Kidney disease

Chronic kidney disease damages your kidneys slowly over several years, causing fluid and waste to build up in your body. It can also cause other problems that can harm your health. Our kidney experts at Atrium Health Floyd and Harbin Clinic will provide diagnosis and comprehensive treatment for kidney disease.

What is kidney disease?

You have two kidneys, each about the size of your fist. Their main job is to filter wastes and excess water out of your blood. They also maintain the body’s chemical balance, help control blood pressure and make hormones.

Inside each kidney about a million tiny structures called nephrons filter blood. They remove waste products and extra water, which become urine. The urine flows through tubes called ureters to your bladder, which stores the urine until you urinate.

Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes.

Symptoms of chronic kidney disease

The early symptoms of chronic kidney disease (CKD) are the same as for many other illnesses. These symptoms may be the only sign of a problem in the early stages. Symptoms of chronic kidney disease may include:

• Appetite loss
• General ill feeling and fatigue
• Headaches
• Itching (pruritus) and dry skin
• Nausea
• Weight loss without trying to lose weight

Symptoms that may occur when kidney function has gotten worse include:

• Abnormally dark or light skin
• Bone pain
• Breath odor
• Drowsiness or problems concentrating or thinking
• Easy bruising or blood in the stool
• Excessive thirst
• Frequent hiccups
• Menstrual periods stop (amenorrhea)
• Muscle twitching or cramps
• Numbness or swelling of hands and feet
• Problems with sexual function
• Shortness of breath
• Sleep problems
• Vomiting, often in the morning

Chronic kidney disease causes

Chronic kidney disease slowly gets worse over months or years. You may not notice any symptoms for some time. The loss of function may be so slow that you don’t have symptoms until your kidneys have almost stopped working.

Many diseases and conditions can damage the kidneys, including:

• Autoimmune disorders (such as systemic lupus erythematosus and scleroderma)
• Backward flow of urine into the kidneys (reflux nephropathy)
• Birth defects of the kidneys (such as polycystic kidney disease)
• Injury to the kidney
• Kidney stones and infections
• Other kidney diseases
• Problems with the arteries supplying blood to the kidneys
• Some medicines, such as pain relievers and cancer drugs
• Some toxic chemicals

Risk factors for chronic kidney disease

Some things that put you at higher risk of developing kidney disease are:

• Having diabetes
• Having high blood pressure
• Having heart failure
• Having a family history of chronic kidney disease
• Being overweight or obese

Due to factors such as genetics, socioeconomic status and having barriers to health care access, some racial and ethnic groups are at higher risk for chronic kidney disease. People who are Black, Asian, Native American, or Hispanic or Latino are at higher risk.

Diagnosis of chronic kidney disease

Most people will have high blood pressure at all stages of CKD. During an exam, your health care provider may also hear abnormal heart or lung sounds in your chest. You may have signs of nerve damage during a nervous system exam.

A urinalysis may show excess protein (proteinuria) or other changes in your urine. These changes may appear 6-10 months or more before symptoms appear.

Tests that check how well the kidneys are working include:

• Creatinine clearance and levels

Chronic kidney disease changes the results of several other tests. You’ll need to have the following levels tested as often as every two to three months when kidney disease gets worse:

• Calcium
• Cholesterol
• Complete blood count (CBC)
• Electrolytes
• Magnesium
• Phosphorous
• Potassium
• Protein in the urine
• Sodium

Other tests that may be done to look for the cause or type of kidney disease include:

• CT scan of the abdomen
• MRI of the abdomen
• Ultrasound of the abdomen
• Kidney biopsy
• Kidney scan
• Kidney ultrasound

Chronic kidney disease may also change vitamin D levels and the results of bone density tests.

Treatment of chronic kidney disease

While chronic kidney disease can get worse over time and there is no cure, your Atrium Health Floyd and Harbin Clinic care team will recommend the best treatment for your individual case so you can live comfortably. Treatment may include medicines to lower blood pressure, control blood glucose and lower blood cholesterol.

Additionally, making lifestyle changes can help protect the kidneys while also helping prevent heart disease and stroke. Such lifestyle changes include:

• Avoiding consuming too much salt or potassium
• Eating meals that are low in fat and cholesterol
• Getting regular exercise (talk to your doctor or nurse before starting to exercise)
• Keeping your blood pressure below 130/80
• Keeping your blood sugar under control
• Quitting smoking
• Taking drugs to lower your cholesterol, if needed
• Taking extra calcium and vitamin D

Always talk to your kidney specialist before taking any vitamins, herbs, supplements or over-the-counter medicine. If you have CKD, make sure all your health care providers know about it.

Your health care provider may have you follow a special diet for chronic kidney disease by:

• Eating less protein
• Getting enough calories to prevent weight loss
• Limiting fluids
• Restricting salt, potassium, phosphorous, and other electrolytes

They may also recommend:

• Extra iron in the diet, iron pills, iron given through a vein (intravenous iron), special shots of a medicine called erythropoietin or blood transfusions to treat anemia
• Medicines called phosphate binders to help prevent high phosphorous levels

All people with chronic kidney disease should be up to date on vaccinations for hepatitis A, hepatitis B, flu and pneumonia (PPV).

Kidney failure

Many people are not diagnosed with CKD until they’ve lost most of their kidney function. The final stage of CKD is called end-stage renal disease (ESRD), when the kidneys fail completely. The only treatment options are dialysis or a kidney transplant.

Whether CKD worsens to end stage renal disease and how quickly that happens depends on:

• The cause of kidney damage
• How well you take care of yourself

Your health care provider will discuss dialysis with you before you need it. Dialysis removes waste products from your blood when your kidneys can no longer do their job.

In most cases, you will go to dialysis when you have only 10-15% of your kidney function left.

People who are waiting for a kidney transplant may need dialysis while waiting.