Kidney disease

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Kidney disease can be divided in to 2 broad categories. Acute and Chronic kidney disease.

Acute Kidney disease

Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your body.

Causes

There are many possible causes of kidney damage. They include:

• Acute tubular necrosis (ATN; damage to the tubule cells of the kidneys)
• Autoimmune kidney disease
• Blood clot from cholesterol (cholesterol emboli)
• Decreased blood flow due to very low blood pressure, which can result from burns, dehydration, hemorrhage, injury, septic shock, serious illness, or surgery
• Disorders that cause clotting within the kidney blood vessels Infections that directly injure the kidney, such as acute pyelonephritis or septicemia
• Pregnancy complications, including placenta abruption or placenta previa Urinary tract blockage Illicit drugs such as cocaine and heroine
• Medicines including non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics and blood pressure medicines, intravenous contrast (dye), some cancer and HIV drugs

Symptoms

Symptoms of acute kidney failure may include any of the following:

• Bloody stools
• Breath odor and metallic taste in the mouth
• Bruising easily
• Changes in mental status or mood
• Decreased appetite
• Decreased sensation, especially in the hands or feet
• Fatigue or slow sluggish movements
• Flank pain (between the ribs and hips)
• Hand tremor Heart murmur
• High blood pressure
• Nausea or vomiting, may last for days
• Nosebleeds
• Persistent hiccups
• Prolonged bleeding
• Seizures
• Shortness of breath
• Swelling due to the body keeping in fluid (may be seen in the legs, ankles, and feet)
• Urination changes, such as little or no urine, urination that stops completely.

Exams and Tests

The health care provider will examine you.

Tests to check how well your kidneys are working include:

• BUN
• Creatinine clearance
• Serum creatinine
• Serum potassium
• Urinalysis

A kidney or abdominal ultrasound is the preferred test for diagnosing a blockage in the urinary tract. X-ray, CT scan, or MRI of the abdomen can also tell if there is a blockage.

Other blood tests may be done to find the underlying cause of kidney failure.

Treatment

Once the cause is found, the goal of treatment is to help your kidneys work again and prevent fluid and waste from building up in your body while they heal. Usually, you will have to stay overnight in the hospital for treatment.

The amount of liquid you drink will be limited to the amount of urine you can produce. You will be told what you may and may not eat to reduce the buildup of toxins that the kidneys would normally remove. Your diet may need to be high in carbohydrates and low in protein, salt, and potassium.

You may need antibiotics to treat or prevent infection. Water pills (diuretics) may be used to help remove fluid from your body.

Medicines will be given through a vein to help control your blood potassium level.

You may need dialysis. This is a treatment that does what healthy kidneys normally do -- rid the body of harmful wastes, extra salt, and water. Dialysis can save your life if your potassium levels are dangerously high. Dialysis will also be used if:

• Your mental status changes
• You develop pericarditis
• You retain too much fluid
• You cannot remove nitrogen waste products from your body

Dialysis will most often be short term. In some cases, the kidney damage is so great that dialysis is needed permanently.

Chronic kidney disease

Chronic kidney disease (CKD) means that your kidneys are damaged and can't filter blood as they should. This damage can cause wastes to build up in your body. It can also cause other problems that can harm your health. Diabetes and high blood pressure are the most common causes of CKD.

The kidney damage occurs slowly over many years. Many people don't have any symptoms until their kidney disease is very advanced. Blood and urine tests are the only way to know if you have kidney disease.

Treatments cannot cure kidney disease, but they may slow kidney disease.

Symptoms

The early symptoms of CKD are the same as for many other illnesses. These symptoms may be the only sign of a problem in the early stages.

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

Symptoms

The early symptoms of CKD are the same as for many other illnesses. These symptoms may be the only sign of a problem in the early stages.

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

Exams and Tests

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 protein or other changes in your urine. These changes may appear 6 to 10 months or more before symptoms appear.

