There is no cure for chronic kidney disease. The four goals of therapy are to:
1. slow the progression of disease;
2. treat underlying causes and contributing factors;
3. treat complications of disease; and
4. replace lost kidney function.
Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:
* Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
* Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep your blood pressure below 130/80 mm Hg if you have kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.
* Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with your health care practitioner and a dietitian. For some general guidelines, see the Self-Care at Home section of this article.
The complications of chronic kidney disease may require medical treatment.
* Fluid retention can be treated with any of a number of diuretic medications, which remove excess water from the body. However, these drugs are not suitable for all patients.
* Anemia can be treated with erythropoiesis stimulating agents such as erythropoietin or darbepoetin (Aranesp, Aranesp Albumin Free, Aranesp SureClick). Erythropoiesis stimulating agents are a group of drugs that replace the deficiency of erythropoietin, which is normally produced by healthy kidneys. Often, patients treated with such drugs require iron supplements by mouth or sometimes even intravenously.
* Bone disease develops in kidney disease due to an inability to excrete phosphorus and a failure to form activated Vitamin D. In such circumstances, your physician may prescribe drugs binding phosphorus in the gut, and may prescribe active forms of vitamin D.
* Acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation, and bone disease. If the acidosis is significant, your doctor may use drugs such as sodium bicarbonate (baking soda) to correct the problem.
Monday, January 17, 2011
Kidney Transplantation
Kidney transplantation offers the best outcomes and the best quality of life. Successful kidney transplants occur every day in the United States. Transplanted kidneys may come from living related donors, living unrelated donors, or people who have died of other causes (cadaveric donors). In people with type I diabetes, a combined kidney-pancreas transplant is often a better option.
However, not everyone is a candidate for a kidney transplant. People need to undergo extensive testing to ensure their suitability for transplantation. Also, there is a shortage of organs for transplantation, requiring waiting times of months to years before getting a transplant.
A person who needs a kidney transplant undergoes several tests to identify characteristics of his or her immune system. The recipient can accept only a kidney that comes from a donor who matches certain of his or her immunologic characteristics. The more similar the donor is in these characteristics, the greater the chance of long-term success of the transplant. Transplants from a living related donor generally have the best results.
Transplant surgery is a major procedure and generally requires four to seven days in the hospital. All transplant recipients require lifelong immunosuppressant medications to prevent their bodies from rejecting the new kidney. Immunosuppressant medications require careful monitoring of blood levels and increase the risk of infection as well as some types of cancer.
However, not everyone is a candidate for a kidney transplant. People need to undergo extensive testing to ensure their suitability for transplantation. Also, there is a shortage of organs for transplantation, requiring waiting times of months to years before getting a transplant.
A person who needs a kidney transplant undergoes several tests to identify characteristics of his or her immune system. The recipient can accept only a kidney that comes from a donor who matches certain of his or her immunologic characteristics. The more similar the donor is in these characteristics, the greater the chance of long-term success of the transplant. Transplants from a living related donor generally have the best results.
Transplant surgery is a major procedure and generally requires four to seven days in the hospital. All transplant recipients require lifelong immunosuppressant medications to prevent their bodies from rejecting the new kidney. Immunosuppressant medications require careful monitoring of blood levels and increase the risk of infection as well as some types of cancer.
Kidney Stones Treatment
Kidney Stone Home Remedy
* Prevention is always the preferable way to treat kidney stones. Remaining well hydrated keeps the urine dilute and helps prevent kidney stones from forming.
* Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do at home to control the debilitating pain and vomiting that can occur with a kidney stone other than to seek emergency care. If this is the first episode and no previous diagnosis has been established, it is important to be seen by a health-care provider to confirm the diagnosis.
* For those who have a history of stones, home therapy may be appropriate. Most kidney stones, given time, will pass on their own, and treatment is directed toward symptom control. The patient should be instructed to drink plenty of oral fluids. Ibuprofen may be used as an anti-inflammatory medication if there is no contraindication to its use. If further pain medication is needed, the primary-care provider may be willing to prescribe stronger narcotic pain medications.
