Chronic Kidney Disease (CKD)

What Is Chronic Kidney Disease (CKD)?

Chronic kidney disease (CKD) or chronic kidney failure is a long-term health condition where the kidneys are damaged and no longer functioning as they should. This refers to the ability of the kidneys to remove excess fluid and toxins from our body and produce hormones that regulate our blood pressure, control the production of red blood cells in our body (that is, preventing anaemia) and maintain bone health.

Chronic kidney disease is different from acute kidney injury or acute renal failure, where your kidney stops working suddenly due to causes such as:

– Severe dehydration

– Blood loss

– Traumatic injuries

– Severe liver or heart failure

Autoimmune diseases (when your immune system attacks your body)

– Sudden shock due to sepsis (severe infection)

– Pregnancy complications such as eclampsia and preeclampsia

– Enlarged prostate or kidney stones that block your urine flow

– Take certain drugs that damage the kidneys

…among others

Acute kidney failure can be severe enough to cause significant kidney dysfunction very fast, which can be reversible in many instances if identified promptly and treated adequately. However, some patients with acute kidney failure can develop permanent damage to the kidneys or even total kidney failure, with no recovery and needing dialysis. In contrast, chronic kidney disease tends to gradually progress, that is, to get worse over a longer period of time.

When the kidney damage worsens, high levels of waste products are built up in our blood, causing health complications such as heart disease, fluid retention, breathlessness and even heart failure, weaker bones, anaemia (when your body doesn’t produce enough red blood cells), muscle cramps, itch, nausea, vomiting, malnutrition and loss of weight, diminished energy, insomnia, etc.

These health problems usually happen gradually over a long period of time, so for most people, chronic kidney disease is usually discovered only at its late stages. However, regular health screening can help in early detection and treatment, to keep chronic kidney disease from getting worse or leading to complete kidney failure.

A kidney patient with end-stage kidney disease would require dialysis or a kidney transplant to stay alive.

Dialysis helps in removing excess fluid, salt, and toxins from our body. It is usually done in a dialysis centre, hospital or at home through a dialysis machine in the case of haemodialysis or through a catheter inserted in your tummy in the case of peritoneal dialysis. On the other hand, a kidney transplant involves the surgical insertion of a donated healthy kidney into your body, which then would clean your blood in the same way your kidneys did when they used to work fine.

Causes of chronic kidney disease

Two of the most common causes of chronic kidney failure are diabetes and high blood pressure; followed by different types of inflammation of the kidneys and other miscellaneous causes.

Diabetes happens when our blood sugar is too high, thus causing damage to the major organs in our body, such as our heart, brain, eyes, blood vessels, and of course, our kidneys.

High blood pressure (hypertension) occurs when the pressure of our blood against the walls of our blood vessels increases. When poorly controlled, high blood pressure can lead to strokes, heart attacks, vision problems, and chronic kidney disease.

Inflammation of the kidneys, the so-called glomerulonephritis, typically presents with protein and blood leakage in the urine. There are multiple causes of glomerulonephritis. Many of them are silent; being discovered incidentally or through screening tests. They can cause acute or chronic kidney failure.

Other risk factors for chronic kidney failure include obesity, smoking, high cholesterol, and a family history of kidney disease.

Signs & symptoms of chronic kidney disease

Kidney disease symptoms usually show up only when it is at a serious stage. That is why it is crucial to be aware of conditions that may predispose you to kidney disease. The best way to know if you have kidney disease is to get blood tests for kidney function and have your urine examined as well.

How Can You Identify Kidney Disease | Dr Francisco Salcido-Ochoa

The most common signs and symptoms of chronic kidney failure may include:

  • darker (or more concentrated) urine
  • blood in urine
  • protein in urine
  • decreased urine output (but occasionally the opposite)
  • more frequent urination, especially at night
  • persistent itching
  • chest pain (fluid building up around the lining of the heart)
  • fatigue
  • loss of appetite and malnutrition
  • high blood pressure
  • decreased mental alertness
  • anaemia
  • sleeplessness
  • muscle cramps
  • nausea
  • shortness of breath (fluid building up in the lungs)
  • swelling of feet and ankles
  • pain on the side or mid to lower back (eg this can indicate urinary stones)

That being said, symptoms of chronic kidney disease are often non-specific (which means they can also be caused by other diseases). So, specialist advice is sensible if suspected, and regular health screening will help you detect kidney disease earlier to prevent the progression of kidney disease to total kidney failure.

