Chronic kidney disease: Symptoms, causes, and treatment

Chronic kidney disease is a slow and progressive loss of kidney function over a period of several years. Eventually, a person will develop permanent kidney failure.

Chronic kidney disease, also known as chronic renal failure, chronic renal disease, or chronic kidney failure, is much more widespread than people realize; it often goes undetected and undiagnosed until the disease is well advanced.

It is not unusual for people to realize they have chronic kidney failure only when their kidney function is down to 25 percent of normal.

As kidney failure advances and the organ’s function is severely impaired, dangerous levels of waste and fluid can rapidly build up in the body. Treatment is aimed at stopping or slowing down the progression of the disease – this is usually done by controlling its underlying cause.

Fast facts on chronic kidney disease

Here are some key points about chronic kidney disease. More detail and supporting information is in the main article.

Common symptoms include blood in urine, high blood pressure, and fatigue.

Causes include diabetes and specific kidney diseases, which includes polycystic kidney disease.

There is no cure for chronic kidney disease, which means treatment is focussed on reducing symptoms.

Diagnosis commonly occurs after blood tests, kidney scans, or biopsy.

Symptoms

A cross-section graphic of the kidneys.
Chronic kidney disease rarely shows symptoms until the later stages, so screening is recommended for those who are at risk..

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:

anemia

blood in urine

dark urine

decreased mental alertness

decreased urine output

edema – swollen feet, hands, and ankles (face if edema is severe)

fatigue (tiredness)

hypertension (high blood pressure)

insomnia

itchy skin, can become persistent

loss of appetite

male inability to get or maintain an erection (erectile dysfunction)

more frequent urination, especially at night

muscle cramps

muscle twitches

nausea

pain on the side or mid to lower back

panting (shortness of breath)

protein in urine

sudden change in bodyweight

unexplained headaches

Stages

Changes in the GFR rate can assess how advanced the kidney disease is. In the UK, and many other countries, kidney disease stages are classified as follows:

Stage 1 – GFR rate is normal. However, evidence of kidney disease has been detected.

Stage 2 – GFR rate is lower than 90 milliliters, and evidence of kidney disease has been detected.

Stage 3 – GFR rate is lower than 60 milliliters, regardless of whether evidence of kidney disease has been detected.

Stage 4 – GRF rate is lower than 30 milliliters, regardless of whether evidence of kidney disease has been detected.

Stage 5 – GFR rate is lower than 15 milliliters. Renal failure has occurred.

The majority of patients with chronic kidney disease rarely progress beyond Stage 2. It is important for kidney disease to be diagnosed and treated early for serious damage to be prevented.

Patients with diabetes should have an annual test, which measures microalbuminuria (small amounts of protein) in urine. This test can detect early diabetic nephropathy (early kidney damage linked to diabetes).

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Treatment

There is no current cure for chronic kidney disease. However, some therapies can help control the signs and symptoms, reduce the risk of complications, and slow the progression of the disease.

Patients with chronic kidney disease typically need to take a large number of medications. Treatments include:

Anemia treatment

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.

Phosphate balance

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.

Skin itching

Antihistamines, such as chlorphenamine, may help alleviate symptoms of itching.

Anti-sickness medications

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.

End-stage treatment

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.

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