* Please note, if a fever is associated with the symptoms of a kidney stone, this becomes an emergency, and medical care should be accessed immediately. Urinary tract infections associated with a kidney stone often require urgent assessment and may need intervention by a urologist to remove or bypass the stone.
* Prevention is always the preferable way to treat kidney stones. Remaining well hydrated keeps the urine dilute and helps prevent kidney stones from forming.
* Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do at home to control the debilitating pain and vomiting that can occur with a kidney stone other than to seek emergency care. If this is the first episode and no previous diagnosis has been established, it is important to be seen by a health-care provider to confirm the diagnosis.
* For those who have a history of stones, home therapy may be appropriate. Most kidney stones, given time, will pass on their own, and treatment is directed toward symptom control. The patient should be instructed to drink plenty of oral fluids. Ibuprofen may be used as an anti-inflammatory medication if there is no contraindication to its use. If further pain medication is needed, the primary-care provider may be willing to prescribe stronger narcotic pain medications.
* Please note, if a fever is associated with the symptoms of a kidney stone, this becomes an emergency, and medical care should be accessed immediately. Urinary tract infections associated with a kidney stone often require urgent assessment and may need intervention by a urologist to remove or bypass the stone.
Kidney Stones Symptoms and Signs
When a tubular structure is blocked in the body, waves of pain occur as the body tries to unblock the obstruction. These waves of pain are called colic. This is opposed to non-colicky type pain, like that associated with appendicitis or pancreatitis, in which movement causes increased pain and the patient tries to hold very still.
* Renal colic (renal is the medical term for things related to the kidney) has a classic presentation when a kidney stone is being passed.
o The pain is intense and comes on suddenly. It may wax and wane, but there is usually a significant underlying ache between the acute spasms of pain.
o It is usually located in the flank or the side of the mid back and may radiate to the groin. Males may complain of pain in the testicle or scrotum.
o The patient cannot find a comfortable position and often writhes or paces with pain.
* Sweating, nausea, and vomiting are common.
* Blood may or may not be visible in the urine because the stone has irritated the kidney or ureter. Blood in the urine (hematuria), however, does not always mean a person has a kidney stone. There may be other reasons for the blood, including kidney and bladder infections, trauma, or tumors. Urinalysis with a microscope may detect blood even if it is not appreciated by the naked eye. Sometimes, if the stone causes complete obstruction, no blood may be found in the urine because it cannot get past the stone.
* Renal colic (renal is the medical term for things related to the kidney) has a classic presentation when a kidney stone is being passed.
o The pain is intense and comes on suddenly. It may wax and wane, but there is usually a significant underlying ache between the acute spasms of pain.
o It is usually located in the flank or the side of the mid back and may radiate to the groin. Males may complain of pain in the testicle or scrotum.
o The patient cannot find a comfortable position and often writhes or paces with pain.
* Sweating, nausea, and vomiting are common.
* Blood may or may not be visible in the urine because the stone has irritated the kidney or ureter. Blood in the urine (hematuria), however, does not always mean a person has a kidney stone. There may be other reasons for the blood, including kidney and bladder infections, trauma, or tumors. Urinalysis with a microscope may detect blood even if it is not appreciated by the naked eye. Sometimes, if the stone causes complete obstruction, no blood may be found in the urine because it cannot get past the stone.
Kidney Stones Overview
The kidney acts as a filter for blood, removing waste products from the body and making urine. It also helps regulate electrolyte levels that are important for body function. Urine drains from the kidney through a narrow tube called the ureter into the bladder. When the bladder fills and there is an urge to urinate, the bladder empties to the outside through the urethra, a much wider tube than the ureter.
In some people, chemicals crystallize in the urine and form the beginning, or nidus, of a kidney stone. These stones are very tiny when they form, smaller than a grain of sand, but gradually can grow over time to 1/10 of an inch or larger. Urolithiasis is the term that refers to the presence of stones in the urinary tract, while nephrolithiasis refers to kidney stones and ureterolithiasis refers to stones lodged in the ureter. The size of the stone doesn't matter as much as where it is located and whether it obstructs or prevents urine from draining.
When the stone sits in the kidney, it rarely causes problems, but when it falls into the ureter, it acts like a dam. As the kidney continues to function and make urine, pressure builds up behind the stone and causes the kidney to swell. This pressure is what causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.
