Kidney disease: Early attention needed

Kidney disease is particularly common in people with poorly controlled diabetes and high blood pressure. Other causes are glomerulonephritis, reflux kidney damage, drugs, polycystic kidney disease, and renal artery stenosis. Kidney (renal) failure can occur in one of three forms: 

• Acute failure—the kidneys suddenly stop functioning. 

• Chronic failure—the disorder develops gradually over many years. 

• End-stage failure—kidney function is so poor that technical support is needed to take over kidney function.

What is Chronic kidney disease (CKD)?

CKD is a condition where the kidneys are damaged and do not filter the waste products out of the blood efficiently. Kidneys also regulate blood pressure, fluid level, levels of salts including sodium and potassium, and help to prevent anemia. Kidney failure is nothing but a breakdown in kidney function. It usually develops gradually over a long period of time and people can be unaware they have CKD. There are five stages of CKD and special care is needed to manage stages 4 and 5 which are dangerous.

What are the symptoms of CKD? 

Most of the people with mild to moderate CKD (stages 1, 2, and possibly 3) do not have any symptoms, which tend to manifest at stages 4 and 5. These include: 

• Generally feeling unwell

• Tiredness and lethargy

• Anorexia (poor appetite)

• Nausea and vomiting

• Muscle cramps

• Dry and itchy skin

What are the risk factors for CKD? 

• Diabetes 

• High blood pressure 

• Obesity 

• Family history of kidney disease 

• Increasing age 

• Aboriginal or Torres Strait Islander descent 

• Smoking 

• Drug overuse and abuse

What are the complications of CKD? 

There is a gradual accumulation of waste products (e.g. urea) and chemicals (e.g. potassium) in the blood. The kidneys face difficulty in limiting the amount of water passing into the urine. Early signs are 

• The effects of anemia and 

• Increasing blood pressure (which can be both a cause and a result of CKD)

How is CKD diagnosed?

• The levels of creatinine and albumin in the blood and urine- give an indication of kidney function and the presence of disease. 
• A blood test known as the eGFR (estimated glomerular filtration rate) is commonly used. 
• Normal is >90 while <30 indicates severe failure and less than 15 end-stage failure.

What is the treatment of CKD? 

Early-stage CKD is treated with 

• Advice about diet 

1. Low in protein, fat, and salt—(sodium and potassium) 

1. Careful use of drugs 

1. Ample fluids (take care with fluids—keep fluid in/fluid out diary) 

1. Avoid smoking and 

1. Regular physical activity. 

• The medication used in early-stage disease is 

1.  ACE inhibitor drug, which also helps lower blood pressure. 

End-stage treatment options are: 

• Dialysis 

• Kidney transplantation

What is dialysis? 

Dialysis is a method of removing waste products from the blood after kidney failure. It can be provided in two main ways. 

Haemodialysis: 

• Done using an ‘artificial kidney’ machine to take blood from the body and pump it through a filtering machine, then returning the purified blood to the body at the same rate at which it is taken. 
• Each treatment, which can be done in a ‘dialysis unit’ or at home, takes about 4 to 6 hours and is generally given 2-3 times a week. 
• A new approach is a nocturnal dialysis which is given overnight during sleep. 

Peritoneal dialysis: 

• Here the fluid is exchanged by infusing a cleansing fluid into the peritoneal cavity of the abdomen and then draining away the used fluid. 
• It is usual to have an indwelling catheter in the cavity. 
• The doctor decides the number of exchanges needed, which can vary from one person to another. 
• It can be done at home provided sterile practice is followed. 
• Varieties of this type are continuous ambulatory peritoneal dialysis (CAPD) performed for about 30 minutes about 4 times a day and automated peritoneal dialysis (APD) where a machine (cycler) exchanges fluid during sleep.

What is kidney transplantation?

• A kidney transplant is done from a living or deceased donor allows more freedom in lifestyle but has its downside also. 
• The recipient requires a lifetime of care and medical management including medication to avoid rejection. 
• The old kidneys are left in the body but do no harm.

References:

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
3. https://www.healthdirect.gov.au/kidney-disease-treatment photo credit
4. https://chemical-materials.elsevier.com/new-materials-applications/materials-medicine-hemodialysis-prosthetic-vascular-grafts/ photo credit