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Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body.
Chronic kidney disease (CKD) slowly gets worse over time. In the early stages, there may be no symptoms. The loss of function usually takes months or years to occur. It may be so slow that symptoms do not appear until kidney function is less than one-tenth of normal.
The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. The patient needs dialysis or a kidney transplant.
Chronic kidney disease and ESRD affect more than 2 out of every 1,000 people in the United States.
Many other diseases and conditions can damage the kidneys, including:
Birth defects of the kidneys (such as polycystic kidney disease)
Certain toxic chemicals
Injury or trauma
Kidney stones and infection
Problems with the arteries leading to or inside the kidneys
Some pain medications and other drugs (such as cancer drugs)
Reflux nephropathy (in which the kidneys are damaged by the backward flow of urine into the kidneys)
Other kidney diseases
Chronic kidney disease leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including:
Blood pressure control
Red blood cell production
Vitamin D and bone health
The early symptoms of chronic kidney disease are also symptoms of other illnesses. These symptoms may be the only signs of kidney disease until the condition is more advanced.
Symptoms may include:
Itching (pruritus) and dry skin
Weight loss without trying to lose weight
Other symptoms that may develop, especially when kidney function has gotten worse, include:
Brain and nervous system symptoms:
Problems concentrating or thinking
Numbness in the hands, feet, or other areas
Muscle twitching or cramps
Low level of sexual interest and impotence
Menstrual periods stop (amenorrhea)
Shortness of breath
Swelling of the feet and hands (edema)
Vomiting, typically in the morning
High blood pressure is almost always present during all stages of chronic kidney disease. A nervous system exam may show signs of nerve damage. The health care provider may hear abnormal heart or lung sounds when listening with a stethoscope.
Tests that check how well the kidneys are working include:
Chronic kidney disease changes the results of several other tests. Every patient needs to have the following checked regularly, as often as every 2 - 3 months when kidney disease gets worse:
Complete blood count (CBC)
Causes of chronic kidney disease may be seen on:
This disease may also change the results of the following tests:
Controlling blood pressure will slow further kidney damage.
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
The goal is to keep blood pressure at or below 130/80 mmHg
Other tips for protecting the kidneys and preventing heart disease and stroke:
Do not smoke.
Eat meals that are low in fat and cholesterol.
Get regular exercise (talk to your doctor or nurse before starting to exercise).
Take drugs to lower your cholesterol, if needed.
Keep your blood sugar under control.
Avoid eating too much salt or potassium.
Always talk to your kidney doctor before taking any over-the-counter medicine, vitamin, or herbal supplement. Make sure all of the doctors you visit know you have chronic kidney disease.
Other treatments may include:
Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
Treatment for anemia, such as extra iron in the diet, iron pills, iron through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions
Extra calcium and vitamin D (always talk to your doctor before taking)
You may need to make changes in your diet. See: Diet for chronic kidney disease for more details.
You may need to limit fluids.
Your health care provider may recommend a low-protein diet.
You may have to restrict salt, potassium, phosphorous, and other electrolytes.
It is important to get enough calories when you are losing weight.
Different treatments are available for problems with sleep or restless legs syndrome.
Everyone with chronic kidney disease should be up-to-date on important vaccinations, including:
H1N1 (swine flu) vaccine
When the loss of kidney function becomes more severe, you will need to prepare for dialysis or a kidney transplant.
When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness.
You should begin to prepare for dialysis before you need it. Learn about dialysis and the types of dialysis therapies, and how a dialysis access is placed.
Even people who are candidates for a kidney transplant may need dialysis while waiting for a kidney to become available.
Many people are not diagnosed with chronic kidney disease until they have lost most of their kidney function.
There is no cure for chronic kidney disease. Untreated, it usually worsens to end-stage renal disease. Lifelong treatment may control the symptoms of chronic kidney disease.
Bleeding from the stomach or intestines
Bone, joint, and muscle pain
Changes in blood sugar
Damage to nerves of the legs and arms (peripheral neuropathy)
Fluid buildup around the lungs (pleural effusion)
Heart and blood vessel complications
High phosphorous levels
Increased risk of infections
Liver damage or failure
Weakening of the bones and increased risk of fractures
Treating the condition that is causing the problem may help prevent or delay chronic kidney disease. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke.
Review Date: 9/21/2011.
Reviewed by: Herbert Y. Lin, MD, PhD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine; Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.