In some people, chemicals crystallize in the urine and form the beginning, or nidus, of a kidney stone. These stones are very tiny when they form, smaller than a grain of sand, but gradually can grow over time to 1/10 of an inch or larger. Urolithiasis is the term that refers to the presence of stones in the urinary tract, while nephrolithiasis refers to kidney stones and ureterolithiasis refers to stones lodged in the ureter. The size of the stone doesn't matter as much as where it is located and whether it obstructs or prevents urine from draining.
When the stone sits in the kidney, it rarely causes problems, but when it falls into the ureter, it acts like a dam. As the kidney continues to function and make urine, pressure builds up behind the stone and causes the kidney to swell. This pressure is what causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.
Kidney Stones in Children
The occurrence of a kidney stone in a child is a relatively rare event. In countries where plants are the main source of protein in the diet, for example Southeast Asia, the Middle East, India, and Eastern Europe, the frequency of kidney stone disease in children rises. In developing countries, bladder stones made of uric acid are more commonly found.
Symptoms of kidney stones in children are similar to those in an adult, although with very young children or infants, the symptoms may be harder to appreciate and understand. The initial finding in an infant may be a crying and inconsolable baby, and the presentation may be mistaken for colic.
Symptoms of kidney stones in children are similar to those in an adult, although with very young children or infants, the symptoms may be harder to appreciate and understand. The initial finding in an infant may be a crying and inconsolable baby, and the presentation may be mistaken for colic.
Kidney Stones Diagnosis
The classic presentation of renal colic associated with blood in the urine suggests the diagnosis of kidney stone. Many other conditions can mimic this disease, and the care provider may need to order tests to confirm the diagnosis. In older patients, it is always important to at least consider the diagnosis of a leaking or ruptured abdominal aortic aneurysm (abnormal widening of the large blood vessel that leads from the heart to supply blood to the body) as a source of this type of pain.
Physical examination is often not helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness. The examination is often done to look for potentially dangerous conditions. The care provider may palpate or feel the abdomen trying to find a pulsatile or throbbing mass that might indicate the presence of an abdominal aortic aneurysm. Listening to the abdomen with a stethoscope may reveal a bruit or rushing noise made by abnormal blood flow through the aneurysm. Tenderness under the right rib cage margin may signal gallbladder disease. Tenderness in the lower quadrants may be associated with appendicitis, diverticulitis, or ovarian disease. Examination of the scrotum may exclude a testicular torsion.
In children, colicky abdominal pain may be associated with intussusception of the intestine.
Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.
A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.
Blood tests are usually not indicated, unless the health-care provider has concerns about the diagnosis or is worried about kidney stone complications.
Computerized tomography (CT) scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney. The CT can also evaluate many other organs in the abdomen, including the appendix, gallbladder, liver, pancreas, aorta, and bowel. However, since no contrast material is used, there are some limitations to the detail that can be observed in the images of the scan.
Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to interpret the images and may not always be available.
In those patients who already have the diagnosis of a kidney stone, plain abdominal X-rays may be used to track its movement down the ureter toward the bladder. As well, in patients with known kidney stone disease, no imaging may be necessary if the diagnosis seems certain, so that the amount of X-ray radiation that can accumulate over a lifetime is minimized.
Physical examination is often not helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness. The examination is often done to look for potentially dangerous conditions. The care provider may palpate or feel the abdomen trying to find a pulsatile or throbbing mass that might indicate the presence of an abdominal aortic aneurysm. Listening to the abdomen with a stethoscope may reveal a bruit or rushing noise made by abnormal blood flow through the aneurysm. Tenderness under the right rib cage margin may signal gallbladder disease. Tenderness in the lower quadrants may be associated with appendicitis, diverticulitis, or ovarian disease. Examination of the scrotum may exclude a testicular torsion.
In children, colicky abdominal pain may be associated with intussusception of the intestine.
Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.
A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.
Blood tests are usually not indicated, unless the health-care provider has concerns about the diagnosis or is worried about kidney stone complications.
