1. What is Chronic Kidney Disease (CKD)?

The kidneys are responsible for filtering blood and removing waste through urination. When you have chronic kidney disease your kidneys’ ability to filter and remove waste becomes impaired. There are often ways to prevent the progression of kidney disease through certain lifestyle modifications and treatments. The kidneys are responsible for maintaining the chemistry of the body. They are also responsible for the removal of waste products, extra water, and adjusting the levels of chemicals and minerals in the body. The kidney also produces hormones responsible for blood pressure control and red blood cell production. It is also referred with the following names: Chronic renal failure. Chronic Kidney failure, Kidney failure, Kidney Weakness, decreased kidney function, elevated creatinine, decrease GFR(Glomerular Filtration Rate)

2. What causes Chronic Kidney Disease(CKD)?

Multiple factors contribute to development of Chronic Kidney Disease. Uncontrolled diabetes and high blood pressure are among the major causes, which damage the blood vessels in the kidneys. Certain diseases that cause inflammation in and around the kidneys can also reduce their ability to function properly, as well as mechanical obstructions of the urinary tract, such as kidney stones. Other factors that can contribute to kidney damage include frequent urinary tract infections, family history of kidney disease, smoking and obesity. 

3. What are the symptoms of Chronic Kidney Disease?

Chronic Kidney Disease(CKD) is essentially asymptomatic in mild to moderate disease. Symptoms usually arise when the damage to the kidneys becomes severe. The most common symptoms of severe kidney disease include fatigue, nausea, loss of appetite, metallic taste in the mouth, itching, confusion, feet/ankle swelling, and difficulty breathing. It is important to routinely monitor kidney function by testing the blood and urine. 

4. What is the treatment options of Chronic Kidney Disease?

Most often kidney disease has no cure. In mild to moderate disease, treatment usually involves identifying reversible causes of kidney damage, preventing or slowing the progression of kidney disease, and treating the complications that arise from kidney disease. If the kidneys become severely damaged, the treatment is dialysis and determining if a renal transplant is an option. Early detection of kidney disease increases the chances of slowing the progression.

5. Do Chronic Kidney Disease(CKD) increase the risk for other health problems?

When you have renal failure, your risk of other health problems can increase. Patients with renal failure are at higher risk of stroke and heart disease. An important role of the kidneys is to help make red blood cells. The red blood cells are responsible for carrying oxygen throughout the body. When the kidneys are weak, they are unable to increase red blood cell production resulting in anemia.

Another important function of the kidneys is electrolyte handling, specifically phosphorus and potassium. When the kidneys are not functioning well, both potassium and phosphorus can build up in the blood. When the phosphorus is elevated, the calcium in your bones is decreased resulting in weak bone. Elevated potassium in the blood can cause problems with your heart rhythm and at certain levels is a medical emergency requiring ER evaluation.

6. What is the treatment for End Stage Kidney Disease(ESRD)?

Kidney disease can ultimately lead to End Stage Renal Failure or ESRD. Meaning, the kidneys are no longer functioning and renal replacement therapy or dialysis is required. When the kidneys stop functioning, waste products, toxins, and fluid buildup in the body. This can occur over many year or quickly depending on cause of the disease. Renal failure cannot be cured, however, there are life-saving treatments available. For example, dialysis can do the job of your kidneys by filtering your blood and removing excess fluid. Kidney transplant is another option.

7. How to prevent Kidney Disease?

Progression of renal failure can be slowed down by keeping your blood pressure and blood sugar under good control by medication and diet. Regular exercise is also important to maintain a healthy weight and help reduce your blood pressure. Dietary restriction of protein and salt will also help relieve the burden on your kidneys. It is also important to quit smoking. Each patient is the most important member of the healthcare team. There are several ways you can protect your kidneys and potentially slow the progression of disease.  Most important is having good blood pressure control. You should also make diet modifications as recommended. If you have diabetes, it is important keep your blood sugar under control. It is also important to know your latest renal function and ask question to be better involved with the treatment plan.

8. What can be done to help cope with kidney disease?

Attending support groups for patients and their family may help. A daily routine is also important. This may help decrease feeling of disappointment. Daily exercise and physical activity are equally important and may help decrease the anxiety and fatigue that are common in kidney disease.

9. What are the functions of the Kidney?

The kidneys are organs located in the middle of your back, right below your rib cage. They are bean-shaped and about the size of your fist. The kidney filters the blood of toxins. Each day, the kidneys will process about 200 quarts of blood and can filter out almost 2 quarts of extra water and waste products from the body. The filtered water and waste are removed from the body as urine.

The toxins or waste in the blood comes from the normal breakdown of muscle and the food you eat. Food is used by your body for self-repair and energy. Afterward, the waste is moved to the blood. When the kidneys are not working to remove the wastes, they would build up in the blood and can cause damage.

The filtering occurs inside your kidney. There are tiny units called nephrons. Each kidney has about 1 million nephrons. Here small blood vessels called capillaries combine with urine-carrying tubes known as tubules. Then a complicated chemical exchange happens, waste materials and excess water leave the blood and enter into the urinary system.  The kidney then measures out electrolytes, such as phosphorus, sodium, and potassium and then releases them back to the blood.

There are several important hormones released from the kidney. Erythropoietin stimulates red blood cell production in the bones. Renin, regulates blood pressure and the active form of vitamin D helps maintain calcium for the bones and normal balance in the body.

