What do the kidneys do?
The kidneys make urine which contains waste products filtered out from the blood. They make some hormones which are involved in blood pressure control and in preventing anaemia. They also help keep various salts and chemicals in the blood at the right level.
What is chronic kidney disease and what causes it?
Chronic kidney disease (CKD) means that your kidneys are damaged. As a result your kidneys may not work as well as they should. Three common conditions in the UK which cause most cases of CKD in adults are: high blood pressure, ageing kidneys, and diabetes (diabetic kidney disease is a common complication of diabetes).
Various other conditions of the kidney can cause CKD. For example: inflammation of the kidneys (glomerulonephritis); polycystic kidney disease; blockages to the flow of urine; drug-induced kidney damage - but this list is not complete and there are many other uncommon causes.
Various other conditions of the kidney can cause CKD. For example: inflammation of the kidneys (glomerulonephritis); polycystic kidney disease; blockages to the flow of urine; drug-induced kidney damage - but this list is not complete and there are many other uncommon causes.
How is CKD diagnosed?
A blood test called the eGFR (estimated glomerular filtration rate) is used. If your kidneys are not working properly the eGFR goes down. CKD is divided into five stages depending on the eGFR level - stage 1 (very mild) to stage 5 (end-stage kidney failure).
How common is CKD?
About 1 in 10 people have some degree of CKD. It can develop at any age. It becomes more common with increasing age. About half of people aged 75 or more have some degree of CKD. Most cases of CKD are mild or moderate (stage 1-3).
What are the symptoms of CKD?
Most people with mild to moderate CKD (stage 1 to 3) do not have any symptoms. Symptoms tend to develop when CKD becomes severe (stage 4) or worse. The symptoms can include: feeling tired; a poor appetite; weight loss; dry and itchy skin; muscle cramps; swollen feet and ankles; puffiness around the eyes; being pale due to anaemia; feeling sick. As the kidney function declines to stage 4 or 5, you are likely to feel very unwell. End-stage renal failure (stage 5) is eventually fatal unless treated.
Do I need any further tests?
Routine urine 'dipstick' tests and blood tests are usual from time to time to check on your kidney function. The need for other tests then depends on various factors. For example, a scan of the kidneys or a kidney biopsy may be advised if certain kidney conditions are suspected. These are not needed in most cases. This is because most people with CKD have a known cause such as a complication of diabetes, high blood pressure, or ageing.
What is the treatment for CKD?
Treatment for most cases of CKD is done by GPs. Your GP may refer you to a specialist if you develop stage 4 or 5 CKD, or if you have problems or symptoms that require specialist investigation. Treatment usually includes the following:
Treating any underlying condition
There are various conditions that can cause CKD. For some of these there may be specific treatments for that particular condition. For example, good glucose control for people with diabetes, blood pressure control for people with high blood pressure, surgery for people with a blockage to urine flow, etc.
Preventing or slowing down the progression of CKD
This usually includes:
- Blood pressure control. The most important treatment to prevent or delay the progression of CKD, whatever the underlying cause, is to keep your blood pressure well controlled. Most people with CKD will require medication to control their blood pressure. Your doctor will give you a 'target' blood pressure level to aim for.
- Review of your medication. Certain medicines can affect the kidneys as a side-effect which can make CKD worse. For example, if you have CKD you should not take anti-inflammatory medicines unless advised to by a doctor. You may also need to adjust the dose of certain medicines that you may take if your CKD gets worse.
- Reducing the risk of developing cardiovascular disease
People with CKD have an increased risk of developing cardiovascular diseases such as heart disease and stroke. More people with CKD die of cardiovascular related problems than of end-stage renal failure. This is why reducing any other cardiovascular 'risk factors' is so important. Briefly, this typically includes:
- Good control of blood pressure (and blood glucose level if you have diabetes).
- Medication to lower the cholesterol level - needed in many cases.
- A daily low dose of aspirin - depending on your age and other factors. This reduces the risk of blood clots forming which helps to prevent heart attacks and strokes.
- Where relevant, to tackle lifestyle risk factors. This means to:
- Stop smoking if you smoke.
- Eat a healthy diet which includes a low salt intake.
- Keep your weight and waist in check.
- Take regular physical activity.
- Cut back if you drink a lot of alcohol.
- Relieving symptoms and problems caused by CKD
If CKD becomes severe you may need treatment to combat various problems and symptoms caused by the poor kidney function. If end-stage kidney failure develops, you are likely to need kidney dialysis or a kidney transplant to survive.
People with stage 3 CKD or worse should be immunised against influenza each year and have a one-off immunisation against pneumococcus. People with stage 4 CKD should be immunised against hepatitis B.
People with stage 3 CKD or worse should be immunised against influenza each year and have a one-off immunisation against pneumococcus. People with stage 4 CKD should be immunised against hepatitis B.
What is the outlook (prognosis)?
Stage 1-3 CKD (mild to moderate) is common with most cases occurring in older people. It tends to get worse over months or years. However, in many cases CKD progresses very slowly. Only about 1 in 10 people with CKD progress to end-stage kidney failure (stage 5 CKD) that requires kidney dialysis or kidney transplant.
For many people with CKD there is a much higher risk of developing serious cardiovascular disease than of developing end-stage kidney failure. Attention to blood pressure control and to factors that reduce your risk of developing cardiovascular diseases can make a big difference to your outlook.
For many people with CKD there is a much higher risk of developing serious cardiovascular disease than of developing end-stage kidney failure. Attention to blood pressure control and to factors that reduce your risk of developing cardiovascular diseases can make a big difference to your outlook.
© EMIS and PiP 2007
Further help and information
National Kidney Federation
References
- Chronic Kidney Disease in Adults: UK Guidelines for Identification, Management and Referral. Royal College of Physicians and Renal Association 2006
- Clinical Practice Guidelines for the Care of Patients with Chronic Kidney Disease. Renal Association 2007
- Mauro Verrelli Chronic Renal Failure eMedicine June 2006
- Renal Association The short CKD eGuide, derived from the UK CKD Guidelines (2005)
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