Computerized tomography (CT) scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney. The CT can also evaluate many other organs in the abdomen, including the appendix, gallbladder, liver, pancreas, aorta, and bowel. However, since no contrast material is used, there are some limitations to the detail that can be observed in the images of the scan.
Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to interpret the images and may not always be available.
In those patients who already have the diagnosis of a kidney stone, plain abdominal X-rays may be used to track its movement down the ureter toward the bladder. As well, in patients with known kidney stone disease, no imaging may be necessary if the diagnosis seems certain, so that the amount of X-ray radiation that can accumulate over a lifetime is minimized.
Kidney Stones Causes
There is no consensus as to why kidney stones form.
* Heredity: Some people are more susceptible to forming kidney stones, and heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).
* Geographical location: There may be a geographic predisposition, and where a person lives may predispose them to form kidney stones. There are regional "stone belts," with people living in the southern United States having an increased risk of stone formation. The hot climate in this region combined with poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.
* Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming stones, diet probably will not change that risk.
* Medications: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir (Crixivan) may form indinavir stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like ceftriaxone (Rocephin) and ciprofloxacin (Cipro).
* Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.
* Heredity: Some people are more susceptible to forming kidney stones, and heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).
* Geographical location: There may be a geographic predisposition, and where a person lives may predispose them to form kidney stones. There are regional "stone belts," with people living in the southern United States having an increased risk of stone formation. The hot climate in this region combined with poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.
* Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming stones, diet probably will not change that risk.
* Medications: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir (Crixivan) may form indinavir stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like ceftriaxone (Rocephin) and ciprofloxacin (Cipro).
* Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.
Kidney Stone Prognosis
Once a patient has passed a stone, there is a great likelihood that another stone will be passed in his or her lifetime. Since kidney stones may also be hereditary, this likelihood is passed on to the next generation. A patient who has experienced a stone is unlikely to forget the experience and often will arrive at the health-care facility already knowing the diagnosis. Those with recurrent stones may be given medication to keep at home should symptoms recur
Kidney Stone Prevention
* While kidney stones and renal colic probably cannot be prevented, the risk of forming a stone can be minimized by avoiding dehydration. Keeping the urine dilute will not allow the chemical crystals to come out of solution and form the beginning nidus of a stone. Making certain that the urine remains clear and not concentrated (dark yellow) will help minimize stone formation.
* Medication may be prescribed for certain types of stones, and compliance with taking the medication is a must to reduce the risk of future episodes.
* Medication may be prescribed for certain types of stones, and compliance with taking the medication is a must to reduce the risk of future episodes.
How Common is Chronic Kidney Disease?
# Chronic kidney disease is a growing health problem in the United States. A report by the Centers for Disease Control (CDC) determined that 16.8% of all adults above the age of 20 years have chronic kidney disease. Thus, one in six individuals has kidney disease. By disease stage, the prevalence is as follows:
* stage 1, 3.1%;
* stage 2, 4.1%;
* stage 3, 7.6%;
* stage 4; and
* stage 5, 0.5%.
# There are over 500,000 persons on dialysis or who have received kidney transplants.
# The prevalence of chronic kidney disease has increased by 16% from the previous decade. The increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have contributed to this increase in kidney disease.
# Chronic kidney disease is more prevalent among individuals above 60 years of age (39.4%).
# Kidney disease is more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.
* stage 1, 3.1%;
* stage 2, 4.1%;
* stage 3, 7.6%;
* stage 4; and
* stage 5, 0.5%.
# There are over 500,000 persons on dialysis or who have received kidney transplants.
# The prevalence of chronic kidney disease has increased by 16% from the previous decade. The increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have contributed to this increase in kidney disease.
# Chronic kidney disease is more prevalent among individuals above 60 years of age (39.4%).
# Kidney disease is more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.
Follow-up
Follow-up
If you have chronic kidney disease, your health care practitioner will recommend a schedule of regular follow-up visits.
* At these visits, your underlying condition and your kidney status will be evaluated.
* You will have regular blood and urine tests and possibly imaging studies as part of this ongoing evaluation.
If you have chronic kidney disease, your health care practitioner will recommend a schedule of regular follow-up visits.
* At these visits, your underlying condition and your kidney status will be evaluated.
