Chronic kidney disease (CKD) means that the kidneys are not working to full capacity after damage from either advancing age or a disease process such as diabetes. You have two kidneys, and their function is to filter out waste products from the body via the urine and balance up certain salts like potassium and sodium in your blood.
CKD is sometimes referred to as renal failure, and is a long-term condition that usually causes no symptoms in the early stages.
It can get worse over time, but it usually progresses slowly over years, and it’s rare to progress to a stage where the kidneys stop working altogether, which requires dialysis. For this reason, CKD is monitored regularly and risk factors for further damage are carefully controlled, such as diabetes and high blood pressure.
CKD can occur at any age, but is more likely in those over 60. Those with a family history of kidney disease such as polycystic kidney disease are more likely to develop it, and this will occur at an early age. Certain ethnicities are at increased risk, including those of black African, Caribbean or south-east Asian origin.
Certain health conditions can put a strain on the kidneys, including diabetes, high blood pressure, high cholesterol and obesity, and smoking is also damaging. The kidneys may be directly affected, or the blood vessels that supply them, and this goes hand-in-hand with the risk of heart disease and stroke.
Certain medicines can cause damage to the kidneys: this may be temporary, and the kidneys recover once you stop taking the medication. Occasionally there may be reason to stay on a medication, such as lithium for bipolar disorder, and either damage is irreversible, the dose is reduced, or it's a risk weighed up against the benefit the medication is bringing to your health.
Your kidney function is a standard measure on many blood tests, such as those ordered if you have a planned operation or are admitted to hospital for any reason, as part of monitoring other health conditions or medication, or on NHS screening for those over 40 years old.
The blood test checks your urea and electrolytes (so-called "U’s and E’s"). If creatinine and possibly urea are raised on repeated tests, this may be used to diagnose CKD. Other markers of kidney function in the blood test include eGFR (estimated glomerular filtration rate), which may be low in CKD, and potassium, which may be higher than usual if you have an acute illness or in the advanced stages.
A urine sample can show protein or blood, which is abnormal. This indicates the kidneys are not processing waste products that are passed through urine and out of the body as well as they should. An ultrasound can show any abnormalities in the structure of the kidneys, which may be more relevant in those with CKD at an early age.
These factors together can be used to stage your CKD, with Stage 1 the earliest stage and Stage 5 the most advanced, and requiring dialysis to assist your kidneys in removing waste products.
You should make sure you attend all invites from your doctor to follow up your CKD, so they can advise further if it’s getting worse. You should work on weight loss if you are overweight or obese, as this will improve the health of the blood vessels to your kidneys, heart and brain, and reduce the fat around internal organs including the kidneys. Stopping smoking will also be one of the best things you can do for your overall health and preventing further damage to the kidneys and blood vessels.
If you are diagnosed with diabetes, high blood pressure or high cholesterol, you should make sure you attend all relevant appointments and follow advice regarding eating a healthy low-fat low-salt diet and taking regular exercise.
Make sure you stay well-hydrated at all times, as this reduces stress on the kidneys, and take particular care to rehydrate if you are feverish or unwell, or in hot weather.
Most people live alongside mild to moderate CKD without it causing them major problems. Kidney function can become temporarily worse at times – usually if you have a sudden illness such as sepsis, pneumonia, a kidney infection (pyelonephritis) or a urinary tract infection (UTI).
Alongside this, you may be given medication such as certain painkillers or antibiotics that further stress the kidney. This can be managed either by your doctor or the hospital doctor if you are admitted – they can adjust doses, give alternatives or ensure you are kept well-hydrated with an intravenous drip. This is sometimes referred to as an acute kidney injury (AKI) and should resolve once you are better or medication has stopped.
If you do reach the advanced stages of CKD, your kidneys will be unable to effectively filter the waste products from your blood. This can cause you to feel tired, get easily out of breath and your ankles can swell. About 1 in 50 people with CKD require dialysis, where a machine filters the blood every couple of days in a hospital clinic.
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