10. What causes Kidney Disease?

There are several types of kidney disease. These diseases attack the nephrons inside the kidney. When this happens, the kidney loses the ability to filter blood. This damage may occur quickly, due to injury or poison. However, most kidney diseases are slow and silent taking place over many years.

The most common causes of kidney disease are hypertension and diabetes. Diabetes prevents your body from using sugar appropriately. When sugar stays in the blood instead of breaking down, it can become a poison. This causes damage to the kidney and is called diabetic nephropathy.

Uncontrolled blood pressure may cause damage to the small blood vessels in the kidney. When this happens, the damaged vessels are unable to filter poison from the blood. Your nephrologist may prescribe medications to treat the hypertension. There is a group of medications used to treat hypertension called ACE inhibitors that may give extra protection in patients with diabetes.

Some kidney diseases are inherited. Polycystic kidney disease, for example, is a genetic disorder that causes cysts grow in the kidneys. These cysts can slowly replace much of the mass of the kidneys, causing reduced kidney function and leading to kidney failure.

Some other causes are due to poisons or trauma, A direct forceful blow to the kidneys, may lead to kidney disease. Many over-the-counter medications may harm your kidneys when taken regularly over a long time. These medications often combine aspirin, acetaminophen, and other medications like ibuprofen can be dangerous to the kidney.

11. What should I do if I have Kidney Disease?

Unfortunately, there is not a cure for renal failure. However, if you are in the early stages of the disease, you may be able to slow the progression of disease and make the kidneys last longer.

– If you have diabetes, watch your blood sugar closely to keep it under control.

-Have your blood pressure checked regularly. Eat healthy diet with low salt

-Avoid pain pills that may make your kidney disease worse.

12. What are some dietary modifications that may benefit my health in renal disease?

If you have renal disease, you should be aware that parts of a normal diet can speed up kidney failure.  One recommendation is to limit the amount of protein consumed. This will give the kidneys less work to do. Cholesterol should also be limited be eating a low-fat diet. Sodium is a chemical found in many foods and in salt. Diets high in sodium will raise your blood pressure. Foods that are high in sodium include canned or processed foods like frozen dinners.  A low potassium diet may be recommended for some patients. Potassium is found in fruits and vegetables, like bananas, potatoes, dried fruits, dried beans and peas, nuts, and tomatoes. When your kidneys are weak, they may not be able to filter out the excess potassium from the diet.

13. Preparing for dialysis and end-stage renal disease (ESRD)

As your kidney disease progresses, there will be several decisions to make. You will be taught about the options for treating ESRD and different types of dialysis. The options include renal transplant, home peritoneal dialysis, and hemodialysis. When your kidney function declines to a certain level, your nephrologist will go over the different types of dialysis to find which modality is best for you.

14. What are the 5 stages of Chronic Kidney Disease(CKD)?

The 5 stages are:

  • CKD Stage 1 — GFR > 90
  • CKD Stage 2 — GFR 60-89
  • CKD Stage 3 — GFR 30-59
  • CKD Stage 4 — GFR 15-29
  • CKD Stage 5 — GFR < 15 or Dialysis

15. What tests are done to assess & monitor kidney function?

Blood Tests – Serum creatinine, Electrolytes, & BUN, often ordered as a renal panel

Urine Tests – Urinalysis, protein/creatinine ratio

Imaging Tests – A renal ultrasound may be completed to assess the size, shape and anatomy of your kidney.

Kidney Biopsy – A kidney biopsy is a test where a small piece of kidney tissue is removed by a needle. The tissue is examined under a microscope to determine the cause of kidney disease.

16. What is the relation between Diabetes and Kidney Disease?

In the United States, diabetes is the most common cause of kidney disease. Having high blood sugars can damage the blood vessels in the kidney and affect the kidneys ability to filter blood. Having controlled blood sugar can help slow the progression of kidney disease.

17. What is the relation between High Blood Pressure and Kidney Disease?

Having high blood pressure can cause damage to the blood vessels in your kidney and reduces supply of blood to the kidney. Uncontrolled blood pressure can cause irreversible damage to your kidneys.

18. What are there medications I should avoid in CKD?

NSAID (nonsteroidal anti-inflammatory drugs) should be avoided. Also, any “cure all” remedies and nutritional supplements or herbs should be avoided.  It would be beneficial to ask your nephrologist before taking any medications or over-the counter drug.

19. What is dialysis?

Dialysis is a process that cleans and filters your blood. There are two types of dialysis, hemodialysis and peritoneal dialysis.

Hemodialysis – This modality cleans your blood using a machine with a filter called a dialyzer. During a hemodialysis treatment blood travels from your body through tubes to the dialyzer which filters out wastes and extra water. The cleaned blood flows through another set of tubes back into your body. This is usually performed in a dialysis unit three times a week for 4 hours each treatment.

Peritoneal Dialysis – removes wastes and extra water from your body using the lining of your abdomen to filter your blood. A solution travels through a soft tube into your abdomen. The solution draws wastes and extra water from tiny blood vessels in your abdomen back into the solution which is then drained from your abdomen through the soft tube. This form of dialysis is completed at your home every night.

20. What is vascular access?

If you decide to do hemodialysis, it is necessary to create a vascular access to your blood. You will be sent to a vascular surgeon and the access will be placed during a brief surgery. There are two types of access. One type is a fistula and the other is a graft. You may require an external temporary dialysis catheter depending on the circumstances surrounding the progression of the renal failure.