* You will have regular blood and urine tests and possibly imaging studies as part of this ongoing evaluation.
Chronic Kidney Disease Treatment
Self-Care at Home
Chronic kidney disease is a disease that must be managed in close consultation with your health care practitioner. Self-treatment is not appropriate.
* There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications.
* This is a complex process and must be individualized, generally with the help of your health care practitioner and a registered dietitian.
The following are general dietary guidelines:
* Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
* Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure.
* Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake.
* Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
* Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.
Other important measures that you can take include:
* carefully follow prescribed regimens to control your blood pressure and/or diabetes;
* stop smoking; and
* lose excess weight.
In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:
* Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
* Fleets or phosphosoda enemas because of their high content of phosphorus
* Laxatives and antacids containing magnesium and aluminum such as magnesium hydroxide (Milk of Magnesia) and famotidine (Mylanta)
* Ulcer medication H2-receptor antagonists: cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease)
* Decongestants such as pseudoephedrine (Sudafed) especially if you have high blood pressure
* Alka Seltzer, since this contains large amounts of salt
* Herbal medications
If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your health care practitioner as recommended for follow-up and monitoring.
Chronic kidney disease is a disease that must be managed in close consultation with your health care practitioner. Self-treatment is not appropriate.
* There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications.
* This is a complex process and must be individualized, generally with the help of your health care practitioner and a registered dietitian.
The following are general dietary guidelines:
* Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
* Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure.
* Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake.
* Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
* Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.
Other important measures that you can take include:
* carefully follow prescribed regimens to control your blood pressure and/or diabetes;
* stop smoking; and
* lose excess weight.
In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:
* Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
* Fleets or phosphosoda enemas because of their high content of phosphorus
* Laxatives and antacids containing magnesium and aluminum such as magnesium hydroxide (Milk of Magnesia) and famotidine (Mylanta)
* Ulcer medication H2-receptor antagonists: cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease)
* Decongestants such as pseudoephedrine (Sudafed) especially if you have high blood pressure
* Alka Seltzer, since this contains large amounts of salt
* Herbal medications
If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your health care practitioner as recommended for follow-up and monitoring.
Chronic Kidney Disease Symptoms
The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left.
Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.
Effects and symptoms of chronic kidney disease include;
* need to urinate frequently, especially at night (nocturia);
* swelling of the legs and puffiness around the eyes (fluid retention);
* high blood pressure;
* fatigue and weakness (from anemia or accumulation of waste products in the body);
* loss of appetite, nausea and vomiting;
* itching, easy bruising, and pale skin (from anemia);
* shortness of breath from fluid accumulation in the lungs;
* headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome;
* chest pain due to pericarditis (inflammation around the heart);
* bleeding (due to poor blood clotting);
* bone pain and fractures; and
* decreased sexual interest and erectile dysfunction.
Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.
Effects and symptoms of chronic kidney disease include;
* need to urinate frequently, especially at night (nocturia);
* swelling of the legs and puffiness around the eyes (fluid retention);
* high blood pressure;
* fatigue and weakness (from anemia or accumulation of waste products in the body);
* loss of appetite, nausea and vomiting;
* itching, easy bruising, and pale skin (from anemia);
* shortness of breath from fluid accumulation in the lungs;
* headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome;
* chest pain due to pericarditis (inflammation around the heart);
* bleeding (due to poor blood clotting);
* bone pain and fractures; and
* decreased sexual interest and erectile dysfunction.
Chronic Kidney Disease Prognosis
There is no cure for chronic kidney disease. The natural course of the disease is to progress until dialysis or transplant is required.
* Patients with chronic kidney disease are at a much higher risk than the general population to develop strokes and heart attacks.
* People undergoing dialysis have an overall five year survival rate of 32%. The elderly and those with diabetes have worse outcomes.
* Recipients of a kidney transplant from a living related donor have a two year survival rate greater than 90%.
* Recipients of a kidney from a donor who has died have a two year survival rate of 88%.
* Patients with chronic kidney disease are at a much higher risk than the general population to develop strokes and heart attacks.
* People undergoing dialysis have an overall five year survival rate of 32%. The elderly and those with diabetes have worse outcomes.
