World Kidney Day

Be kind to your  kidneys; get informed about chronic kidney disease

Chronic kidney disease (CKD) is a condition where the kidneys are damaged and lose the ability to keep you healthy. As kidney disease worsens, body waste can build up in your blood and make you feel sick. You may develop complications such as high blood pressure, anemia, weak bones, poor nutritional health and nerve damage. These problems may happen slowly over a long period of time.

CKD may be caused by diabetes, high blood pressure, old age and other disorders. As it progresses, it may eventually lead to kidney failure (also called end-stage kidney disease), which requires either dialysis or a kidney transplant to sustain life.

Early detection is extremely important to prevent progression of CKD to kidney failure. Diabetes and high blood pressure, two very widespread diseases, are the most common reasons for CKD. CKD also is a risk factor for heart and blood vessel disease.

CKD is fairly common. In fact, nearly 26 million American adults have the disease, but only a small fraction of them know it (1 in 10 according the the American Society for Nephrology). It’s easy to find out if you have CKD by testing your blood and urine.  Regular physical exams are crucial for kidney health, especially after age 40.

What causes CKD?

The two main causes of CKD are diabetes and high blood pressure. They are responsible for more than two-thirds of all cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If poorly controlled, high blood pressure can lead to heart attacks, strokes and CKD. High blood pressure can also be a consequence of CKD, as the body starts to retain salt and water.

Some of the other causes of CKD include polycystic kidney disease, glomerulonephritis (where there is inflammation of the filtering units of the kidney), systemic lupus erythematosus, long-term use of common medications such as Ibuprofen, consumption of some types of Chinese herbs, kidney malformation at birth, kidney stones and obstruction to the flow of urine, especially in men with prostate problems.

What are the symptoms of CKD?

Most people may not have any severe symptoms until their kidney disease is fairly advanced. Even with advanced CKD, symptoms are not specific. They include tiredness, lack of energy, decreased concentration, poor appetite, problems with sleep, muscle cramps, swollen feet and ankles, puffiness around the eyes especially in the morning, difficulty breathing and dry itchy skin. It is very important to note that even people with advanced CKD may make normal amounts of urine, which can often be misleading.

How is CKD diagnosed?

Three simple tests can detect CKD: checking blood pressure, checking the urine for protein spillage and checking the blood for creatinine. These days, another value called the eGFR (estimated glomerular filtration rate) is reported based on the creatinine value. This number gives a rough estimate of how the kidneys are performing. Ideally, the eGFR should be more than 90. If it is less than that, it is wise to consult a doctor as this may an early sign of CKD. Advanced diagnostic tests such as 24-hour urine tests, kidney ultrasound and kidney biopsy are usually performed by a nephrologist.

How is CKD managed?

Taking care of overall health helps protect the kidneys. Good practices include exercising regularly, maintaining a low-salt diet, controlling weight, monitoring blood pressure, cholesterol and glucose levels, not smoking, drinking moderately, avoiding medications such as Motrin and Ibuprofen, and getting an annual physical exam especially after age 40.

Specific management should be directed by a nephrologist and include education about CKD and aggressively managing the underlying disease that is responsible for the disease. Blood pressure should be maintained below 130/80 mm Hg by using specific types of blood pressure medications. Other complications such as anemia and bone disease should be managed simultaneously when present.

What are treatment options when the kidneys completely fail?

When the kidneys completely fail, the body will be unable to maintain its normal functions. Dialysis and kidney transplantation are the treatments currently available for end-stage kidney disease. There are two types of dialysis, namely hemodialysis and peritoneal dialysis. Kidney transplantation is the best choice. However, you have to be evaluated to determine if you would be a good candidate for a transplant, and this is done at a transplant center.

Remember, even if you have CKD, if properly managed, you can lead a normal, active and healthy life.

Dr. Pradeep V. Kadambi is a nephrologist and associate professor and medical director of kidney and pancreas transplantation at the University of Texas Medical Branch at Galveston. He serves patients at UTMB Health's Multispecialty Center, in League City.