Kidney Disease

Kidney disease refers to the gradual deterioration of kidney function over time. The kidneys are vital organs responsible for filtering waste and excess fluids from the blood, which are subsequently expelled through urine. When the kidneys face damage, they may not operate effectively, leading to the accumulation of waste products and fluids that can cause various health complications. Ultimately, kidney disease can progress to kidney failure, necessitating dialysis or a kidney transplant. Therefore, early detection and management are crucial to slow the disease's progression and support kidney health.

Causes

Chronic Kidney Disease (CKD) can develop from several factors that affect the kidneys throughout a person's life. Common causes include:

• Diabetes: A widespread condition that can damage the kidneys' blood vessels.

• High Blood Pressure: Often occurring with diabetes, it can also damage kidney blood vessels.

• Obesity: Increases the risk of kidney injury.

• Heart Failure: A condition contributing to kidney issues.

• Infections: Frequent urinary tract infections can harm kidney health.

• Kidney Stones: Can lead to CKD if they cause ongoing damage or blockage.

• Glomerulonephritis: A form of kidney disease affecting the kidneys' filtering units.

• Renal Artery Stenosis: Narrowing of arteries supplying the kidneys, limiting blood flow.

• Autoimmune Diseases: Conditions such as lupus nephritis cause kidney inflammation and harm.

• Medications and Toxins: Certain drugs and harmful substances like lead or pesticides can damage kidneys.

Genetic factors also influence CKD, and these conditions can be inherited:

• Polycystic Kidney Disease: A genetic disorder characterized by cysts in the kidneys.

• Sickle Cell Trait and Disease: These conditions heighten CKD risk, especially in individuals of African descent.

• Alport Syndrome: A genetic condition impacting kidney function, often affecting hearing and vision too.

Symptoms

Chronic kidney disease (CKD) often shows no noticeable symptoms in its early stages, frequently identified through routine blood or urine tests. Many adults with CKD are unaware of their condition. However, as CKD advances, symptoms may include:

• Blood in urine

• Foamy urine

• Increased urination at night

• Pain in the lower back or flank

• Reduced urination frequency

In advanced CKD stages, additional symptoms might appear:

• Persistent fatigue

• Unexplained weight loss

• Nausea and vomiting

• Swelling in the legs

• Breathing difficulties

• Itchy skin

It's crucial to consult a healthcare professional if experiencing these symptoms for further evaluation and management.

Diagnosis

Diagnosing chronic kidney disease (CKD) primarily involves two tests: the estimated glomerular filtration rate (GFR) and the albumin to creatinine ratio (ACR). The GFR measures kidney function through a simple blood test called a metabolic panel. CKD is categorized into five stages based on GFR results, with higher stages indicating more severe kidney impairment.

The ACR test measures protein in urine, indicating possible kidney damage and aiding in CKD staging. A urinalysis might also detect blood or abnormal cells in the urine.

CKD diagnosis occurs when GFR is below 60 mL/min/1.73 m² or kidney damage signs persist for over three months. Evidence of kidney damage includes protein in urine with an ACR of 30 mg/g or higher, abnormal blood or urine tests, unusual kidney appearance or tissue, or a kidney transplant history. Kidney function tests may need repeating over months to confirm diagnosis, and imaging tests like ultrasounds may be used for closer kidney examination.

Treatments

Managing chronic kidney disease (CKD) involves addressing underlying causes and managing health conditions like heart disease, high blood pressure, and diabetes that negatively impact kidney function. Controlling and treating these conditions is essential to prevent further kidney deterioration. Regular monitoring of kidney function is vital, starting with primary care providers and eventually consulting a nephrologist, especially in later CKD stages or unclear CKD causes. Moderate to severe CKD complications like anemia, high potassium, or mineral imbalances are identified through blood tests and managed with medications, dietary changes, or supplements.

Medications

Medications play a critical role in managing kidney disease:

• Although CKD isn't curable, medications help slow progression and manage complications.

• ACE inhibitors and ARBs, used to treat high blood pressure, are recommended for CKD patients with high urine protein, even with normal blood pressure. Examples are lisinopril (Zestril) and losartan (Cozaar).

• Dapagliflozin (Farxiga) is FDA-approved to slow CKD progression in patients with increased urine protein and is part of the diabetes-treating SGLT2 inhibitors class.

• Medications like sevelamer (Renvela) manage high phosphorus levels in CKD.

• Anemia, a common CKD complication, is managed with erythropoiesis-stimulating drugs like epoetin alfa (Procrit) due to insufficient kidney hormone erythropoietin for red blood cell production.

• Metabolic acidosis from CKD is treated with Sodium Bicarbonate to neutralize blood acidity.

Living

Living with chronic kidney disease (CKD) involves regular monitoring and long-term care, which can be overwhelming due to the condition's lack of early symptoms but significant health impact. Remember, you're not alone. Healthcare teams offer invaluable support, and numerous individuals in the U.S. and worldwide live with CKD. National organizations like the National Kidney Foundation and the American Association of Kidney Patients provide support groups and services, while the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers resources.

For financial assistance in managing CKD medication costs, services like GoodRx help compare medication prices, such as dapagliflozin, sevelamer, and Losartan, at local pharmacies.