden loss of kidney function may improve if the underlying cause — such as a pregnancy complication — is resolved.

But with long-term kidney disease, if the kidneys deteriorate and can no longer function at all, there are only two treatment options: dialysis, which uses an artificial device to clean the blood of waste products, or a kidney transplant. With some underlying medical conditions, acute kidney failure complicates treatment, as well as being life-threatening in itself.

Medication for kidney disease

High blood pressure is both a cause and a symptom of kidney disease. Your doctor may prescribe a blood pressure medication for your kidney disease, such as an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Along with controlling blood pressure, these medicines give added help to kidneys over time.

Since damaged kidneys may no longer be able to produce erythropoietin, which regulates the manufacture of red blood cells, your doctor may need to give erythropoietin medicines to curb anaemia. Medication to help control phosphorus levels is often needed as well as vitamin D. The NHS says “People with kidney disease can have low levels of vitamin D, which is needed for healthy bones. This is because the kidneys need to activate the vitamin D from food and from the sun before it can be used by the body. You may be given a vitamin D supplement called alfacalcidol or calcitriol to help boost vitamin D levels and reduce the risk of bone damage.”

Because medicines are excreted through the kidneys, you’ll need to consult with your doctor before taking any medications — including over-the-counter medicines. You may be told to avoid anti-inflammatory drugs, such as ibuprofen, which are possible contributors to kidney disease. Always discuss any alternative or herbal treatments with your doctor before trying them.

Diet for kidney disease

With kidney damage, your kidneys lose their ability to excrete sodium, potassium, phosphorus, and other waste by-products. Depending on your stage of disease, your doctor may advise a special diet to decrease the workload on your kidneys, keep body fluids and minerals in balance, and fend off a buildup of wastes in the body. If a special diet is advised, a kidney diet specialist, called a renal dietician, can help you with these diet changes. These diets may include changes in your amount of:

• Protein
• Potassium
• Sodium
• Phosphorus

Your doctor may also advise specific amounts of vitamins and minerals to take, such as calcium and the active form of vitamin D.

If you have diabetes or hypertension

Just as critical for kidney health, if you have diabetes or hypertension, is to follow a diet to manage these conditions.

• With diabetes, eating to manage your blood sugar levels throughout the day is key.
• With hypertension, a low- salt diet may be advised to control high blood pressure.

Some studies have shown that rigidly following a diet that severely restricts protein can delay or prevent more kidney damage — especially for people with diabetes. Other studies have shown that diabetics who follow a diet that keeps their blood glucose levels within a tight range can help slow the progression of kidney disease.

Kidney dialysis

For advanced kidney disease, dialysis is needed to perform the failing kidneys’ functions. Two types of dialysis are commonly used today. Decisions on treatment options are made in discussions between you and your nephrologist, who can prescribe and oversee the best treatment plan for you.

Haemodialysis

Haemodialysis uses an artificial kidney machine with a mechanical filter to help cleanse your blood.

Before the first treatment, a surgeon implants a shunt, or small tube, in your arm or leg. Several times a week, for several hours at a time, another tube is connected to the shunt so that blood can be circulated through the kidney machine, cleaned, and pumped back into your body.

Peritoneal dialysis

Peritoneal dialysis is a form of dialysis that makes use of the lining of the abdomen, or peritoneal membrane – which has many of the kidneys’ filtering characteristics – to help clean the blood.

A tube is surgically implanted into the abdominal cavity. Then, during each treatment, a dialysis fluid called dialysate is sent (or “instilled”) through the tube and into the abdomen. The dialysis fluid picks up waste products and is then drained out after several hours. Several cycles of treatment — fluid instillation, time in the abdomen, and drainage — are needed every 24 hours. Automated devices can now do this overnight, allowing people more freedom of movement and time during the day for usual activities.

Both types of dialysis have possible complications and risks, including infection. The stress of repeatedly having to do dialysis can also take its toll on emotional wellbeing.

Kidney transplants

People with advanced kidney disease often opt for a kidney transplant to avoid a lifetime of repeated dialysis and improve their quality of life. A “matching” kidney may come from a family member or unrelated person, or be donated by the family of a recently deceased person.

New anti-rejection medicines and improved follow-up care have greatly increased the success rate for kidney transplants. But not everyone with kidney disease is a candidate for a transplant. Some people have underlying medical conditions that rule out this surgery.

Preventing kidney failure

The key to prevention or delay of severe kidney failure is early detection and aggressive intervention -while there’s still time to try to slow down the disease. Medical care with early intervention can slow the development and progression of chronic kidney disease.

Diabetes and hypertension are the two most common causes of kidney failure – and both are conditions you can help control. By aggressively managing diabetes and hypertension with diet, exercise, and medication, you may be able to prevent kidney failure and help keep as much kidney function as possible.

Know your risks of kidney failure

Since diabetes and high blood pressure put you at risk of kidney disease, know where you stand with these risks. Do you have diabetes or hypertension? Is your diabetes or hypertension under control? If you can, find out about your family’s medical history, as well, so you’ll know if diabetes, hypertension, and kidney disease run in your family. The prolonged overuse of some drugs, including non-steroid anti-inflammatory analgesia such as ibuprofen, has also been linked to an increased risk of kidney disease. Discuss this with your GP if you are using this type of medication.

Get tested regularly

At your next doctor’s appointment, and at least within the next year if you haven’t had these tests done:

Ask for a urine test to see if you have excess protein, glucose, or blood in the urine.
Ask for a blood pressure reading, to see if your blood pressure is high.
Ask for a fasting blood glucose test, to see if you have too much glucose ( sugar) in your blood.

Control diabetes

If you have diabetes, work with your doctor to keep your blood sugar levels under the best possible control. A programme of diet, regular exercise, glucose monitoring, and medication to control blood sugars and protect kidney function can help.

Control hypertension

If you have hypertension, work with your doctor to get your blood pressure as close as possible within normal ranges. Again, a programme of diet, regular exercise, and medication can help.

Consider a referral to a nephrologist

If you’ve already lost some kidney function, or your doctor tells you that you’re likely to have more kidney damage in the future, ask about a referral to a nephrologist, also known as a renal physician (a kidney disease specialist). A nephrologist can provide specialised testing, evaluate your condition, and talk with you about possible ways to slow down the progress of chronic kidney disease.

Source: WebMD