Chronic Kidney disease: Diagnosis, Treatment and Prevention


Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering called dialysis or a kidney transplant.

August 18, 2018

Chronic kidney disease is a slow and progressive loss of kidney function over a period of several years, which will lead eventually to permanent kidney failure.
Diagnosis can be confirmed after blood tests, kidney scans, or biopsy. As there is no cure for chronic kidney disease, treatment is focused on reducing symptoms. Treatment is aimed at stopping or slowing down the progression of the disease, which is usually done by controlling its underlying cause. The causes could be diabetes and specific kidney diseases, which includes polycystic kidney disease. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering called dialysis or a kidney transplant.

Diagnosis of Chronic Kidney disease:

Your doctor discusses your personal and family history with you initially for diagnosis of kidney disease. Your doctor might ask questions about whether you have been diagnosed with high blood pressure, if you have taken a medication that might affect kidney function, if you have noticed changes in your urinary habits, and whether you have any family members who have kidney disease. He will check for signs and ask the patient about symptoms. A physical examination also be performed by your doctor checking for signs of problems with your heart or blood vessels, along with a neurological examination. For kidney disease diagnosis, you may also need certain tests and procedures. These include:

Blood tests:

Kidney function tests can be done to look for the level of waste products, such as creatinine and urea, in your blood. If levels of urea and creatinine are persistently high, the doctor will most likely diagnose end-stage kidney disease.

Urine test:

A urine test helps find out whether there is either blood or protein in the urine. Analyzing a sample of your urine may reveal these abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.

Imaging tests:

Kidney scans may include a magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or an ultrasound scan. Your doctor may use ultrasound to assess the structure and size of your kidneys. In advanced stages of kidney disease the kidneys are smaller and have an uneven shape. Any blockages in the urine flow can also be determined by these test. Sometimes a chest X-ray can also be done to check for pulmonary edema, that is to know if fluid has retained in the lungs.

Kidney biopsy:

A small sample of kidney tissue is extracted and examined for cell damage. An analysis of kidney tissue makes it easier to make a precise diagnosis of kidney disease. Kidney biopsy is often done with local anesthesia using a long, thin needle that is inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine the underlying cause of your kidney problem.

Glomerular filtration rate (GFR):

GFR is a test that measures the glomerular filtration rate. It compares the levels of waste products in blood and urine of the patient. GFR measures how many milliliters of waste the kidneys can filter per minute. The kidneys of healthy individuals can typically filter over 90 ml per minute.

Treatment of Chronic Kidney disease:

There is no current cure for chronic kidney disease. However, some therapies can help control the signs and symptoms, reduce the risk of complications, and slow the progression of the disease depending on the underlying cause. If your kidneys become severely damaged, you may need treatment for end-stage kidney disease. Treatment options vary, depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled. Patients with chronic kidney disease typically need to take a large number of medications.

Treatments with Medication:

Medications for High blood pressure:

High blood pressure is a very common problem for patients with chronic kidney disease. It is important to bring the blood pressure down to protect the kidneys, and subsequently slow down the progression of the disease. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers are most commonly recommeded medications tolower your blood pressure and to preserve kidney function.
As these medications can initially decrease kidney function and change electrolyte levels, you may need frequent blood tests to monitor your condition. A water pill or diuretic and a low-salt diet is also recommended by your doctor.

Medications to lower cholesterol levels:

People with chronic kidney disease often experience high levels of bad cholesterol, which can increase the risk of heart disease. The most commonly recommended medication is statins to lower your cholesterol.

Medications to treat anemia:

Hemoglobin is the substance in red blood cells that carries vital oxygen around the body. The patient has anemia if hemoglobin levels are low. A patient with kidney disease will usually have to take iron supplements, either in the form of daily ferrous sulfate tablets, or occasionally in the form of injections.
Sometimes supplements of the hormone erythropoietin with added iron are recommended. Erythropoietin supplements aid in production of more red blood cells, which may relieve fatigue and weakness associated with anemia. Some kidney disease patients with anemia will require blood transfusions.

Medications to relieve swelling:

People with chronic kidney disease may retain fluids which can lead to swelling in the legs, as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.

Medications to protect your bones:

Calcium and vitamin D supplements are often prescribed to prevent weak bones and lower your risk of fracture. People with kidney disease may not be able to eliminate phosphate from their body properly. In such cases, patients will be advised to reduce their nutritional phosphate intake which usually means reducing consumption of dairy products, red meat, eggs, and fish.

Medications for skin itching:

Antihistamines, such as chlorphenamine, may help alleviate symptoms of itching.

