Chronic Kidney Disease: Causes, Symptoms, and Treatment

What is Chronic Kidney Disease?

Chronic kidney disease (CKD) means that your kidneys are not working as well as they once did. The kidneys may be diseased or damaged in some way, or the decline in function may be due to ageing. The word “chronic” means ongoing, persistent and long-term, but this does not necessarily mean the condition is severe. In most people with chronic kidney disease, there is only a mild or moderate drop in kidney function.

It is important to understand that chronic kidney disease used to be called chronic renal failure, but chronic kidney disease is now considered a better term. The word “failure” implies that the kidneys have stopped working entirely, but in most cases of chronic kidney disease this is not the case—they are simply not working as well as would be expected. Damaged kidneys are unable to keep you healthy because they cannot filter your blood well enough, and they cannot perform their other jobs as effectively as they should.

Many people do not realize they have chronic kidney disease because the condition often develops without noticeable symptoms. In fact, chronic kidney disease is usually diagnosed by a blood test before any symptoms develop. The kidneys play many important roles in maintaining bodily balance, including removing waste and toxins from the bloodstream, removing excess water (which is carried out of the body in urine), helping to make hormones that produce red blood cells, and turning vitamin D into its active form so it can be used effectively in the body.

What Causes Chronic Kidney Disease?

A wide range of conditions can cause chronic kidney disease. The most common causes include:

• Diabetes: High blood sugar levels can damage the blood vessels in the kidneys over time.
• High blood pressure: Excessive pressure on blood vessel walls can damage kidney tissue and reduce filtering capacity.
• Heart disease: Cardiovascular conditions can impair kidney function through reduced blood flow.
• Glomerulonephritis: Inflammation of the blood vessels in the kidneys that filter waste.
• Autoimmune diseases: Conditions like lupus can cause the immune system to attack kidney tissue.
• Genetic disorders: Such as polycystic kidney disease, where cysts develop in the kidneys.
• Recurrent kidney infections: Repeated infections can cause permanent kidney damage.
• Blockages: Stones, tumors, or enlargement of the prostate can obstruct urine flow.
• Previous acute kidney injury: After an acute kidney injury, blood tests should be done regularly for at least three years to monitor kidney function.
• Having only one functioning kidney: Although most people with a single kidney do not experience problems, kidney function should be monitored once a year.

Key risk factors for developing chronic kidney disease include diabetes, high blood pressure, heart disease, and a family history of kidney disease.

Symptoms of Chronic Kidney Disease

One of the most important things to understand about chronic kidney disease is that there are usually no symptoms with mild-to-moderate chronic kidney disease—that is, stages 1 to 3. This means many people do not realize they have the condition until it is detected through routine blood tests. Symptoms develop slowly and do not appear until most of your kidney tissue has been damaged.

When symptoms do develop, they tend to appear when chronic kidney disease becomes severe (stage 4) or worse. The symptoms at first tend to be vague and nonspecific, such as:

• Feeling tired or fatigued
• Having less energy than usual
• Not feeling well generally

With more severe chronic kidney disease, additional symptoms may develop, including:

• Shortness of breath
• Swollen ankles
• Nausea and vomiting
• Loss of appetite
• Difficulty concentrating

If kidney function declines to stage 4 or 5, various other problems may develop. For example, anaemia (low red blood cell count) or an imbalance of calcium, phosphate and other chemicals in the bloodstream can occur. These complications can cause various symptoms, such as tiredness due to anaemia, and bone thinning (osteoporosis) or fractures due to calcium and phosphate imbalance.

It is crucial to remember that not having symptoms does not mean that CKD has not gotten worse. This is why regular tests by your doctor are essential for monitoring kidney function over time.

Stages of Chronic Kidney Disease

Chronic kidney disease is classified into five stages based on kidney function, measured by the estimated glomerular filtration rate (eGFR). Understanding these stages helps determine the appropriate level of care and monitoring:

Important note about Stage 3: Stage 3 is subdivided into 3a and 3b because patients in stage 3b have an increased rate of cardiovascular diseases (heart attacks, strokes, and narrowing of other arteries). Despite the mild-to-moderate impairment, only a minority of patients progress to end stage kidney failure. Most patients with stage 3a CKD can be treated in general practice, but stage 3b patients need to be reviewed by a GP and then referred to a kidney specialist if necessary.

How is Chronic Kidney Disease Diagnosed and Monitored?

Chronic kidney disease is diagnosed and monitored by either your GP or nephrologist (kidney specialist). Diagnosis is informed by your medical history and various tests, including:

• Blood tests: Measure creatinine levels and eGFR to assess kidney function
• Urine tests: Check for protein (albumin) in the urine
• Blood pressure measurement: Elevated blood pressure can indicate kidney problems
• Imaging studies: Ultrasound or CT scans may be used to visualize kidney structure

In the early stages of CKD, people may be unaware that they have it, and a diagnosis is often made incidentally during routine testing. Regular monitoring typically includes checks of blood creatinine, potassium, and haemoglobin (Hb), urinary albumin (protein), blood pressure, and assessment of cardiovascular risk.

If your urine tests show a lot of protein in the urine, or your kidney function is declining fast over time, this should be discussed with a kidney specialist.

Who Cares for Patients with Chronic Kidney Disease?

