Chronic Kidney Disease

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1 Chronic Kidney Disease Introduction Chronic kidney disease, also known as CKD, is the gradual loss of kidney function. When CKD reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. When this happens, you will require treatment for the rest of your life. Failing Kidneys This reference summary explains chronic kidney disease. It covers the anatomy of the kidneys and symptoms and causes of the condition. It also talks about treatment options. Anatomy of the Kidneys The kidneys are organs that are located in the middle to lower back on both sides of the spine. Each kidney weighs about 1 pound. The kidneys are each about the size of an adult fist. The left kidney is usually a little larger than the right one. The kidneys continuously filter our blood. The purpose of the kidneys is to: Filter wastes and excess fluid. Make a hormone called erythropoietin that helps the body make red blood cells. The kidneys also regulate: Bone metabolism. Blood pressure. Acid-base and electrolyte balance. Kidneys Ureters Bladder 1

2 Your kidneys filter wastes and fluids from your blood. The waste leaves your body through your urine. The urine that is made in the kidneys flows through tubes, called ureters, to be stored in the bladder. When the bladder is full, a person feels the urge to urinate. Urine is emptied through the urethra. Symptoms You may start to have symptoms of chronic kidney disease only a few months after your kidneys begin to fail. But most people don't have symptoms early on. Many people do not have symptoms of CKD for as long as 30 years or more. This is called the silent phase of the disease. As your kidney function gets worse, you may: Feel tired or sleepy. Have swelling from fluid buildup. Not feel hungry, or you may lose weight without trying. Urinate less than normal. CKD also can cause you to: Have headaches or trouble thinking clearly. Have trouble sleeping. Often feel sick to your stomach or vomit. Causes Chronic kidney disease develops gradually, over many years. The condition causes permanent and irreversible loss of kidney function. CKD is caused by damage to the kidneys. The most common causes of this damage are: High blood pressure. High blood sugar and diabetes. Other common causes of CKD include: Drug abuse. Inherited genetic diseases, such as polycystic kidney disease. Lupus. 2

3 Polycystic kidney disease, or PKD, runs in families. In PKD, fluid-filled sacs called cysts take the place of the normal tissue. They enlarge the kidneys and make them work poorly, leading to kidney failure. Lupus is an autoimmune disease. This means the immune system mistakenly attacks the body s healthy tissues. It can damage any part of the body, including the skin, joints and organs inside the body. Common causes of CKD also include: Kidney infections or blockages. Long-term use of medicines that can damage the kidneys. Diagnosis To diagnose chronic kidney disease, your health care provider will perform a physical exam. He or she will ask you questions about your personal and family medical history. Blood and urine tests will also be done. This can help your health care provider find out how well your kidneys are working. A blood chemistry screen can show if you have normal levels of sodium, potassium and calcium. You may also have an ultrasound. This imaging test lets your health care provider see a picture of your kidneys. Other imaging tests that may be done include: CT scan. MRI. X-rays. CT scans create cross-sectional images of the body using X-rays and a computer. An MRI uses a large magnet and radio waves to look at organs and structures inside your body. A kidney biopsy may be done if your health care provider thinks your kidney may be inflamed. A kidney biopsy is usually done using a long, thin needle put through the back into the kidney. A tissue sample is taken and then sent to a lab for examination. Your health care provider may be able to diagnose CKD if tests show that you have: Blood in your urine. A certain medical condition, such as polycystic kidney disease. Excess protein in your urine. Kidneys that are not structurally normal. 3

4 Treatment Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. CKD is divided into 5 stages. In the early stages, you may have few signs or symptoms. CKD may not cause symptoms until your kidney function is dangerously low. In stage 1, the kidneys may function normally but tests show other evidence of kidney disease. Stage 2 is mildly reduced kidney function, along with other evidence of kidney disease. People in stages 1 and 2 may not be aware that they are at risk because they may not feel ill. Treatment for patients with stage 1 and 2 CKD includes: Blood pressure control. Treating diseases such as diabetes. Treatment for patients with stage 1 and 2 CKD also includes: Close monitoring by a health care provider and occasional testing. Lifestyle changes, slowing the progress of the disease with diet and medication. To reduce the risk of CKD progressing: Don't smoke. Drink alcohol only in moderation, or don t drink. Follow all instructions on over-the-counter medications. Maintain a healthy weight. Manage your medical conditions. If you're a smoker, talk to your health care provider about ways to quit smoking. Support groups, counseling and medications can help you stop. If you choose to drink alcohol, do so only in moderation. If you're at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, talk to your health care provider about healthy weight loss. 4

5 If you have diseases or conditions that increase your risk of kidney failure, work with your health care provider to control them. Ask about tests to look for signs of kidney damage. Stage 3 CKD is moderately reduced kidney function. Most stage 3 symptoms can be managed through monitoring by a health care provider and regular testing. Medications can help prevent further kidney damage and control symptoms. The goal of treatment for stage 3 is to prevent further kidney disease and reduce other risks associated with the condition, such as: Heart attacks. Narrowing of the arteries. Strokes. Stage 4 CKD is severely reduced kidney function. During stage 4, health care providers treat complications and help the person prepare for treatment. During stage 4, you should learn about: Different types of dialysis. Accesses used to perform dialysis. Other treatment options. In some cases, you or a caregiver can be trained to do dialysis at home. Dialysis is the artificial filtering of wastes and fluids from your blood. There are two main types of dialysis: hemodialysis and peritoneal dialysis. Both types filter your blood. They remove harmful wastes, extra salt and water. Hemodialysis uses a machine called a dialyzer, or artificial kidney. For this treatment, surgery is needed. An access, or entrance, is usually made in your arm so that your blood flow can be directed into the dialyzer. Blood is cleaned in the dialyzer. The blood is then infused back into your body. 5

6 You can be taught to do hemodialysis at home or you may go to a special clinic for treatments several times a week. Peritoneal dialysis uses the lining of your abdomen, called the peritoneal membrane, to filter your blood. It can be done at home and is a more comfortable and natural way to do dialysis. Surgery is needed to insert a soft plastic tube called a catheter in your abdomen. During peritoneal dialysis, a cleansing fluid flows into your body through this catheter. When the filtering process is done, the fluid leaves your body through the catheter. A person diagnosed with stage 5 CKD will require frequent monitoring and treatment for complications. Stage 5 CKD can cause death unless you receive dialysis or a kidney transplant. In addition to medical treatment, you may choose to receive palliative care. The goal of palliative care is to help people with a serious illness feel better. It prevents or treats symptoms and side effects of the disease and of its treatments. Palliative care can be given at the same time as treatments meant to cure or treat the disease. You may get palliative care when the illness is diagnosed and throughout your treatment. Summary Chronic kidney disease is the gradual loss of kidney function. It is also known as CKD. When CKD reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. When this happens, you will require treatment for the rest of your life. The purpose of the kidneys is to: Filter wastes and excess fluid. Make a hormone called erythropoietin that helps the body make red blood cells. The kidneys also regulate: Bone metabolism. Blood pressure. Acid-base and electrolyte balance. 6

7 You may start to have symptoms of chronic kidney disease only a few months after your kidneys begin to fail. But most people don't have symptoms early on. Many people do not have symptoms of CKD for as long as 30 years or more. This is called the silent phase of the disease. As your kidney function gets worse, you may: Feel tired or sleepy. Have swelling from fluid buildup in your tissues. Not feel hungry, or you may lose weight without trying. Urinate less than normal. CKD is caused by damage to the kidneys. The most common causes of this damage are: High blood pressure. High blood sugar and diabetes. Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. In the later stages, dialysis or a kidney transplant may be needed. 7

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