· In most cases, kidneys can eliminate most waste materials that our body produces. However, if the blood flow to the kidneys is affected, they are not working properly because of damage or disease, or if urine outflow is obstructed, problems can occur.
· In most cases, progressive kidney damage is the result of a chronic disease (a long-term disease), such as:
· Diabetes - chronic kidney disease is linked to diabetes types 1 and 2. If the patient's diabetes is not well controlled, excess sugar (glucose) can accumulate in the blood. Kidney disease is not common during the first 10 years of diabetes; it more commonly occurs 15-25 years after diagnosis of diabetes.
· Hypertension (high blood pressure) - high blood pressure can damage the glomeruli - parts of the kidney involved in filtering waste products.
· Obstructed urine flow - if urine flow is blocked it can back up into the kidney from the bladder (vesicoureteral reflux). Blocked urine flow increases pressure on the kidneys and undermines their function. Possible causes include an enlarged prostate, kidney stones, or a tumor.
· Kidney diseases - including polycystic kidney disease, pyelonephritis, or glomerulonephritis.
· Kidney artery stenosis - the renal artery narrows or is blocked before it enters the kidney.
· Certain toxins - including fuels, solvents (such as carbon tetrachloride), and lead (and lead-based paint, pipes, and soldering materials). Even some types of jewelry have toxins, which can lead to chronic kidney failure.
· Fetal developmental problem - if the kidneys do not develop properly in the unborn baby while it is developing in the womb.
· Systemic lupus erythematosus - an autoimmune disease. The body's own immune system attacks the kidneys as though they were foreign tissue.
· Malaria and yellow fever - known to cause impaired kidney function.
· Some medications - overuse of, for example, NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin or ibuprofen.
· Illegal substance abuse - such as heroin or cocaine.
· Injury - a sharp blow or physical injury to the kidney(s).
The following conditions or situations are linked to a higher risk of developing kidney disease:
Chronic kidney failure, as opposed to acute kidney failure, is a slow and gradually progressive disease. Even if one kidney stops functioning, the other can carry out normal functions. It is not usually until the disease is fairly well advanced and the condition has become severe that signs and symptoms are noticeable; by which time most of the damage is irreversible.
It is important that people who are at high risk of developing kidney disease have their kidney functions regularly checked. Early detection can significantly help prevent serious kidney damage.
The most common signs and symptoms of chronic kidney disease include:
A doctor will check for signs and ask the patient about symptoms. The following tests may also be ordered:
Hemoglobin is the substance in red blood cells that carries vital oxygen around the body. If hemoglobin levels are low, the patient has anemia.
Some kidney disease patients with anemia will require blood transfusions. A patient with kidney disease will usually have to take iron supplements, either in the form of daily ferrous sulfate tablets, or occasionally in the form of injections.
People with kidney disease may not be able to eliminate phosphate from their body properly. Patients will be advised to reduce their nutritional phosphate intake - this usually means reducing consumption of dairy products, red meat, eggs, and fish.
High blood pressure
High blood pressure is a common problem for patients with chronic kidney disease. It is important to bring the blood pressure down to protect the kidneys, and subsequently slow down the progression of the disease.
Antihistamines, such as chlorphenamine, may help alleviate symptoms of itching.
If toxins build up in the body because the kidneys don't work properly, patients may feel sick (nausea). Medications such as cyclizine or metaclopramide help relieve sickness.
NSAIDs (nonsteroidal anti-inflammatory drugs)
NSAIDs, such as aspirin or ibuprofen should be avoided and only taken if a doctor recommends them.
This is when the kidneys are functioning at less than 10-15 percent of normal capacity. Measures used so far - diet, medications, and treatments controlling underlying causes - are no longer enough. The kidneys of patients with end-stage kidney disease cannot keep up with the waste and fluid elimination process on their own - the patient will need dialysis or a kidney transplant in order to survive.
Most doctors will try to delay the need for dialysis or a kidney transplant for as long as possible because they carry the risk of potentially serious complications.
Peritoneal dialysis is a treatment option for chronic kidney disease.
This is the removal of waste products and excessive fluids from blood when the kidneys cannot do the job properly any more. Dialysis has some serious risks, including infection.
There are two main types of kidney dialysis. Each type also has subtypes. The two main types are:
Hemodialysis: Blood is pumped out of the patient's body and goes through a dialyzer (an artificial kidney). The patient undergoes hemodialysis about three times per week. Each session lasts for at least 3 hours.
Experts now recognize that more frequent sessions result in a better quality of life for the patient, but modern home-use dialysis machines are making this more regular use of hemodialysis possible.
Peritoneal dialysis: The blood is filtered in the patient's own abdomen; in the peritoneal cavity which contains a vast network of tiny blood vessels. A catheter is implanted into the abdomen, into which a dialysis solution is infused and drained out for as long as is necessary to remove waste and excess fluid.
A kidney transplant is a better option than dialysis for patients who have no other conditions apart from kidney failure. Even so, candidates for kidney transplant will have to undergo dialysis until they receive a new kidney.
The kidney donor and recipient should have the same blood type, cell-surface proteins and antibodies, in order to minimize the risk of rejection of the new kidney. Siblings or very close relatives are usually the best types of donors. If a living donor is not possible, the search will begin for a cadaver donor (dead person).
Following a proper diet is vital for effective kidney failure treatment. Restricting the amount of protein in the diet may help slow down the progression of the disease.
Diet may also help alleviate symptoms of nausea.
Salt intake must be carefully regulated to control hypertension. Potassium and phosphorus consumption, over time, may also need to be restricted.
Patients with kidney disease typically have low levels of vitamin D. Vitamin D is essential for healthy bones. The vitamin D we obtain from the sun or food has to be activated by the kidneys before the body can use it. Patients may be given alfacalcidol, or calcitriol.
People with chronic kidney disease need to be careful with their fluid intake. Most patients will be asked to restrict their fluid intake. If the kidneys do not work properly, the patient is much more susceptible to fluid build-up.
Managing the chronic condition
Some conditions increase the risk of chronic kidney disease (such as diabetes). Controlling the condition can significantly reduce the chances of developing kidney failure. Individuals should follow their doctor's instructions, advice, and recommendations.
A healthy diet, including plenty of fruits and vegetables, whole grains, and lean meats or fish will help keep blood pressure down.
Regular physical exercise is ideal for maintaining healthy blood pressure levels; it also helps control chronic conditions such as diabetes and heart disease. Individuals should check with a doctor that an exercise program is suited to their age, weight, and health.
Avoiding certain substances
Including abusing alcohol and drugs. Avoid long-term exposure to heavy metals, such as lead. Avoid long-term exposure to fuels, solvents, and other toxic chemicals.