* Recipients of a kidney transplant from a living related donor have a two year survival rate greater than 90%.
* Recipients of a kidney from a donor who has died have a two year survival rate of 88%.
Chronic Kidney Disease Prevention
Chronic kidney disease cannot be prevented in most situations. You may be able to protect your kidneys from damage, or slow the progression of the disease by controlling your underlying conditions such as diabetes mellitus and high blood pressure.
* Kidney disease is usually advanced by the time symptoms appear. If you are at high risk of developing chronic kidney disease, see your health care practitioner as recommended for screening tests.
* If you have a chronic condition such as diabetes, high blood pressure, or high cholesterol, follow the treatment recommendations of your health care practitioner. See your healthcare practitioner regularly for monitoring. Aggressive treatment of these diseases is essential.
Avoid exposure to drugs especially NSAIDs (nonsteroidal antiinflammatory drugs), chemicals, and other toxic substances as much as possible.
* Kidney disease is usually advanced by the time symptoms appear. If you are at high risk of developing chronic kidney disease, see your health care practitioner as recommended for screening tests.
* If you have a chronic condition such as diabetes, high blood pressure, or high cholesterol, follow the treatment recommendations of your health care practitioner. See your healthcare practitioner regularly for monitoring. Aggressive treatment of these diseases is essential.
Avoid exposure to drugs especially NSAIDs (nonsteroidal antiinflammatory drugs), chemicals, and other toxic substances as much as possible.
Chronic Kidney Disease Overview
Normal Kidneys and Their Function
The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.
The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.
The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.
* As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule.
* The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule.
The kidneys also produce certain hormones that have important functions in the body, including the following:
* Active form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone.
* Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.
* Renin, which regulates blood volume and blood pressure.
Chronic kidney disease
Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.
With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease.
Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive.
Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.
* Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it.
* Acute kidney failure is often reversible, with complete recovery of kidney function.
* Some patients are left with residual damage and can have a progressive decline in kidney function in the future.
* Others may develop irreversible kidney failure after an acute injury and remain dialysis-dependent.
*GFR is glomerular filtration rate, a measure of the kidney's function.
The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.
The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.
The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.
* As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule.
* The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule.
The kidneys also produce certain hormones that have important functions in the body, including the following:
* Active form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone.
* Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.
* Renin, which regulates blood volume and blood pressure.
Chronic kidney disease
Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.
With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease.
Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive.
Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.
* Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it.
* Acute kidney failure is often reversible, with complete recovery of kidney function.
* Some patients are left with residual damage and can have a progressive decline in kidney function in the future.
* Others may develop irreversible kidney failure after an acute injury and remain dialysis-dependent.
*GFR is glomerular filtration rate, a measure of the kidney's function.
Chronic Kidney Disease Diagnosis
Chronic kidney disease usually causes no symptoms in its early stages. Only lab tests can detect any developing problems. Anyone at increased risk for chronic kidney disease should be routinely tested for development of this disease.
* Urine, blood, and imaging tests (X-rays) are used to detect kidney disease, as well as to follow its progress.
* All of these tests have limitations. They are often used together to develop a picture of the nature and extent of the kidney disease.
* In general, this testing can be performed on an outpatient basis.
Urine Tests
Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has reagents that check the urine for the presence of various normal and abnormal constituents including protein. Then, the urine is examined under a microscope to look for red and white blood cells, and the presence of casts and crystals (solids).
Only minimal quantities of albumin (protein) are present in urine normally. A positive result on a dipstick test for protein is abnormal. More sensitive than a dipstick test for protein is a laboratory estimation of the urine albumin (protein) and creatinine in the urine. The ratio of albumin (protein) and creatinine in the urine provides a good estimate of albumin (protein) excretion per day.
Twenty-four hour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea nitrogen, and creatinine). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR).
Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in women. It decreases in most people with age. The GFR may be calculated from the amount of waste products in the 24-hour urine or by using special markers administered intravenously. An estimation of the GFR (eGFR) can be calculated from the patient's routine blood tests. Patients are divided into five stages of chronic kidney disease based on their GFR (see Table 1 above).
Blood Tests
Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens.
