Chronic kidney disease (CKD) is the progressive and irreversible destruction of the kidneys.
Your kidneys are essential parts of your body. They have several functions, including:
helping maintain the balance of minerals and electrolytes in your body, such as calcium, sodium, and potassium
playing an essential role in the production of red blood cells
maintaining the delicate acid-base balance of your blood
excreting water-soluble wastes from your body
Damaged kidneys lose their ability to perform these functions.
What Causes Chronic Kidney Disease?
Each kidney contains about 1 million tiny filtering units called nephrons. Any disease that injures or scars these filtering units can cause kidney disease. Diabetes and high blood pressure can both damage your nephrons.
High blood pressure can also damage the blood vessels of your kidneys, heart, and brain. This is key because blood vessel diseases are generally dangerous to your kidneys. The kidneys are highly vascularized, meaning they contain lots of blood vessels.
Autoimmune diseases such as lupus can damage blood vessels and can make antibodies against kidney tissue.
There are various other causes of CKD. Polycystic kidney disease is a hereditary cause of CKD. Glomerulonephritis can be due to lupus. It can also appear after a streptococcal infection.
Who Is at Risk for Chronic Kidney Disease?
The risk of CKD increases for those over the age of 65. It runs in families. It’s more likely to occur in African-Americans, Native Americans, and Asian-Americans. Other risk factors for CKD include:
diabetes (types 1 and 2)
obstructive kidney disease, including bladder obstruction caused by benign prostatic hyperplasia (BPH)
cirrhosis and liver failure
narrowing of the artery that supplies your kidney
systemic lupus erythematosus (SLE)
vesicoureteral reflux, which occurs when urine flows back into your kidney
What Are the Symptoms of Chronic Kidney Disease?
swelling around your eyes, which is called periorbital edema
swelling of your legs, which is called pedal edema
shortness of breath
vomiting, especially in the morning and after eating
a urine-like odor to your breath
abnormally dark or light skin
an ashen cast to your skin, which is called uremic frost
numbness in your hands and feet
restless leg syndrome
brittle hair and nails
a loss of muscle mass
muscle twitching and cramps
easy bruising and bleeding
blood in your stools
low level of interest in sex, impotence
You may also have the symptoms of any diseases that are contributing to your kidney problems.
How Is Chronic Kidney Disease Diagnosed?
A.Complete Blood Count (CBC)
A complete blood count (CBC) can show anemia. Your kidneys make erythropoietin, which is a hormone. This hormone stimulates your bone marrow to make red blood cells. When your kidney is severely damaged, your ability to make erythropoietin decreases. This causes a decline in red blood cells known as anemia.
CKD can affect your electrolyte levels. Potassium may be high and bicarbonate levels may be low if you have CKD. There may also be an increase of acid in the blood.
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C.Blood Urea Nitrogen (BUN)
Blood urea nitrogen (BUN) can become elevated when your kidney starts to fail. Normally, your kidney clears the products of protein breakdown from your blood. However, after kidney damage, these byproducts build up. Urea is one byproduct of protein breakdown. Urea is what gives urine its odor.
As kidney function declines, your creatinine increases. This protein is also related to muscle mass.
E.Parathyroid Hormone (PTH)
The kidney and the parathyroid glands interact through the regulation of calcium and phosphorus. A change in kidney function affects the release of PTH. This affects calcium levels throughout your body.
When your kidney progresses to end-stage renal disease (ESRD), it no longer excretes enough phosphorus and it impairs vitamin D synthesis. Your bones may release calcium. This causes your bones to become weak over time.
F.Renal Flow and Scan
This is an imaging study of kidney function.
This noninvasive test provides images to help determine whether there’s an obstruction.
H.Additional tests for CKD include:
a kidney biopsy
a bone density test
an abdominal CT scan
an abdominal MRI
How is kidney failure treated in diabetic patients?
Three types of treatment can be used once your kidneys have failed: kidney transplantation, hemodialysis and peritoneal dialysis.
A kidney transplant is an operation that places a healthy kidney from another person into your body. The kidney may come from someone who has died or from a living person who may be a close relative, spouse, or friend.
It can even come from someone who wishes to donate a kidney to anyone in need of a transplant. Your new kidney will be placed in your lower abdomen and connected to your bladder and blood vessels.
The transplant operation takes about 3 hours and you will be in the hospital for about 5 to 7 days. After the transplant, you will need to take special medications to prevent your body from rejecting the new kidney.
You will have to take these medications for as long as you have the transplant. Many patients prefer a transplant over dialysis because it gives them more freedom, allows for a less restricted diet and may improve the quality and length of life.
A kidney transplant is a treatment, not a cure. A person with a kidney transplant still has kidney disease, and may need some of the other medicines they took before the transplant.