Diagnosing chronic kidney disease

People who are at greater risk of kidney diseases or end-stage renal failure are those with:

  • Diabetes
  • History of strokes
  • High blood pressure
  • Family history of kidney disease
  • Congestive or coronary heart disease
  • Prolonged use of non-prescription drugs, like painkillers of the non-steroidal anti-inflammatory drugs
  • History of certain autoimmune disorders
  • Urinary or urological problems

If you have these risk factors that put you at higher risks of chronic kidney disease, be sure to have regular checkups and report any unusual symptoms to your doctor. Managing these underlying diseases and health issues well can slow down the progression of kidney damage.

Preliminary physical examination

Kidney failure may be causing fluids to fill up in your heart or/and lungs. Your doctor will usually examine these major organs by listening to them with a stethoscope to check your condition. There can be swelling in your legs and around your eyes. Occasionally, the kidneys can be enlarged on examination.

Blood & urine tests

If your kidney specialist suspects that you might have chronic kidney disease, the next step is usually going for blood and urine tests before diagnostic or therapeutic decisions are made.

Blood tests for kidney function measure the levels of electrolytes and waste products in the blood (such as blood urea and creatinine), which are excreted when our kidneys are working optimally; but they build up in the blood when the kidneys do not work well.

Urine tests are carried out to check for abnormalities in the protein level in your urine (a finding that usually emerges before other symptoms of chronic kidney disease). Usually, protein is only present in trace amounts in your urine but can be significant in kidney disease. Your urine sediment and cells will be examined in a laboratory as well, especially looking for blood in the urine or signs of infection and inflammation.

Kidney imaging tests

Your nephrologist will make use of some imaging tests such as ultrasound (most commonly), a CT scan or an MRI scan to check the structural details of your kidneys and a more complete assessment of your condition.

Kidney biopsy

In the case where your renal specialist still needs confirmation on the cause of the symptoms you are facing; when the cause is not very obvious; or when there is suspicion of inflammation of the kidneys, you may need to go through a kidney biopsy. The kidney biopsy provides detailed and valuable information to your nephrologist regarding the diagnosis, best treatment options and prognosis of your kidney disease.

A kidney biopsy is typically performed using a needle piercing your skin all the way to the kidneys and taking a couple of tiny samples of your kidneys for examination under the microscope. This is done under ultrasound guidance and using local anaesthesia. 

Rarely, the biopsy needs to be performed through an incision (surgical cut) with general anaesthesia to collect a sample of your kidney tissue.

But it is important to note that kidney biopsy is not suitable for certain people, such as those who are taking blood thinners like aspirin (but in some cases can be suspended temporarily), have a bleeding tendency, when the kidneys are too small or in very debilitated patients and occasionally in very elderly patients.

The Purpose of a Kidney Biopsy | Dr Francisco Salcido-Ochoa

What happens if my test results show I may have chronic kidney disease?

You need to be assessed by a kidney specialist to further advise you on the need for extra confirmatory blood or urine tests, imaging tests or a kidney biopsy. So, he or she can prescribe the most suitable treatment for your condition. But remember, adopting a healthier lifestyle and a holistic renal diet is crucial in the management of chronic kidney disease. 

Stages of chronic kidney disease 

Stages of Chronic Kidney Disease | Dr Francisco Salcido-Ochoa

Early stages of CKD

Chronic kidney disease usually does not show obvious signs and symptoms during the early stages because our body can normally cope with mild reductions in our kidney function. That is why we can donate one kidney to someone and still live a normal life as our remaining kidney works harder to compensate for the absent partner kidney.

However, regular health screening with blood and urine tests can help discover potential kidney problems earlier before other chronic renal disease symptoms appear. This way, more regular tests can be conducted to monitor the patient’s condition, and a healthy diet or medicines can be prescribed to prevent the kidney problems from deteriorating or at least to slow down the progression of kidney disease.

Late stages of CKD

People with more advanced kidney disease may experience undesirable symptoms such as blood and/or protein in the urine, increased frequency or urination, muscle cramps, poor appetite, itch, fatigue, weight loss, nausea, vomiting, fluid retention, inability to sleep or concentrate, etc.

How do you classify the stages of CKD?

Changes in the GFR (Glomerular Filtration Rate, a sort of an estimate of the percentage of kidney function) can be used to assess how advanced the kidney disease is.

The stages of chronic kidney disease (CKD) are classified as follows:

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)

Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m2)

Stage 3b: Moderately advanced reduction in GFR (30-44 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Total renal failure, or end-stage kidney disease (GFR < 15 mL/min/1.73 m2 or dialysis)

It is crucial for kidney disease to be diagnosed and treated as early as possible to avoid irreversible damage to the kidneys, especially in those patients with progressive diseases like diabetes and glomerulonephritis.

