Chronic Kidney Disease (CKD)

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Mar 30, 2007
Chronic Kidney Disease (CKD)
Chronic Kidney Disease (CKD): Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

  • 26 million Americans have CKD and another 20 million more are at increased risk.
  • Early detection can help prevent the progression of kidney disease to kidney failure.
  • Heart disease is the major cause of death for all people with CKD.
  • Glomerular filtration rate (GFR) is the best estimate of kidney function.
  • Hypertension causes CKD and CKD causes hypertension.
  • Persistent proteinuria means CKD.
  • High risk groups include those with diabetes, hypertension and family history of kidney disease.
  • African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are at increased risk.
  • Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

[FONT=&quot]Chronic kidney disease usually causes no symptoms in its early stages. Only lab tests can detect any developing problems. Anyone at increased risk for chronic kidney disease should be routinely tested for development of this disease. [/FONT]

  • Urine, blood, and imaging tests are used to detect kidney disease, as well as to follow its progress.
  • All of these tests have limitations. They are often used together to develop a picture of the nature and extent of the kidney disease.
[FONT=&quot]Urine tests[/FONT][FONT=&quot][/FONT]
[FONT=&quot]urinalysis:[/FONT][FONT=&quot] Analysis of the urine affords enormous insight into the function of the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has reagents that check the urine for the presence of various normal and abnormal constituents including protein. Then, the urine is examined under a microscope to look for red and white blood cells, and the presence of casts and crystals (solids). [/FONT]
[FONT=&quot]Only minimal quantities of protein are present in urine normally. A positive result on a dipstick test for protein is abnormal. More sensitive than a dipstick test for protein is a laboratory estimation of the urine albumin (protein) and creatinine in the urine. The ratio of albumin (protein) and creatinine in the urine provides a good estimate of albumin (protein) excretion per day. [/FONT]
[FONT=&quot]Twenty-four–hour urine tests:[/FONT][FONT=&quot] This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products. The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR).[/FONT]
[FONT=&quot]Glomerular filtration rate (GFR):[/FONT][FONT=&quot] The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in women. It decreases in most people with age. The GFR may be calculated from the amount of waste products in the 24-hour urine or by using special markers administered intravenously. Patients are divided into five stages of chronic kidney disease based on their GFR (see Table 1 above). [/FONT]
[FONT=&quot]Blood tests[/FONT][FONT=&quot][/FONT]
[FONT=&quot]Creatinine and urea (BUN) in the blood: [/FONT][FONT=&quot]A[/FONT][FONT=&quot]re the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a breakdown product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens.[/FONT]
[FONT=&quot]Estimated GFR:[/FONT][FONT=&quot] The laboratory or your physician may calculate an estimated GFR using the information from your blood work. It is important to be aware of your estimated GFR and stage of chronic kidney disease. Your physician uses your stage of kidney disease to recommend additional testing and suggestions on management.[/FONT]
[FONT=&quot]Electrolyte levels and acid-base balance:[/FONT][FONT=&quot] Kidney dysfunction causes imbalances in electrolytes,especially potassium, phosphorus, and calcium. High potassium is a particular concern. The acid-base balance of the blood is usually disrupted as well.[/FONT]
[FONT=&quot]Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be abnormal.[/FONT]
[FONT=&quot]Blood cell counts:[/FONT][FONT=&quot] Because kidney disease disrupts blood cell production and shortens the survival of red cell, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells.[/FONT]
[FONT=&quot]Other tests[/FONT][FONT=&quot][/FONT]
[FONT=&quot]Ultrsound:[/FONT][FONT=&quot]Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a noninvasive type of test. In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose the presence of urinary obstruction, kidney stone and also to assess the blood flow into the kidneys.[/FONT]
[FONT=&quot]Biopsy:[/FONT][FONT=&quot] A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia only by introducing a needle through the skin into the kidney. This is usually done as an outpatient procedure, though some institutions may require an overnight hospital stay[/FONT]
[FONT=&quot]Treatment: [/FONT][FONT=&quot]Chronic kidney disease is a disease that must be managed in close consultation with your healthcare provider. Self-treatment is not appropriate. [/FONT]

  • There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications.
  • This is a complex process and must be individualized, generally with the help of your healthcare provider and a registered dietitian.
The following are general dietary guidelines:

  • Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
  • Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure.
  • Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake.
  • Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
  • Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.
If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your healthcare provider as recommended for follow-up and monitoring.