Chronic Kidney Disease

In addition to having uncontrolled high blood pressure or diabetes, other risk factor for chronic kidney disease (CKD) include:

• Smoking or use of tobacco products including vaping
• Obesity
• Over 65 yrs old
• Family history of kidney disease
• History of Acute Kidney Injury
• diagnosed with an autoimmune disease
• African-Americans and Asian-Americans are also at increased risk of developing chronic kidney disease

Once CKD is diagnosed by lab work, urine test, ultrasound, and or biopsy, it is important to determine the level of kidney function.  The National Kidney Foundation has identified 5 stages of chronic kidney disease.  Each stage represents a level of kidney function as defined by a creatinine clearance or estimated glomerular filtration rate or eGFR.

Estimated glomerular filtration rate is calculated using creatinine, age, race and gender to estimate the creatinine clearance. A normal eGFR is considered 60 or more. If your eGFR is less than 60 for three months or more, your kidneys may not be working well.

The 5 stages of CKD consist of:

• Stage 1 – mild kidney damage, with an estimated glomerular filtration rate (eGFR) of 90 or greater.  At this stage there are typically no symptoms and your kidneys are working well, but there may be protein or blood in your urine which is an early indicator your kidneys are damaged.   Usually monitoring and optimizing your blood pressure or diabetes is key at this point.
• Stage 2 – still considered mild damage, with an eGFR of 60-89 ml/min. While people in this stage can live normally, it’s still a good idea to make an appointment with a nephrologist and work on ways to slow the progression.
• Stage 3 – mild to moderate kidney damage with an eGFR of 45-59 ml/min and Stage 3b, moderate to severe damage with a GFR of 30-44 ml/min. A chronic kidney disease stage 3 treatment plan is important to keep the kidneys working as long as possible and slow the progression of CKD.
• Stage 4 – is considered moderate to severe damage with an eGFR of 15-29 ml/min, and advanced kidney damage. The probability of undergoing a kidney transplant or dialysis soon is high depending on your age and rate of decreasing eGFR.  You and your nephrologist will continue to work on slowing the progression of CKD, and plans may be discussed for future treatments such as dialysis or transplant.
• Stage 5 –  with an eGFR of less than 15ml.min.  This means that your kidneys are close to kidney failure or have failed, and no longer able to keep the body chemically balanced and healthy.  You and your nephrologist will put together a plan to keep you as healthy as possible while preparing you for dialysis or a kidney transplant.

• Diabetes
• High blood pressure
• Polycystic kidney disease (PKD)
• IgA nephropathy
• Focal segmental glomerulosclerosis (FSGS)
• Kidney stones

Other causes of kidney disease that are less common include:

Glomerulonephritis

Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories:

• Glomerulonephritis – describes the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood.
• Glomerulosclerosis – describes the scarring or hardening of the tiny blood vessels within the kidney.

Lupus nephritis

This is a type of  kidney disease caused by systemic lupus erythematosus, it is an autoimmune disease, meaning the body attacks it’s own cells and organs. Kidney disease caused by lupus may get worse over time and lead to kidney failure.

Minimal change disease

(MCD) involves damage to your kidneys’ tiny filters. The cause of MCD is unknown. Some suspected causes for MCD are allergic reactions, tumors, using NSAIDs, or infections.

Alport syndrome

Alport syndrome is a genetic disease, meaning that people with Alport syndrome are born with it.  It is caused by problems with three genes that control the way certain parts of your body are shaped, and can cause your kidneys, ears, and eyes to grow incorrectly.

Amyloidosis

This is cause by proteins called amyloids to build up and form clumps inside your organs and tissues, causing damage. These clumps can form in the kidneys and lead to CKD.

 Goodpasture syndrome

This a group of conditions that affects the kidneys and the lungs and causes your immune system to attack the tiny filters in your kidneys leading to CKD.

Wegener’s granulomatosis

This is formerly known as Wegener’s granulomatosis, is a disease that causes swelling and irritation of blood vessels in the kidneys, nose, sinuses, throat and lungs. Swelling and irritation of blood vessels in your kidneys would lead to CKD.

It is important to know the cause of your kidney disease so your treatment can be individualized.

 There are a number of ways you can protect your kidneys and slow the progression of CKD.

Good blood pressure control, diet modifications, smoking cessation and if you are diabetic, keeping your blood sugar in a safe range are all ways you can positively affect your kidney function. In addition, keep informed about your test results, ask questions, and be involved in your treatment plan. You are the most important member of your health care team.

Nutrition and life style changes can help slow the progression of CKD. Learn More

With advanced kidney disease, you may develop edema (swelling of the feet, ankles, or legs), loss of appetite, increased sleepiness, nausea, vomiting, confusion, and difficulty thinking. Patients often develop high blood pressure, blood chemistry (electrolyte) abnormalities such as a high potassium concentration, anemia (a decrease in red blood cells, which can cause fatigue and other symptoms), and bone disease.

The goal in treating chronic kidney disease is to slow the progression of CKD and prevent kidney failure.

Initially, your physician may recommend dietary changes and medications if your kidney issues are occurring due to conditions like diabetes or high blood pressure.

Medications to protect your kidneys and treat complications you may have such as anemia or other electrolyte imbalances may be prescribed.

If kidney function worsens, you may need to undergo dialysis to remove waste products and excess fluids or receive a kidney transplant.

To learn more about advanced kidney disease treatment options, register for our free modality options education class.