FAQ’s Part II

By | March 27, 2009

What are the signs and symptoms of CKD?

Knowing the symptoms of kidney disease can help people detect it early enough to get treatment. Signs and symptoms of CKD include:

  • Changes in urination – making more or less urine than usual, feeling pressure when urinating, changes in the color of urine, foamy or bubbly urine, or having to get up often at night to urinate.
  • Swelling of the feet, ankles, hands, or face – fluid the kidneys can’t remove may stay in the tissues.
  • Fatigue or weakness – a build-up of wastes or a shortage of red blood cells (anemia) can cause these problems when the kidneys begin to fail.
  • Shortness of breath – kidney failure is sometimes confused with asthma or heart failure, because fluid can build up in the lungs.
  • Ammonia breath or an ammonia or metal taste in the mouth – waste build-up in the body can cause bad breath, changes in taste, or an aversion to protein foods like meat.
  • Back or flank pain – the kidneys are located on either side of the spine in the back.
  • Itching – waste build-up in the body can cause severe itching, especially of the legs.
  • Loss of appetite, resulting in weight loss
  • Nausea, especially at the sight of food or in the morning, and vomiting
  • Muscle cramping at night
  • Trouble concentrating
  • Trouble sleeping at night
  • More episodes of low blood sugar, if diabetic
  • High blood pressure, or worsening hypertension

How do I know if I have chronic kidney disease? What laboratory tests do I need?

Kidney disease can be detected through laboratory tests or by signs and symptoms. Markers of kidney damage include abnormalities in the composition of the blood or urine or abnormalities in imaging tests. High blood levels of creatinine and urea nitrogen (BUN) or high levels of protein in your urine suggest kidney disease. Glomerular filtration rate, or estimated creatinine clearance and endogenous creatinine clearance are tests which will tell you how well your kidneys are working.

  • In Stage 1 and Stage 2 CKD, there are often few or no symptoms. Early CKD is usually diagnosed when the following signs are present, alone or in combination:
  • High blood pressure
  • Higher than normal levels of creatinine or urea in the blood
  • Blood or protein in the urine
  • Evidence of kidney damage or multiple cysts or enlarged or small kidneys in an ultrasound, CT scan, MRI, or contrast X-ray
  • Abnormal looking filters (nephrons) on kidney biopsy

In Stage 3 CKD, anemia (a shortage of red blood cells) and/or early bone disease may appear and should be treated to help you feel your best and reduce problems down the road. When CKD has progressed to Stage 4, abnormal levels of blood or urine electrolytes such as sodium, potassium, calcium, and phosphorus, as well as acids may be detected.

If I have signs and symptoms of kidney disease, what should I do?
You should ask for a referral to or consult a nephrologist, a specialist in kidney diseases. If CKD or risk factors for CKD are detected early, medications and lifestyle changes may help slow its progress and keep you feeling your best for as long as possible. With early diagnosis, it may be possible to slow or even stop progression of CKD, depending on the cause. As such, early referral to a nephrologist is very important in initiating an appropriate action plan. A nephrologist can help you and your primary care doctor to:

  • Slow the rate of decline of your kidney function
  • Decide if a kidney biopsy might be useful
  • Diagnose the type of kidney disease and whether it might be reversible with treatment
  • Manage complications of kidney disease, such as anemia, high blood pressure, metabolic acidosis, and changes in mineral balance

It may be prudent for a non-nephrologist to screen patients at increased risk for CKD and to institute risk reduction strategies when possible. Alternatively, he may refer them to a nephrologist for pre-ESRD care. You may visit http://www.keeponline.org on how to go about early evaluation.

I just found out I have chronic kidney disease. Does this mean I am going to die soon?

No. In the early stages of CKD, you may experience little or no symptoms at all and you can still go about your usual daily chores and lifestyle. In the latter stages, particularly end-stage renal disease, dialysis or a kidney transplant can keep you alive when your kidneys fail. The more you learn and take part in your treatment, the better you can feel. Some people live for decades with kidney failure.

What are the treatment options for CKD? What is pre-ESRD care?

Pre-ESRD care is care aimed at helping delay or prevent progressive kidney failure and ameliorating its complications. It may take the form of lifestyle and dietary modifications, as well as drug treatment in most cases. It encompasses control of blood pressure and diabetes, identification of reversible causes of kidney damage, prevention and treatment of anemia, bone disease, and cardiovascular complications of CKD. It also includes adequate preparation for eventual renal replacement therapy, be it dialysis or kidney transplantation.
Blood glucose control

If you have diabetes, strict control of your blood glucose levels can help slow the progression of kidney disease.

  • Keep your hemoglobin A1c, which measures blood glucose control over the last two to three months, to less than 6.5%.
  • To reach this level of strict glycemic control, you will need to monitor your blood glucose closely to avoid hypoglycemia.

Blood pressure control

  • Keep your blood pressure at 120/70 or lower if you have diabetes and/or protein in your urine.
  • Keep your blood pressure at 130/80 or lower if you have kidney problems but not diabetes.

Lifestyle changes such as losing weight, exercising, eating less salt and drinking less alcohol

Repairing the damage

If you have an obstruction that blocks your urine flow, surgery may help. If you have an infection, antibiotics may
clear it up.

Stop medications that may damage your kidneys. Most painkillers can cause damage to your kidneys. Your doctor may be able to suggest a different medication that is less or not harmful to your kidneys. Sometimes diagnostic studies are ordered with contrast dye. It may be necessary for you to have the study, but first find out if there are alternative methods.

Some diseases, such as IgA nephropathy, glomerulonephritis, and lupus can cause kidney damage when your immune system overreacts and inflammation occurs. It is sometimes possible to slow the disease process by controlling the immune system with steroids and/or other medications.
Smoking is a risk factor for faster progression of kidney disease, so stopping smoking can also help slow progression. Avoiding too much protein, potassium- and phosphorus-rich foods in the diet may also help.

» data courtesy of Phil. Society of Nephrology «

6 thoughts on “FAQ’s Part II

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  5. jtsantos

    Thanks, Drea! It was very hard at the start but I have learned to cope now. I am and would always be happy that this blog serves useful information.

    Thank you!

  6. Drea

    You have a very informative blog here. My grandmother was a dialysis patients for many years longer than doctors said she’d survive. I don’t know first hand what its like, but as children my cousins and I would go along with her sometimes to keep her company and get her what she needed. Stay strong.


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