Chronic Kidney Disease
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Chronic kidney disease is long-term damage to the kidneys due to underlying conditions such as diabetes, hypertension, kidney infections, or inflammatory disease. Symptoms of chronic kidney disease include swelling, low urine output, fatigue, weakness, chest pain, shortness of breath, and others.
What is chronic kidney disease?
Chronic kidney disease is long-term damage to the kidneys, the organs responsible for producing urine. Causes of chronic kidney disease include diabetes, hypertension, kidney infections, and inflammatory diseases, medications or toxins, inherited kidney diseases, and prematurity and low birth weight.
Symptoms include swelling (edema) and decreased urine output (oliguria), fatigue, weakness, chest pain, shortness of breath, bone pain, nausea and vomiting, and neurological symptoms.
Diagnosis is made by laboratory tests. Chronic kidney disease is defined by laboratory evidence of kidney damage or decreased kidney function for three or more months.
Treatments include dietary changes and medications to treat the symptoms, slow progression of the disease, and manage complications. End-stage chronic kidney disease requires treatment with renal replacement therapy, which includes dialysis and kidney transplant.
You should make an appointment with your primary care physician to discuss your symptoms as soon as possible.
Symptoms of chronic kidney disease
Chronic kidney disease is defined based on laboratory tests, and some people with early chronic kidney disease may not have any symptoms. In other people, symptoms may be due to the decreased kidney function or due to complications of chronic kidney disease.
The main symptoms experienced by those with chronic kidney disease include the following.
- Swelling and decreased urine output: This can occur because the kidneys are normally responsible for producing urine, and kidney damage can lead to decreased urine output and fluid retention in the body.
- Fatigue, weakness, and exercise intolerance: This is due to anemia, or low red blood cell counts because the kidneys are responsible for producing a substance that increases red blood cell production.
- Muscle weakness and paralysis: This is due to possibly high levels of potassium in your blood, as the kidneys are normally responsible for excreting potassium.
Other symptoms and complications
Other symptoms and complications that can occur as chronic kidney disease progresses include the following.
- Chest pain and/or shortness of breath: Having chronic kidney disease increases the risk of developing heart disease, which may cause chest pain or shortness of breath. In addition, fluid overload from decreased urine output may cause fluid to build up in the lungs, causing shortness of breath.
- Bone pain, skeletal deformities, and easy fractures: This is due to a mineral bone disorder that can develop with CKD, in which the normal mineral balance of the bones is disrupted.
- Nausea, vomiting, and loss of appetite: A condition called uremia may cause these symptoms in the early stages. Uremia is caused by the inability of the kidneys to remove toxins from the body.
- Loss of concentration, confusion, seizures, or coma: If severe uremia develops, this may result in these neurological symptoms.
What causes chronic kidney disease?
Causes leading to chronic kidney disease may be inherited or acquired. Your overall health and lifestyle may determine the presence of additional risk factors. Common causes include:
- Diabetes: Diabetes, a disease that causes abnormally high blood sugar, is the most common cause of chronic kidney disease in most countries, constituting about 40 percent of cases overall. About 30 to 40 percent of people with diabetes will eventually develop chronic kidney disease. Diabetes causes chronic kidney disease by altering blood flow in the kidneys and causing inflammation.
- Hypertension: Hypertension causes chronic kidney disease by damaging the blood vessels in the kidneys.
- Kidney infections: Repeated and/or long-term kidney infections can lead to the development of chronic kidney disease. These include certain bacterial infections as well as HIV, the virus that causes AIDS.
- Inflammatory diseases of the kidneys: These include lupus, sarcoidosis, and Sjogren's syndrome.
- Inherited kidney diseases: Certain inherited kidney diseases can lead to the development of chronic kidney disease. A common example is a condition called polycystic kidney disease, in which multiple fluid-filled structures develop in the kidneys.
Other risk factors
Other specific risk factors for chronic kidney disease include the following.
- Obesity: Obesity, defined as a body mass index of 30 kg/m2 or greater, is a risk factor for developing chronic kidney disease. This may be due to the systemic inflammation caused by obesity.
- Prolonged exposure to toxins or medications toxic to the kidneys: These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, antibiotics, chemotherapy agents, heavy metals, and irradiation.
- Being born prematurely or with low birthweight: This can occur because the kidneys are not completely developed at birth. These individuals often develop chronic kidney disease in adolescence.
Treatment options and prevention for chronic kidney disease
Chronic kidney disease is a chronic condition that cannot be cured. Treatment focuses on medications and lifestyle changes to slow the progression of the disease and to manage symptoms and complications. End-stage chronic kidney disease may require "renal replacement therapy," or therapy to replace the function of the kidneys. Renal replacement therapy includes various options for dialysis as well as a kidney transplant.
Most people with chronic kidney disease will benefit from dietary changes to prevent complications of chronic kidney disease. These include:
- Limiting sodium: This is salt intake, which in excess can cause volume overload.
- Limiting potassium intake: This is to avoid high potassium levels.
- Limiting phosphate intake: This is to prevent high phosphate levels and chronic kidney disease-associated bone disorders.
Medication for blood pressure and protein excretion
To slow the progression of kidney damage, it is usually beneficial to reduce blood pressure and protein excretion in the urine. Medications include lisinopril, valsartan, diltiazem (Cardizem) and verapamil.
Medication for volume, mineral, and other imbalances
CKD is often associated with volume overload and mineral and other imbalances. Therefore, some people may benefit from medications for specific adjustments.
- For volume overload: Diuretics such as furosemide (Lasix)
- For abnormal phosphate and parathyroid hormone levels: Calcium carbonate, calcium acetate (PhosLo), sevelamer (Renagel, Renvela), and/or calcitriol
- For low red blood cells: Erythropoietin (EPO)
- For acidic blood levels: Sodium bicarbonate
Dialysis involves using an external machine to maintain the normal balance of volume and minerals in the blood and remove toxins from the blood. The two primary options for dialysis are:
- Hemodialysis: Blood is removed and replaced through a vein in the arm.
- Peritoneal dialysis: Fluid is filtered through the abdominal cavity.
People with end-stage chronic kidney disease may eventually require a kidney transplant, in which their diseased kidney is removed and replaced with a healthy kidney from a donor. Donor kidneys may be received from either a living donor or a deceased donor; outcomes are usually better for kidneys from living donors.
Prevention of chronic kidney disease focuses on managing chronic conditions such as diabetes and high blood pressure that can lead to chronic kidney disease and avoiding other forms of kidney damage that can lead to chronic kidney disease.
When to seek further consultation for chronic kidney disease
If you have any conditions that can cause chronic kidney disease such as diabetes or hypertension you should see your physician. He or she can come up with a treatment plan to help you manage your chronic condition and reduce your risk of developing chronic kidney disease.
If you develop symptoms of chronic kidney disease
You should see your physician. He or she can order laboratory tests to determine if you have chronic kidney disease as well as the potential cause of your disease, and then come up with a treatment plan.
Questions your doctor may ask to determine chronic kidney disease
- Do you have trouble sleeping?
- Any fever today or during the last week?
- Have you lost your appetite recently?
- Are you having difficulty concentrating or thinking through daily activities?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He graduated Phi Beta Kappa from Swarthmore College with a BA in biology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness. In his free time, he enjoys running, biking, and spending time with his friends and family.
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