Diabetic nephropathy is the chronic loss of kidney function occurring in those with diabetes mellitus, and diabetes patients should go for a microalbuminuria test at least once a year, and to have their kidney function checked, to detect diabetic nephropathy early.

Treatment for chronic kidney disease

There is no actual cure for chronic kidney disease. Unfortunately, there is no medication that can make the kidneys heal and restore the previous kidney function. The focus of the treatment of chronic kidney disease is the improvement of symptoms; retardation of the progression of kidney disease, to delay the encounter of total kidney failure and the imminent need for dialysis or a kidney transplant; the avoidance of developing new health issues that can further damage the kidneys, and minimisation of complications

Upon total kidney failure, the only true solution is a successful kidney transplant, for those patients who are medically suitable for it. Otherwise, once the kidneys are no longer able to remove excess fluid and toxins from the body properly, kidney patients will need to go for dialysis treatment to partially replace the cleansing function of the kidneys.

There are two main types of dialysis treatment, blood dialysis (or haemodialysis), and tummy/water dialysis (or peritoneal dialysis).

For haemodialysis, a kidney machine removes the extra fluids and waste products from your blood, while peritoneal dialysis uses the abdomen lining (the peritoneum) for the blood filtering process.

If you are suitable for a kidney transplant, and there is a suitable donor, you can receive a healthy kidney from the (living or deceased) donor. As alluded to before, kidney transplantation trumps dialysis in quantity and quality of life provided to the patient and offers the best chances for rehabilitation closer to a normal life than what dialysis can offer. 

In most cases, the damaged kidneys are usually left in place and the transplanted kidney is placed in the lower belly on the front side of the body. But in some rare cases, your diseased kidney may need to be removed.

After the kidney transplant procedure, you need to take immunosuppressants, or anti-rejection medicines to ensure that your immune system does not reject your new kidney. But these medications will weaken your immune system, so you need to take certain precautions. 

How can I prevent chronic kidney disease?

If you have diabetes or high blood pressure (which are the most common causes of chronic kidney disease), the first step is to work with your doctor to keep your blood sugar and blood pressure under control. Or to act preemptively, living a healthier life, if you have early signs or strong family risk factors for them.

Even if you seem healthy now, living a healthy lifestyle and adopting a healthy diet can help you prevent chronic kidney disease, such as exercising regularly, adopting a low fat and low salt diet, avoiding foods with high levels of sodium, not smoking or drinking excessive alcohol, having a positive outlook to life, minimising stress and sleeping well, and going for regular health check-ups; as opportune detection of a silent kidney problem could save your kidneys – as mentioned above, in many instances, kidney disease is progressing quietly inside your body without you noticing it.

Battling chronic kidney disease (CKD) can be a daunting and exhausting journey. And the treatment for kidney diseases varies for everyone based on their medical history, current medical conditions, lifestyle and diet. That is why a personalised approach is crucial. If you need any advice on chronic kidney disease (CKD) or any other kidney problems, feel free to reach out to Dr Francisco at Francisco Kidney & Medical Centre.

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About Dr Francisco Salcido-Ochoa

Dr Francisco Salcido-Ochoa is a kidney specialist, transplant immunologist, and international health coach, who offers empathetic & personalised specialist medical care for patients with acute and chronic kidney disease, haemodialysis, peritoneal dialysis, kidney transplant, glomerulonephritis (protein or blood leakage in urine), as well as for kidney-related conditions like type 2 diabetes, high blood pressure, metabolic syndrome, and holistic weight loss.

His private medical practice Francisco Kidney & Medical Centre is located at Mount Elizabeth Novena Hospital, #07-32, 38 Irrawaddy Road, Singapore 329563. Dr Francisco also offers telemedicine consultations worldwide, both in English & Spanish.

More information can be found at https://www.franciscokidneycentre.com

Dr Francisco is also the author of:

 “A Comprehensive Guide to Kidney Health, Kidney Disease & Kidney Care by Dr Francisco: For Patients & Their Caregivers”,

OLYMPIA Lifestyle Formula – A Total Body, Mind & Health Transformation, and

 “The Truths & Myths of Weight Loss Methods (An Eye-Opener): Weight Loss Explained & Demystified by a Specialist Medical Doctor”.

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What is chronic kidney disease (CKD)?
Signs and symptoms of chronic kidney disease
Stages of chronic kidney disease
Diagnosing chronic kidney disease
Treatments for chronic kidney disease
How can I prevent chronic kidney disease?
Renal diet for chronic kidney disease patients
Kidney dialysis for chronic kidney disease patients