Chronic Kidney Disease (CKD)

Definition

Chronic kidney disease is the name that medical professionals assign to any condition that leads to a gradual loss of kidney function.  Your kidneys are responsible for filtering wastes from your blood and processing those wastes out of the body as urine.  The kidneys process such chemicals as potassium, calcium, sodium, phosphorus, and creatinine.  The accumulation of these chemicals in the body can lead to symptoms, kidney failure, and eventually death.  It is a serious condition that needs aggressive and regular attention to preserve as much kidney function as possible.

Symptoms

As with many other potentially debilitating disease, most of the time the early stages have no symptoms or very vague symptoms.  The early symptoms of chronic kidney disease are vague and can seem like other diseases.  Complaints such as fatigue, weight loss, and appetite loss are common to a number of conditions.  You may also experience itching, headaches, nausea, and a general feeling of illness.  Sometimes, it is just a sick feeling that provides the only clue for chronic kidney disease.

For more progressive forms of the condition, you can see increased thirst, swelling of the hands and feet, drowsiness, and confusion.  With the buildup of chemicals, you may experience muscle twitching, an abnormal odor to the breath, shortness of breath, and sleep problems.  Sometimes you may feel nauseated in the morning, have easy bruising, and notice skin color changes.

Causes

Many diseases cause chronic kidney disease, but the most well-known one is diabetes.  The chronic elevation of blood sugar destroys the small vessels of the body, including those in the kidneys.  When these vessels are destroyed, the kidney cannot filter the blood as effectively and toxins accumulate in the body.  High blood pressure is another common cause of chronic kidney failure.  Again, the small vessels of the body are put under an increased amount of pressure from this chronic condition.  It makes the vessels weaker and unable to filter blood.

Other causes include autoimmune diseases, such as lupus and scleroderma.  Congenital birth defects of the kidneys, such as polycystic kidney disease, also are responsible for a great deal of chronic kidney disease patients.  Kidney stones, infections, certain medications, trauma, and reflux into the kidneys can lead damage of the filtering system.

Care and Treatment

In the early stages of the disease, you will have blood tests to check your creatinine level, your blood urea nitrogen, and your body’s ability to clear creatinine from your system.  These levels will be abnormal when you have chronic kidney disease, and they indicate the relative health of your filtration system.

You will need to make changes to your lifestyle to retain as much kidney function as you can for as long as possible.  Part of the treatment plan for kidney disease is to keep your blood pressure below 130/80, and this is usually facilitated by medications.  You also need to keep your blood sugar in check, or it will continue to destroy the fragile tissue within the kidney.  When your kidneys are not working effectively, you will also have an excess of sodium and potassium accumulate in your blood.  For this reason, you should stay away from salt, high sodium foods, and foods that contain potassium.

As your kidneys progressively decline, you may need to take a medication that binds the phosphorus in your blood and allows it to be eliminated.  In addition, you may need to go on a fluid restriction because your kidneys are unable to filter the excess fluid out of your blood.  When your kidneys fail completely, the condition then becomes known as end-stage renal failure or chronic kidney disease Stage V.  At this point, you will likely need dialysis.  Dialysis runs your blood through a man-made filter, and returns it after removal of the waste products and toxins.  Usually, this treatment is required three days per week to keep the toxins from accumulating which can result in a coma before proving fatal.  Kidney transplants are also considered at this time, and with careful and early planning, it can be done before dialysis is needed.

Prognosis

Most of the time, chronic kidney disease is not diagnosed until it has progressed quite a bit.  Although there is no cure for this condition, you can take steps to cope with the symptoms and preserve kidney function.  It is absolutely essential that you take every opportunity to preserve as much of your kidney tissue as possible, because once it is gone, it never grows back.  For those who do not take care of their kidney disease and ignore the advice of their physicians, the prognosis is rather poor.  However, with concentrated attention to the disease, you can hold off complete kidney failure for quite a long time.

 

Nephrology Consultant:
Datuk Dr. Tan Si Yen