Tests that check how well the kidneys are working include:

• Creatinine clearance
• Creatinine levels
• Blood urea nitrogen (BUN)

CKD changes the results of several other tests. You will need to have the following tests as often as every 2 to 3 months when kidney disease gets worse:

• Albumin
• Calcium
• Cholesterol
• Complete blood count (CBC)
• Electrolytes
• Magnesium
• Phosphorous
• Potassium 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 scanKidney ultrasound

This disease may also change the results of the following tests:Erythropoietin Parathyroid hormone (PTH) Bone density test Vitamin D level

Treatment

Blood pressure control will slow further kidney damage.

• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
• The goal is to keep blood pressure at or below 130/80 mm Hg.

Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as:

• DO NOT smoke.
• Eat meals that are low in fat and cholesterol.
• Get regular exercise (talk to your doctor or nurse before starting to exercise).
• Take drugs to lower your cholesterol, if needed.
• Keep your blood sugar under control.
• Avoid eating too much salt or potassium.

Always talk to your kidney specialist before taking any over-the-counter medicine. This includes vitamins, herbs and supplements. Make sure all of the providers you visit know you have CKD. Other treatments may include:

• Medicines called phosphate binders, to help prevent high phosphorous levels
• Extra iron in the diet, iron pills, iron given through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions to treat anemia
• Extra calcium and vitamin D (always talk to your provider before taking)

Your provider may have you follow a special diet

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

Things you can do

You can take steps to keep your kidneys healthier longer:

• Choose foods with less (sodium)
• Control your blood pressure; your health care provider can tell you what your blood pressure should be
• Keep your blood sugar in the target range
• Limit the amount of alcohol you drink
• Choose foods that are healthy for your heart: fruits, vegetables, whole grains, and low-fat dairy foods
• Lose weight if you are overweight
• Be physically active
• Don't smoke

Topics in Nephrology and Urology

A

• Acidosis
• African Americans and Kidney Disease Fact Sheet
• Alport Syndrome
• Amyloidosis and Kidney Disease
• Analgesic Nephropathy: Painkillers and the Kidneys
• Anatomy of the Kidneys
• Anatomy of the Urinary System
• Anemia in Kidney Disease and Dialysis

B

• Bedwetting
• Biopsy of the Kidneys
• Biopsy of the Prostate
• Bladder and Urinary Tract
• Bladder Control
• Bladder Control for Women
• Blood in Urine
• Blood Pressure
• Bone Disease of Kidney Failure
• BPH Benign Prostatic Hyperplasia

C

• Childhood Nephrotic Syndrome
• Children
• Child's Bedwetting
• Chronic Kidney Disease and Kidney Failure (a research fact sheet)
• Chronic Kidney Disease: A Family Affair
• CKD Quick Reference Card
• Complications
• Cystitis
• Cystocele: Fallen Bladder
• Cystoscopy and Ureteroscopy
• Cysts

D

• Daily Bladder Diary
• Diabetes and Kidney Disease
• Diabetes Insipidus
• Diagnostic Tests
• Dialysis
• Diet for Hemodialysis
• Drug Information

E

• Eat Right to Feel Right on Hemodialysis
• End-Stage Renal Disease
• Enuresis
• Erectile Dysfunction
• Exercising Your Pelvic Muscles

F

• Fallen Bladder
• Financial Help for Treatment of Kidney Failure
• Focal Segmental Glomerulosclerosis

G

• Glomerular Diseases
• Glomerular Filtration Rate
• Glomerulonephritis
• Glomerulosclerosis
• Goodpasture's Syndrome
• Growth Failure in Children With Kidney Disease

H

• Help Your Family Prevent Kidney Failure Brochure
• Help Your Family Prevent Kidney Failure Button
• Help Your Family Prevent Kidney Failure Poster
• Hematuria: Blood in the Urine
• Hemodialysis
• Hemodialysis Dose and Adequacy
• Hemolytic Uremic Syndrome
• High Blood Pressure and Kidney Disease
• History of Advances in Treating Kidney Disease
• Hypertension

