CHRONIC KIDNEY DISEASE
- What are the functions of the kidneys?
The kidneys help to keep the internal environment constant through their excretory and regulatory function and produce hormones that play a role in red blood cell formation, bone metabolism and control of blood pressure.
- What do you mean by kidney failure?
Kidney failure is a disease in which the kidneys fail to filter and excrete adequately the final products of all metabolic activities and surplus water and electrolytes resulting in accumulation of waste products and surplus water and electrolytes in the body. Hormone production by the kidneys is also impaired.
- How do you assess kidney function?
Kidney function is assessed by the rate at which they filter waste products from blood into urine (glomerular filtration rate – GFR). As measurement of GFR is difficult, serum creatinine can be used for this purpose. Serum creatinine can be used in certain mathematical formulae to calculate GFR.
- When we say kidney failure does it imply failure of one kidney or both kidneys?
Kidney failure implies the failure of both kidneys or the failure of the only existing kidney.
- What is chronic kidney disease?
Chronic kidney disease (CKD) is diagnosed when at least one of the following is present for more than 3 months: a) abnormalities of kidney as evidenced by blood, urine and ultrasound scan (a test in which we get details of internal body organs by keeping a sensor over the abdomen) tests; b) GFR less than 60ml/minute/1.73m2. The word “chronic” means over a period of time or gradual.
- What are the causes of CKD?
Common causes of CKD are diabetes mellitus, hypertension, chronic glomerulonephritis (diseases affecting the capillary tuft filters), chronic interstitial nephritis resulting from kidney infection, kidney stones, long standing pain killer use, chronic blockage of the urinary tract etc. (interstitium is the surroundings of tubules which are minute tubes that collect urine from the filters), certain hereditary conditions affecting the kidneys etc.
- What are the symptoms of CKD?
Most people with CKD may not have symptoms until the kidney function is severely impaired and CKD is detected when blood or urine or scan tests done for other reasons are abnormal; such patients may even refuse to accept the diagnosis claiming that they continue to pass usual quantities of (or even more) urine; they should understand that this itself can be a symptom of CKD and urine formed does not contain sufficient amounts of the body’s waste products.
With advanced kidney disease, patients may develop reduced or absent urine output; passing more urine in the night; swelling, especially in the legs or feet; vomiting; not feeling hungry; tiredness; confusion; increased sleepiness; involuntary shaking or jerking muscle movements; irregular or missed periods; sexual dysfunction; high blood pressure; blood chemistry (electrolyte) abnormalities; anemia (a decrease in red blood cells, which can cause fatigue and other symptoms) and bone disease.
- What tests are performed for the diagnosis of CKD?
CKD is diagnosed by estimation of serum creatinine. Further blood and urine tests and ultrasound scan are needed to find the associated abnormalities and to diagnose the cause of CKD. You may also require kidney biopsy to diagnose the cause. Your doctor will decide on the feasibility of biopsy based on ultrasound report.
- What are the treatment options for CKD?
The first step in the treatment of CKD is the determination of the cause of CKD. Then the doctor will try to improve kidney function through treatment of reversible causes that could have contributed to reduced kidney function (use of drugs that impair kidney function, blockage in the urinary tract, very high or low blood pressure or decreased blood volume).
Hypertension, or high blood pressure, is present in 80 to 85 % patients with CKD. Good blood pressure control is the most important goal for trying to slow progression of CKD.
You may require medications to treat swelling of legs if there is associated breathlessness and for improving electrolyte and acid disturbances.
- Is there a specific medication to treat CKD?
Medications called angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) which reduces blood pressure and levels of protein in the urine are thought to slow the progression of chronic kidney disease to a greater extent than some of the other medicines used to treat high blood pressure. There is no other specific medication to treat CKD.
- What are the complications of CKD?
The major complications of CKD are heart disease, anemia and bone disease. Anemia and bone disease are due to deficiency of the hormones mentioned before. These hormones can be supplemented and appropriate treatment for these complications should be started at the right time.
- Will there be diet restriction?
The doctor will advise change in diet to make sure that you do not develop fluid retention and electrolyte and acid disturbances. Depending on urine output and electrolyte abnormalities, you will be prescribed a diet that has the right amount of fluid, salt and nutrient.
- What will be the frequency of follow up?
Follow up will be advised depending on the level of kidney function and its stability and the presence of complications of CKD.
- What other measures will be taken during this period of follow up?
All patients with CKD require Hepatitis B vaccination (4 doses; 20 micrograms into each shoulder) and pneumococcal vaccination if not done before; it is preferable for them to undergo arteriovenous fistula (a small surgical procedure in which two blood vessels are joined to increase blood flow) if they are planning to undergo hemodialysis in future when the progression of CKD suggests that the patient would require initiation on dialysis in the next 6 months.
- What precautions should be taken to prevent progression of CKD?
Patients with CKD slowly lose their ability to filter blood before they stop working completely. It is possible to slow down this progression even if the cause cannot be treated and cured by following these simple measures:
Quit smoking if you are a smoker; visit your nephrologist as advised; inform if you develop any unusual symptom during the course of illness; do not take over the counter medications; inform medications prescribed elsewhere before use; keep blood pressure (and diabetes mellitus if present) under good control; avoid diet indiscretions; avoid use of pain killers other than Paracetamol and Tramadol; avoid alternative medicines; get treated for infections at the earliest especially if you are having diabetes mellitus; inform the nephrologist if you are undergoing angiogram.
- Can a female in reproductive age group conceive?
Females in the reproductive age group should conceive and deliver only under the guidance of the nephrologist and obstetrician. Complications for the mother and fetus will be greater in patients with CKD, especially if blood pressure is not under control, protein leak is more and kidney function is less. Some of the drugs prescribed for CKD are harmful for the embryo and conception should not be attempted while on these drugs.
- Will CKD progress to the stage of dialysis?
The risk of progression of CKD to the stage of dialysis is related to the cause (and its nature) of CKD and the level of kidney function at the time of detection. Apart from this, any intercurrent illness can destabilize the balance and precipitate the need for dialysis. In view of these possibilities, all patients with CKD should have follow up with Nephrologist only.
- When will I require initiation on dialysis?
Generally initiation on dialysis will be required when calculated GFR is less than 10-15 ml/minute/m2.
- What are the types of dialysis?
Hemodialysis, a procedure in which a machine takes over the excretory function of the kidneys and peritoneal dialysis which involves piping a special fluid into the abdomen for collection and removal of wastes, excess salt and water from the blood are the two types of dialysis.
- Is there no alternative to dialysis?
The other option of treatment for advanced CKD is transplantation if there is no medical reason to withhold it.
- Will CKD reduce the life span?
CKD involves risk to life and this risk is multiplied several times by complications, especially heart disease. Dialysis and kidney transplantation improves the quality and quantity of life in patients having advanced CKD.