Management of most cases of chronic kidney disease takes place in general practice, because most cases are mild-to-moderate (stages 1-3) and do not need more specialist treatment. However, the level of care depends on the stage of disease:

• Stages 1-3: Most patients will be checked yearly and sometimes twice a year by their GP. On each visit, you should expect blood pressure measurement, urine and blood tests, and a review of your medicines.
• Stages 4-5: Referral to a kidney specialist (nephrologist) will usually be needed.
• Younger adults: Those without obvious risk factors may need earlier specialist referral.
• Special circumstances: If there are symptoms that might need further investigation, specialist referral may be recommended earlier.

Treatment of Chronic Kidney Disease

Research studies have shown that in many people, treatment at early stages of chronic kidney disease can prevent or slow down progression of the disease. The aims of treatment include:

• If possible, to treat any underlying kidney condition
• To prevent or slow down the progression of CKD and reduce the risk of developing kidney failure
• To reduce the risk of developing cardiovascular disease
• To relieve symptoms and problems caused by CKD

Managing Stage 3 Chronic Kidney Disease: People with stage 3 CKD do not usually need to see a kidney specialist but will need annual blood and urine tests at their GP practice. Treatment will often be advised to reduce the risk of progressing to more severe chronic kidney disease. This includes:

• Blood pressure management: Managing blood pressure aggressively to reduce it to below recommended levels is crucial.
• Diabetes management: Aggressively managing any other conditions such as diabetes.
• Cardiovascular risk reduction: Other treatments might be suggested to reduce the risk of any other problems, particularly cardiovascular diseases.
• Diet changes: Modifications to diet may be advised.
• Medications: Starting new medicines will often be recommended.

Advanced CKD (Stages 4-5): If kidney function continues getting worse and patients are progressing to CKD stage 5, a treatment plan should be made with the kidney specialist. This may involve preparing for renal replacement therapy, which could include dialysis or kidney transplantation.

What is the Outlook for Chronic Kidney Disease?

Stage 1-3 chronic kidney disease (mild-to-moderate) is common, with most cases occurring in older people. It tends to become gradually worse over months or years. However, the rate of progression varies from case to case and often depends on the severity of any underlying condition.

For patients over 75 years old, the kidneys of many CKD patients will get worse a little faster than normal ageing kidneys. However, they are unlikely to suffer severe kidney failure. For other patients, it is difficult to say what the future holds. Your nephrologist may be able to give an estimate if they can access your blood and urine tests from past years to determine the rate of change.

End-stage kidney failure (stage 5) is eventually fatal unless treated. However, with modern medical care and treatment options such as dialysis or kidney transplantation, people with stage 5 CKD can live for many years.

Complications of Chronic Kidney Disease

As kidney function declines, several complications can develop:

• Anaemia: The kidneys produce a hormone called erythropoietin that stimulates red blood cell production. Damaged kidneys produce less of this hormone, leading to anaemia.
• Bone disease: Weakening kidneys cannot properly regulate calcium and phosphate, leading to bone thinning and increased fracture risk.
• Cardiovascular disease: CKD significantly increases the risk of heart attacks and strokes.
• High blood pressure: Kidney damage can cause or worsen high blood pressure.
• Electrolyte imbalances: Damaged kidneys struggle to maintain proper levels of potassium and sodium.
• Fluid retention: Swelling in the legs, ankles, feet, and around the eyes may occur.

Frequently Asked Questions

Q: Can chronic kidney disease be cured?

A: There is no cure for chronic kidney disease, but it can be managed and its progression can often be slowed down with appropriate treatment, particularly when detected early. Treatment focuses on managing underlying conditions like diabetes and high blood pressure, and monitoring kidney function regularly.

Q: How often should I have kidney function tests if I have CKD?

A: Most patients in CKD stages 1, 2, and 3 should have yearly blood and urine tests, and sometimes tests twice a year. Patients in stages 4 and 5 require more frequent monitoring by a kidney specialist.

Q: What should I eat if I have chronic kidney disease?

A: Diet recommendations depend on your stage of CKD and other health conditions. Your doctor or a renal dietitian can provide personalized dietary advice, but generally you may need to limit sodium, potassium, phosphorus, and protein intake as kidney function declines.

Q: Will I eventually need dialysis?

A: Not all people with CKD will need dialysis. Most people with stages 1-3 CKD will never progress to kidney failure. Only those whose kidney function declines to stage 5 (end-stage kidney disease) will need dialysis or a kidney transplant.

Q: Can I live a normal life with chronic kidney disease?

A: Yes, most people with mild-to-moderate CKD can live a normal life. With proper management, regular monitoring, and adherence to treatment recommendations, many people with CKD experience few symptoms and maintain good quality of life.

Q: What is the difference between CKD and acute kidney injury?

A: Acute kidney injury occurs suddenly and may be reversible, whereas CKD develops over months or years and is typically irreversible. However, after an acute kidney injury, regular blood tests should be done for at least three years to monitor kidney function.

Q: Why is blood pressure control important in CKD?

A: High blood pressure damages the delicate blood vessels in the kidneys and speeds up progression of kidney disease. Aggressively managing blood pressure to below recommended levels is one of the most important treatments for slowing CKD progression.

Q: What does eGFR mean?

A: eGFR stands for estimated glomerular filtration rate. It is a blood test that estimates how well your kidneys are filtering waste from your blood. The eGFR value is used to determine your stage of chronic kidney disease.

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medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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