Chronic Kidney Disease

What is Chronic Kidney Disease?

Chronic/end-stage kidney disease is a progressive decline in the function of one’s kidneys. Essentially the kidneys can not filter blood in the way they should causing wastes that the kidneys normally would filter in the urine to build up in the body. This happens gradually over a long period of time.

Who is at risk for Chronic Kidney Disease?

Diabetes is the most common cause of end-stage renal disease. High blood pressure and cardiovascular disease are also very common causes. Glomerulonephritis, polycystic kidney disease, prolonged obstruction of the urinary tract, and recurrent kidney infection call all put one at risk for chronic kidney disease. More generally smoking, obesity, a family history of kidney disease and older age all increase the chance of developing chronic kidney disease.

What are the signs and symptoms of Chronic Kidney Disease?

Chronic kidney disease develops slowly over time and there is no one symptom. However, symptoms may include nausea, vomiting, loss of appetite, fatigue, sleep problems, changes in urination, swelling of the feet, and ankles. Fluid can also build up around the heart or lungs causing chest pain or shortness of breath.

How is Chronic Kidney Disease diagnosed?

The best single indicator of kidney disease progression is proteinuria (protein in the urine). Urine can be collected over 24 hours and a spot urine albumin/Ucreatinine ratio can be done as well. A urine analysis will show abnormal sediment as well as red and white blood cells in the urine. Imaging such as ultrasound may be done and show a smaller kidney. 

How is Chronic Kidney Disease staged?

The GFR or glomerular filtration rate is an estimate of how much blood passes through the kidneys per minute. A normal GFR is 120-130, as chronic kidney disease progresses the GFR drops, providing an estimate of how well the kidneys are working.

Stage 0: No actual kidney damage, normal GFR but patients who are at risk, including diabetics and people with high blood pressure

Stage 1: Some kidney damage with a normal GFR, protein may be seen in the urine.

Stage 2: GFR: 89-60

Stage 3: GFR 59-30

Stage 4: GFR 29-15

Stage 5 (end-stage renal disease); GFR less than 15 and/or serum creatinine greater than 8mg/dL these patients require dialysis and/or a kidney transplant.

How is Chronic Kidney Disease treated?

As diabetes and high blood pressure significantly contribute to chronic kidney disease managing them is essential. One’s blood pressure should be less than 140/90 and one’s A1C should be below 7.0%. Early disease can be managed with ACEi or ARB medication which helps protect the kidneys. Late (stage 5) kidney disease requires dialysis or a kidney transplant.

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