Hemodialysis is a treatment that removes wastes and extra fluid from your blood. During hemodialysis, your blood is pumped through soft tubes to a dialysis machine where it goes through a special filter called a dialyzer (also called an artificial kidney).
As your blood is filtered, it is returned to your bloodstream. Only a small amount of blood is out of your body at any time. In order to be connected to the dialysis machine, you need to have an access, or entrance, to your bloodstream.
Treatments are usually done 3 times a week. Each treatment lasts about 3 to 5 hours.
Hemodialysis treatments can be done at home or in a dialysis center. Dialysis centers may be located within a hospital or in a separate facility. You and your healthcare provider will decide which place is best, based on your medical condition and your wishes.
Your home must have enough space for the equipment and enough water drainage and electric power to operate the dialysis machine and water purification unit.
Health insurance companies may help cover the cost of minor changes to your home for home hemodialysis. You will also need a dialysis care partner. Usually this is a family member or friend, but may also be someone you hire to assist you. You and your partner will be trained in how to do hemodialysis at home.
What is a hemodialysis access?
If you choose hemodialysis, you need to have a permanent access, or entrance, to your bloodstream. This is done with minor surgery, usually to your arm.
There are three different types of access:
A fistula is the recommended choice for an access. It is made by joining an artery to a nearby vein under your skin to make a bigger blood vessel.
This type of access is recommended because it has fewer problems and lasts longer. You should be looked at by a special doctor called a vascular surgeon at least 6 months before you will need to start dialysis. Your kidney doctor or the surgeon may order an ultrasound evaluation of your blood vessels to see the ideal ones for the fistula. This is called “vessel mapping.” A fistula should be placed early (several months before starting dialysis), so it has plenty of time to heal and be ready for use by the time you begin hemodialysis.
Graft: If your blood vessels are not suitable for a fistula, a graft may be used. This involves joining an artery and nearby vein with a small, soft tube made of synthetic material. The graft is entirely beneath your skin.
Catheter:The third type of access, called a catheter, is inserted into a large vein in your neck or chest. The ends of the tubes sit on your skin outside your body. This type of access is generally used when you need dialysis for a short period of time. Catheters are used as a permanent access when a fistula or a graft cannot be placed.
In peritoneal dialysis (PD), your blood is cleaned inside your body, not outside your body. The lining of your abdomen (the peritoneum) acts as a natural filter. A cleansing solution, called dialysate, flows into your abdomen (your belly) through a soft tube called a PD catheter.
The PD catheter is placed during minor surgery. Wastes and extra fluid pass from your blood into the cleansing solution. After several hours, you drain the used solution from your abdomen and refill with fresh cleansing solution to begin the process again.
Removing the used solution and adding fresh solution takes about a half hour and is called an “exchange.”
Peritoneal dialysis can be done at home, at work, at school, or even during travel. Peritoneal dialysis is a home-based treatment. Many people who choose peritoneal dialysis feel it allows them greater flexibility and independence.
Are there different types of peritoneal dialysis?
Yes. The major ones are:
Continuous Ambulatory Peritoneal Dialysis (CAPD). With CAPD, you do the exchanges yourself 4 to 6 times a day.
Automated Peritoneal Dialysis (APD). With APD, a machine called a cycler does the exchanges automatically once you have set up the equipment. APD can be done while you sleep.
However, if you do APD, you may also need to do 1 or 2 exchanges yourself during the day to make sure enough wastes and extra fluid are being cleared from your blood.
Will I need to take special medications?
You may need to take:
Phosphate binders. These medicines keep your bones strong by helping your body keep the right balance of two important minerals—calcium and phosphorus.
A special prescription form of vitamin D. This medicine also helps to keep your bones healthy.
Drugs called ESAs (erythropoiesis-stimulating agents). ESAs act like a natural hormone made by your kidneys called erythropoietin. This hormone tells your body to make red blood cells. Not having enough of it can cause anemia (low red blood cell count). Treatment with an ESA can help your body make red blood cells.
Extra iron. Your body also needs iron to make red blood cells, especially if you are receiving ESAs. Without enough iron, your ESA treatment will not work as well.
Vitamin and mineral supplements You may need to replace some vitamins and minerals that you are not getting in your diet, or that are lost during dialysis. Your healthcare provider or dietitian will tell you which ones you need to take.
Other medicines. You may need to take other medicines, depending on your own medical needs. These could be medicines to control high blood pressure, high cholesterol, or diabetes.
If I choose one type of treatment for kidney failure, will I be able to change to another type?
If you start on one type of treatment but feel you would like to try something else, you can speak to your healthcare professional about the possibility of changing.
For example, if you choose hemodialysis, it doesn’t mean you can’t ask to switch to peritoneal dialysis at a later date.
Even if you choose to have a kidney transplant, you may need a period of dialysis until you can be transplanted with a new kidney.
It is not uncommon for people who have had kidney failure for many years to have had more than one type of treatment in that time.
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