Anti-sickness medications:

Because the kidneys are unable to work properly, toxins build up in the body leading to nausea and the patients may feel sick. Medications such as cyclizine or metaclopramide help relieve sickness.

NSAIDs (nonsteroidal anti-inflammatory drugs):

NSAIDs, such as aspirin or ibuprofen should be avoided and only taken if a doctor recommends them.

A lower protein diet to minimize waste products in your blood:

As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. But when you have kidney disease, your kidneys are unable to perform this task properly as a result of which waste will be accumulated. Therefore eating less protein is recommended to reduce the amount of work your kidneys must do. A dietitian can suggest ways to lower your protein intake while still eating a healthy diet.
You may also take medication known as a phosphate binder to lower the amount of phosphate in your blood, and protect your blood vessels from damage by calcium deposits.
Follow-up testing at regular intervals are recommended to see whether your kidney disease remains stable or progresses.

Treatment for end-stage kidney disease:

If your kidneys can't keep up with waste and fluid clearance on their own, you develop complete or near-complete kidney failure, which is called as end-stage kidney disease. At that point, the kidneys are functioning at less than 10 to 15 percent of normal capacity. Measures such as diet, medications, and treatments controlling underlying causes are no longer enough and you need dialysis or a kidney transplant. The need for dialysis or a kidney transplant are delayed for as long as possible as they carry the risk of potentially serious complications.

Kidney dialysis:

The artificial removal of waste products and excessive fluids from blood when the kidneys cannot do the job properly any more is called as dialysis. It has some serious risks, including infection.
There are two main types of kidney dialysis. Each type also has subtypes. The two main types are:

Hemodialysis:

Blood is pumped out of the patient's body through a machine and goes through a dialyzer which is an artificial kidney. The patient undergoes hemodialysis about three times per week and each session lasts for at least 3 hours. More frequent sessions result in a better quality of life for the patient.

Peritoneal dialysis:

In peritoneal dialysis, a thin tube called catheter is inserted into your abdomen, fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a period of time, the dialysis solution drains from your body, carrying the waste with it. This process is carried out in in the peritoneal cavity of your abdomen which contains a vast network of tiny blood vessels.

Kidney transplant:

A kidney transplant is a better option than dialysis for patients who have kidney failure and no other treatment measures are working. However, the candidates for kidney transplant will have to undergo dialysis until they receive a new kidney.
A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. The blood type, cell-surface proteins and antibodies, should be same for both kidney donor and recipient in order to minimize the risk of rejection of the new kidney. Siblings or very close relatives are usually the best types of donors. You will need to take medications for the rest of your life to keep your body from rejecting the new organ. Your life expectancy generally would be only a few months once you have complete kidney failure. Therefore choose the treatment option as soon as possible.

Potential future treatments:

Regenerative medicine holds the potential to fully heal damaged tissues and organs, which may be developed in the future to help slow progression of kidney disease. Regenerative medicine approaches include:

  • Boosting natural ability of the body to heal itself
  • Using healthy cells, tissues or organs from a living or deceased donor to replace damaged ones
  • Delivering specific types of cells or cell products to diseased tissues or organs to restore tissue and organ function

Prevention of Chronic Kidney disease:

The following things can be done to reduce your risk of developing kidney disease.

Follow instructions on over-the-counter medications:

Follow the instructions on the package when using nonprescription pain relievers, such as aspirin, ibuprofen and acetaminophen. Taking too many pain relievers could lead to kidney damage and generally should be avoided if you have kidney disease.

Maintain a healthy weight:

If you are at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, follow some weight reduction strategies which often involves increasing daily physical activity and reducing calories. Regular physical exercise is ideal for maintaining healthy blood pressure levels. It also helps control chronic conditions such as diabetes and heart disease. You should should check with a doctor to find out an exercise program that suits to your age, weight, and health.

Quit smoking:

Cigarette smoking is injurious to health. Along with many health complications, it can also damage your kidneys and make existing kidney damage worse. If you are a smoker, talk to your doctor about strategies for quitting smoking. Support groups, counseling and medications can all help you to stop smoking.

Manage your medical conditions:

If you have diseases or conditions that increase your risk of kidney disease, such as diabetes or hypertension, work with your doctor to control them. A healthy diet, including plenty of fruits and vegetables, whole grains, and lean meats or fish will help keep blood pressure down. This can also help keeping your blood sugar under control. Follow your doctor's instructions, advice, and recommendations to manage your chronic disease. Screening tests to look for signs of kidney damage can be done when recommended by your doctor.