Estimated GFR (eGFR): The laboratory or your physician may calculate an estimated GFR using the information from your blood work. It is important to be aware of your estimated GFR and stage of chronic kidney disease. Your physician uses your stage of kidney disease to recommend additional testing and suggestions on management.
Electrolyte levels and acid-base balance: Kidney dysfunction causes imbalances in electrolytes, especially potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a particular concern. The acid-base balance of the blood is usually disrupted as well.
Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be abnormal.
Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells.
Other tests
Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a noninvasive type of imaging test. In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose the presence of urinary obstruction, kidney stones and also to assess the blood flow into the kidneys.
Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia by introducing a needle through the skin into the kidney. This is usually done as an outpatient procedure, though some institutions may require an overnight hospital stay.
* Urine, blood, and imaging tests (X-rays) are used to detect kidney disease, as well as to follow its progress.
* All of these tests have limitations. They are often used together to develop a picture of the nature and extent of the kidney disease.
* In general, this testing can be performed on an outpatient basis.
Urine Tests
Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has reagents that check the urine for the presence of various normal and abnormal constituents including protein. Then, the urine is examined under a microscope to look for red and white blood cells, and the presence of casts and crystals (solids).
Only minimal quantities of albumin (protein) are present in urine normally. A positive result on a dipstick test for protein is abnormal. More sensitive than a dipstick test for protein is a laboratory estimation of the urine albumin (protein) and creatinine in the urine. The ratio of albumin (protein) and creatinine in the urine provides a good estimate of albumin (protein) excretion per day.
Twenty-four hour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea nitrogen, and creatinine). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR).
Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in women. It decreases in most people with age. The GFR may be calculated from the amount of waste products in the 24-hour urine or by using special markers administered intravenously. An estimation of the GFR (eGFR) can be calculated from the patient's routine blood tests. Patients are divided into five stages of chronic kidney disease based on their GFR (see Table 1 above).
Blood Tests
Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens.
Estimated GFR (eGFR): The laboratory or your physician may calculate an estimated GFR using the information from your blood work. It is important to be aware of your estimated GFR and stage of chronic kidney disease. Your physician uses your stage of kidney disease to recommend additional testing and suggestions on management.
Electrolyte levels and acid-base balance: Kidney dysfunction causes imbalances in electrolytes, especially potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a particular concern. The acid-base balance of the blood is usually disrupted as well.
Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be abnormal.
Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells.
Other tests
Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a noninvasive type of imaging test. In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose the presence of urinary obstruction, kidney stones and also to assess the blood flow into the kidneys.
Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia by introducing a needle through the skin into the kidney. This is usually done as an outpatient procedure, though some institutions may require an overnight hospital stay.
Chronic Kidney Disease Causes
Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.
* Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States.
* High blood pressure (hypertension), if not controlled, can damage the kidneys over time.
* Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis.
* Polycystic kidney disease is an example of a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts.
* Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys.
* Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage.
* Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease.
* Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.
If you have any of the following conditions, you are at higher-than-normal risk of developing chronic kidney disease. Your kidney functions may need to be monitored regularly.
* Diabetes mellitus type 1 or 2
* High blood pressure
* High cholesterol
* Heart disease
* Liver disease
* Amyloidosis
* Sickle cell disease
* Systemic Lupus erythematosus
* Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia
* Vesicoureteral reflux (a urinary tract problem in which urine travels the wrong way back toward the kidney)
* Require regular use of anti-inflammatory medications
* A family history of kidney disease
* Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States.
* High blood pressure (hypertension), if not controlled, can damage the kidneys over time.
* Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis.
* Polycystic kidney disease is an example of a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts.
* Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys.
* Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage.
* Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease.
* Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.
If you have any of the following conditions, you are at higher-than-normal risk of developing chronic kidney disease. Your kidney functions may need to be monitored regularly.
* Diabetes mellitus type 1 or 2
* High blood pressure
* High cholesterol
* Heart disease
* Liver disease
* Amyloidosis
* Sickle cell disease
* Systemic Lupus erythematosus
* Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia
* Vesicoureteral reflux (a urinary tract problem in which urine travels the wrong way back toward the kidney)
* Require regular use of anti-inflammatory medications
* A family history of kidney disease
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