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Chronic kidney disease

Definition

Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body.

Alternative Names

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure

Causes

Chronic kidney disease (CKD) slowly gets worse over months or years.  you may not notice any symptoms for some time. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.

The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.

Diabetes and high blood pressure are the two most common causes and account for most cases.

Many other diseases and conditions can damage the kidneys, including:

  • Autoimmune disorders (such as systemic lupus erythematosus and scleroderma)
  • Birth defects of the kidneys (such as polycystic kidney disease)
  • Some toxic chemicals
  • Injury to the kidney
  • Kidney stones and infection
  • Problems with the arteries feeding the kidneys
  • Some medicines, such as pain and cancer drugs
  • Backward flow of urine into the kidneys (reflux nephropathy)
  • Other kidney diseases

Chronic kidney disease leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including:

  • High blood pressure
  • Low blood cell count
  • Vitamin D and bone health

Symptoms

The early symptoms of chronic kidney disease are the same as for many other illnesses. These symptoms may be the only sign of a problem in the early stages.

Symptoms may include:

  • Appetite loss
  • General ill feeling and fatigue
  • Headaches
  • Itching (pruritus) and dry skin
  • Nausea
  • Weight loss without trying to lose weight

Symptoms that may occur when kidney function has gotten worse include:

  • Abnormally dark or light skin
  • Bone pain
  • Drowsiness or problems concentrating or thinking
  • Numbness or swelling in the hands and feet
  • Muscle twitching or cramps
  • Breath odor
  • Easy bruising, or blood in the stool
  • Excessive thirst
  • Frequent hiccups
  • Problems with sexual function
  • Menstrual periods stop (amenorrhea)
  • Shortness of breath
  • Sleep problems
  • Vomiting, often in the morning

Exams and Tests

Most people will have high blood pressure at all stages of chronic kidney disease. During an exam, your health care provider may also hear abnormal heart or lung sounds in your chest. You may have signs of nerve damage during a nervous system exam.

A urinalysis may show protein or other changes in your urine. These changes may appear 6 months to 10 or more years before symptoms appear.

Tests that check how well the kidneys are working include:

  • Creatinine clearance
  • Creatinine levels
  • BUN

Chronic kidney disease changes the results of several other tests. You will need to have the following tests as often as every 2 - 3 months when kidney disease gets worse:

  • Albumin
  • Calcium
  • Cholesterol
  • Complete blood count (CBC)
  • Electrolytes
  • Magnesium
  • Phosphorous
  • Potassium
  • Sodium

Other tests that may be done to look for the cause or type of kidney disease include:

This disease may also change the results of the following tests:

Treatment

Controlling blood pressure will slow further kidney damage.

  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
  • The goal is to keep blood pressure at or below 130/80 mmHg.

Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as:

  • Do not smoke.
  • Eat meals that are low in fat and cholesterol.
  • Get regular exercise (talk to your doctor or nurse before starting to exercise).
  • Take drugs to lower your cholesterol, if needed.
  • Keep your blood sugar under control.
  • Avoid eating too much salt or potassium.

Always talk to your kidney doctor before taking any over-the-counter medicine. This includes vitamins, herbs and supplements. Make sure all of the doctors you visit know you have chronic kidney disease.

Other treatments may include:

  • Medicines called phosphate binders, to help prevent high phosphorous levels
  • Extra iron in the diet, iron pills, iron given through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions to treat anemia
  • Extra calcium and vitamin D (always talk to your doctor before taking)

Your doctor may have you follow a special diet for chronic kidney disease.

  • Limiting fluids
  • Eating less protein
  • Restricting salt, potassium, phosphorous, and other electrolytes
  • Getting enough calories to prevent weight loss

All people with chronic kidney disease should be up-to-date on the following vaccinations:

  • Hepatitis A vaccine
  • Hepatitis B vaccine
  • Flu vaccine
  • Pneumonia vaccine (PPV)

Support Groups

Some people benefit from taking part in a kidney disease support group.

Outlook (Prognosis)

Many people are not diagnosed with chronic kidney disease until they have lost most of their kidney function.

There is no cure for chronic kidney disease. If it worsens to end-stage renal disease, and how quickly, depends on:

  • The cause of kidney damage
  • How well you take care of yourself

Kidney failure is the last stage of chronic kidney disease. This is when your kidneys can no longer support our body's needs.

Your health care provider will discuss dialysis with you before you need it. Dialysis removes waste from your blood when your kidneys can no longer do their job.

Usually, you will go to dialysis when you have only 10 - 15% of your kidney function left.

Even people who are waiting for a kidney transplant may need dialysis while waiting.

Possible Complications

  • Anemia
  • Bleeding from the stomach or intestines
  • Bone, joint, and muscle pain
  • Changes in blood sugar
  • Damage to nerves of the legs and arms (peripheral neuropathy)
  • Dementia
  • Fluid buildup around the lungs (pleural effusion)
  • Heart and blood vessel complications
    • Congestive heart failure
    • Coronary artery disease
    • High blood pressure
    • Pericarditis
    • Stroke
  • High phosphorous levels
  • High potassium levels
  • Hyperparathyroidism
  • Increased risk of infections
  • Liver damage or failure
  • Malnutrition
  • Miscarriages and infertility
  • Seizures
  • Swelling (edema)
  • Weakening of the bones and increased risk of fractures

Prevention

Treating the condition that is causing the problem may help prevent or delay chronic kidney disease. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke.

References

Fogarty DG, Tall MW. A stepped are approach to the management of chronic kidney disease. In: Taal MW, Chertow GM, Marsden PA et al. eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 61.

Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010;362:1312-1324.

Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010;362:56-65.

Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154:541-548.

KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007; 50:471-530.

KDOQI; National Kidney Foundation II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis. 2006;47(5 Suppl 3):S16-S85.

Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004; 43(5 Suppl 1):S1-S290.



Review Date: 10/2/2013
Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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