Chronic Kidney Disease – Symptoms, Causes & Treatment

The kidneys normally filter blood and remove waste and excess salt and water from the body. In patients with chronic kidney disease (CKD), the kidneys gradually lose their ability to function properly. When these toxic wastes and excess water accumulate in the blood, they can affect other body systems also, ultimately leading to ill health. As days go by, they can stop working completely. So it is very vital to prevent them from getting worse.  

What are the Risk Factors for Chronic Kidney Disease?  

The most common causes of CKD are diabetes and high blood pressure. Other factors that can increase the risk of developing CKD include a family history of kidney disease, obesity, smoking, having protein in the urine, and having autoimmune diseases such as lupus. 

What are the Symptoms of Chronic Kidney Disease? 

In the early stages of the disease, CKD causes no symptoms. Patients may have leg swelling, high blood pressure, and tiredness as the disease worsens. In the advanced stage, they experience nausea, vomiting, loss of appetite, altered sleep, shortness of breath, confusion, altered sensorium, and ultimately slip into a coma state. 

How Do Doctors Diagnose and Evaluate Chronic Kidney Disease?  

Doctors may order various tests to diagnose CKD and assess any possible reversible cause. 

Kidney function tests — By measuring the creatinine level in the blood, doctors estimate the glomerular filtration rate (GFR). This GFR helps measure the approximate filtering abilities of both kidneys and monitor kidney function impairment during the follow-up period. When GFR is reduced, this implies either worsening of CKD or the developing a new reversible kidney problem. But on the other hand, when there is an increase in GFR, it indicates an improvement in kidney function. A stable GFR in people with CKD shows the disease is stable. 

Urine tests — Urine is tested for the presence of albumin or protein in the urine (called albuminuria or proteinuria).  The earliest sign of CKD in some people with diabetes and high blood pressure is the leak of small amounts of albumin in the urine.  

Imaging studies — Imaging tests like ultrasound and computed tomography [CT] may be ordered to assess kidney size and echo texture and determine if there is any obstruction of the urinary tract or kidney stones. 

Kidney biopsy — In this test, doctors take a small piece of kidney tissue and examine it under a microscope. Biopsy test helps diagnose the underlying cause of kidney disease, enabling health professionals to choose the appropriate treatment regimen.  

Is Anything that Can be Done to Prevent the Kidneys from Getting Worse? 

Yes, we can protect our kidneys by the following:  

  • If you have diabetes, blood sugar has to be adequately controlled
  • Maintain your blood pressure at an optimum level       
  • Follow low salt, and other dietary restricted recommended by doctors and dieticians  
  • Quit smoking if you smoke
  • Maintain ideal weight if overweight  
  • Avoid taking medicines that can affect the kidneys, like painkillers (NSAIDs.) Before starting any new medications, check with the doctor whether it is safe for the kidneys.  

What are the Treatments for Chronic Kidney Disease? 

During the early stages of CKD, doctors prescribe medicines like ACE inhibitors” or “angiotensin receptor blockers to preserve the existing function of kidneys and protect them from further damage.  

What Happens if the Kidneys Stop Working Completely? 

When the kidneys stop working completely, the patient is in the last stage of CKD. There are three options available. 

Kidney transplantation. Here one kidney from another person is transplanted to the patient (We need only one functioning kidney to have a healthy life). In this way, this new kidney can do the job of his own failed kidneys. But he will need to take medicines for the rest of his life to prevent his body from rejecting his new kidney, which was originally obtained from another person. 

Hemodialysis. In this option, the patient is attached to the machine, which filters and cleans his blood. This has to be done for a few hours at least three times a week for the rest of his life.  

Peritoneal dialysis. A tube is placed in the belly of the patient through which he pipes in and out special fluid a few times every day. This technique is easy to perform but requires special training during initial periods.  

How to Choose Between the Different Treatment Options? 

The patient and his doctor need to work together to find the right treatment for him. Most of the time, the best option is kidney transplant surgery because a kidney can be replaced only by another functioning kidney. But often, there are no kidneys available for transplant. The patient needs to analyze the merits and demerits of various options openly with their doctor (nephrologist) and choose the best per his needs and possibilities. 

People may not have symptoms until their kidney function is reduced below 20%, akin to the mobile phone showing signs only when the charge level reaches below 20%. An early warning sign of kidney disease is a protein (albumin) leak in urine. 

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Abeesh Padmanabha Pillai 

Lifecare Specialties