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What Is Chronic Kidney Disease (CKD)

Chronic kidney disease (CKD) is a gradual, progressive condition where the kidneys suffer damage over time and lose their ability to properly filter the blood. Approximately 26 million adults in the U.S. have CKD and millions more are at risk. In the early stages, you may not know your kidneys are not working optimally because they have a remarkable ability to compensate. High risk groups include those with diabetes, hypertension (high blood pressure), and family history of kidney disease. Early detection and treatment to manage CKD can slow the progression of the disease and prevent kidney failure so it is critical to be tested routinely if you are in a high risk group.

Symptoms

  • Changes in urination
  • Swelling of the feet, ankles, hands or face
  • Fatigue or weakness
  • Shortness of breath
  • Ammonia breath or an ammonia or metal taste in the mouth
  • Generalized Itching
  • Loss of appetite
  • Nausea and vomiting
  • More hypoglycemic episodes (if diabetic)
Is it important to find CKD early?

Early detection of CKD is extremely important, as the goal in treating CKD is first of all identification of the cause of the decline, then slow progression and prevent the need for dialysis down the road. This is accomplished through aggressive treatment of the underlying diseases causing CKD. The most common cause of CKD is diabetes followed by hypertension (high blood pressure).

How do I know if I have CKD?

Chronic Kidney Disease can easily be found by drawing simple lab tests, such as a metabolic panel. Within a metabolic panel, the marker that is primarily used to evaluate your kidney function is creatinine. Creatinine is a byproduct of muscle use and is cleared by the kidneys. Based on your creatinine we are able to measure your kidney function. Blood urea nitrogen (another waste product of the body) is also used along with creatinine as a marker of kidney function.

If you believe you have any of these symptoms, talk to your doctor about your concerns. This is especially important if you have a close family member who has kidney disease, or if you have diabetes or high blood pressure, which are the main causes of kidney failure.

The Stages of Chronic Kidney Disease

Chronic kidney disease (CKD) is a gradual, progressive condition where the kidneys suffer damage over time and lose their ability to properly filter the blood. Approximately 26 million adults in the U.S. have CKD and millions more are at risk. CKD is measured based on GFR—Glomerular Filtration Rate, which is a mathematical method that measures the kidney function based on your creatinine level, your age, your sex and your race. Based on your level of GFR, you will fall into one of the five different stages as noted below.

STAGES OF CHRONIC KIDNEY DISEASE (CKD)

There are 5 stages during the disease progression of CKD.

  1. Kidneys function normally but there is proteinuria (protein in the urine) present. This is an indication of future inhibited kidney function. GFR >90 (normal kidney function but with some evidence of damage)
  2. Kidney function is greater than 60%. Proteinuria may or may not be present. GFR 60-89 (mild disease)
  3. Kidney function is at 30-59%. GFR 30-59 (moderate disease)
  4. Kidney function is at 15-29%. GFR 15-29 (severe disease)
  5. Kidney function is below 15% and the patient may require dialysis at any time based upon certain symptoms. This requires very close supervision since this stage is a very critical time. Dialysis is typically recommended. GFR <15 (kidney failure/End Stage Renal Disease)

SYMPTOMS OF STAGE 5 KIDNEY DISEASE

  • Nausea, vomiting
  • Poor appetite, as well as taste abnormalities
  • Anemia with associated weakness
  • Worsened swelling of legs, body
  • Blood pressure difficult to control
  • Potassium and other electrolytes become difficult to control

 

Hypertension and Chronic Kidney Disease

Hypertension is the medical term used to describe high blood pressure. Hypertension is the second most common cause of Chronic Kidney Disease (CKD) and progression to End Stage Renal Disease (Kidney Failure) with diabetes being the most common cause for Chronic Kidney Disease and progression to End Stage Renal Disease. At the same time, about 80% of patients with chronic kidney disease will eventually develop hypertension.

REGULAR KIDNEY FUNCTION

The largest function of the kidneys is to “filter out” the blood stream. Beyond this, the kidneys also help us regulate other processes in the body. One of these processes is blood pressure. Thus, the kidneys have the ability to raise or lower your blood pressure and accomplish this by releasing a hormone called Renin. Renin’s job, once released from the kidneys, is to trigger a cascade of other hormones with the end result being constriction of your blood vessels. This hormone cascade system is known as the Renin-Angiotensin-Aldosterone System (RAAS). We use different medication that target these pathways and other pathways in the treatment of resistant or secondary hypertension.

FUNCTION WITH CHRONIC KIDNEY DISEASE (CKD)

The kidneys release renin in response to sensing decreased blood flow to their functional units, the glomeruli (the kidneys are composed of millions of these functional units which are the small “filters” that clean out the blood stream). In Chronic Kidney Disease (CKD), there is an increased loss of these filters beyond the normal loss we all experience beyond the age of 40. This loss of functional units can contribute to elevated blood pressure over time, but high blood pressure in itself can precipitate further loss of functional units. A unique situation.

MEDICATIONS

Many of the medications that combat high blood pressure work by inhibiting certain components of the RAAS system. In turn, by utilizing these medications, we can effectively lower blood pressure and also increase renal (kidney) protection which is the goal in CKD.

Having a Kidney Biopsy

WHAT IS A KIDNEY BIOPSY?

A kidney biopsy is a procedure in which your healthcare provider takes a sample of your kidney to test in a lab.

WHEN IS IT USED?

Reasons for doing this procedure include blood or protein in your urine. The procedure helps to make a more accurate diagnosis, which will help determine the proper treatment

HOW DO I PREPARE FOR A KIDNEY BIOPSY?

Tell your Doctor if you have had any allergic reactions to X-ray dye (contrast material). Also tell him or her about any problems you have had with substances that contain iodine, such as seafood or cough syrup. Follow any instructions your provider may give you. Find someone to drive you home after the procedure.

WHAT HAPPENS DURING THE PROCEDURE?

You will be given a shot of local anesthetic into the skin. The anesthetic will keep you from feeling pain during the procedure. You may also be given intravenous medicine (a sedative) to help relax you during the procedure. As a result, you may not remember the procedure.

The Doctor will use a scanning technique such as ultrasound or CT scan to see the kidneys. The Doctor will puncture the skin and guide a needle to the kidney. Because the kidneys move when you breathe, you must hold your breath for 15 to 20 seconds as the needle is inserted into your kidney. They will use the needle to remove a small sample of your kidney. The needle may need to be inserted more than once to get enough sample. The kidney sample is sent to the lab for tests.

WHAT HAPPENS AFTER THE PROCEDURE?

You stay under observation for about 6 hours to make sure there is no bleeding. Avoid all heavy activity and do not strain or lift anything the rest of the day and the following day.

Call your provider right away if you develop a fever or have severe pain.

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