I

• IgA Nephropathy
• Imaging of the Urinary Tract
• Impotence
• Incontinence (all topics)
• Incontinence in children
• Incontinence in Men
• Incontinence in Women
• Infection (bladder)
• Infection (kidney)
• Interstitial Cystitis

K

• Kegel Exercises
• Kidney Biopsy
• Kidney Connection Guide
• Kidney Cysts
• Kidney Disease and Kidney Failure
• Kidney Disease in Children
• Kidney Disease of Diabetes
• Kidney Diseases Dictionary
• Kidney Failure
• Kidney Failure Glossary
• Kidney Failure Series
• Kidney Failure: Choosing a Treatment That's Right for You
• Kidney Failure: What to Expect
• Kidney Function-normal
• Kidney Stones
• Kidney Stones in Adults
• Kidney Transplantation

L

• Learn the Risks Brochure
• Lupus Nephritis

M

• Medical Tests for Prostate Problems
• Medical Tests of Kidney Function
• Membranous Nephropathy
• Menopause and Bladder Control
• Minimal Change Disease

N

• Nephrotic Syndrome in Adults
• Nephrotic Syndrome in Children
• Nerve Disease and Bladder Control
• Neurogenic Bladder
• Nocturnal Enuresis
• Nutrition and Kidney Disease
• Nutrition for Early Chronic Kidney Disease in Adults
• Nutrition for Later Chronic Kidney Disease in Adults
• Nutrition in Children with Chronic Kidney Disease

O

• Overactive Bladder
• Overview of Kidney Diseases in Children

P

• Painkillers and the Kidneys
• Pelvic Floor Exercises
• Peritoneal Dialysis
• Peritoneal Dialysis Dose and Adequacy
• Pessary
• Peyronie's Disease
• Polycystic Kidney Disease
• Pregnancy, Childbirth, and Bladder Control
• Prevent Diabetes Problems: Keep Your Kidneys Healthy
• Prostate
• Prostate Enlargement: Benign Prostatic Hyperplasia
• Prostatitis: Disorders of the Prostate
• Proteinuria
• Pyelonephritis (Kidney Infection) in Adults

R

• Rationale for Use and Reporting of Estimated GFR Fact Sheet
• Renal Osteodystrophy
• Renal Tubular Acidosis
• Research Fact Sheet
• Research Updates in Kidney and Urologic Health

S

• School and Family Problems of Children With Kidney Failure
• Sexual and Urologic Problems of Diabetes
• Simple Kidney Cysts
• Solitary Kidney
• Statistics
• Stress Incontinence

T

• Talking to Your Health Care Team About Bladder Control
• Tests
• Tests for Kidney Function
• Tests for Prostate Problems
• Tests for Urinary Problems
• Transplantation
• Treatment
• Treatment Methods for Kidney Failure in Children
• Treatments for Urinary Incontinence in Women

U

• Understanding GFR Fact Sheet
• Ureteroscopy
• Urge Incontinence
• Urinary Incontinence in Children
• Urinary Incontinence in Men
• Urinary Incontinence in Women
• Urinary Tract Infections
• Urinary Tract Infections in Adults
• Urinary Tract Infections in Children
• Urine Blockage in Newborns
• Urodynamic Testing
• Urologic Diseases Dictionary
• Urostomy and Continent Urinary Diversion

V

• Vascular Access for Hemodialysis
• Vesicoureteral Reflux

W

• What I need to know about Erection Problems
• What I need to know about Kidney Stones
• What I need to know about My Child's Bedwetting
• What I need to know about Prostate Problems
• What I need to know about Urinary Tract Infections
• What Your Female Patients Want to Know About Bladder Control

Y

• Your Body's Design for Bladder Control
• Your Kidneys and How They Work
• Your Medicines and Bladder Control
• Your Urinary System and How It Works

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