Are Your Kidneys Working? Recognizing and Preventing Chronic Kidney Disease

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Are you at risk for kidney disease? More than 26 million American adults are living with kidney disease and don’t know it. One in three American adults is at risk for kidney disease. Anyone can develop kidney disease, but some people are at greater risk. Kidney disease is most often caused by diabetes or high blood pressure, both can cause permanent harm to your kidneys. When your kidneys have been permanently damaged, it’s called chronic kidney disease (CKD).

Risk Factors for Chronic Kidney Disease

You may be at higher risk for kidney disease if you: 

  • Have diabetes
  • Have high blood pressure
  • Have heart disease
  • Mother, father, sister or brother had kidney disease  
  • Are over age 60

In the early stages symptoms are subtle. Once the disease process begins, the damage progresses quickly in most cases. The early signs of CKD are subtle making it difficult to recognize, which often results in late diagnosis. It can take years to go from chronic kidney disease (CKD) to end stage kidney failure. This is the primarily the cause for the increased burden of the disease in our country making it a “silent epidemic.”

Kidney disease is usually a progressive disease, which means the damage is permanent and irreversible. Kidney disease also increases the risks for heart disease and stroke. The good news is kidney disease can be treated effectively if caught in the early stages. Early intervention by education and an individual treatment plan can help prevent the progression of CKD.

10 Symptoms of Kidney Disease

1. Changes in urine frequency, quality, character.

Kidneys make urine, so when the kidneys are failing, you may have to get up at night to urinate. This is called “NOCTURIA” and results from loss of the concentrating ability of kidneys as they become damaged. This results in increased tendency of the bladder to fill up with diluted urine at night time. A trip to the restroom in the middle of the night is often times inevitable.

Having foamy or bubbly urine or blood in your urine is also a sign of kidney disease. Healthy kidneys typically prevent the leakage of blood in the urine during the process of purification of the blood. But when the kidney's filters have been damaged, these blood cells can start to "leak" out into the urine. Blood in the urine can also be indicative of kidney tumors, stones or an infection. Excessive bubbles in the urine – that requires you to flush several times before they go away—indicate protein in the urine, which is also a sign of ongoing kidney damage.

2. Swelling

Failing kidneys don't remove extra fluid and salt, which builds up in your body causing swelling in the legs, ankles, feet, face, and/or hands. This is more common in advanced stages of chronic kidney disease. This often requires use of medications called “diuretics” or water pills to restore the fluid balance and promote water and salt excretion from your body. The increased urine frequency related to usage of water pills results in increased bladder urgency or frequency.

3. Fatigue

Healthy kidneys make a hormone called erythropoietin (EPO) that tells your body to make more oxygen-carrying red blood cells. As the kidneys fail, they make less EPO. With fewer red blood cells to carry oxygen, your body cells tire very quickly. Constant exhaustion and excessive sleep are common. This is called anemia, and it can be treated.

4. Skin Rash/Itching

Kidneys remove wastes from the bloodstream. When the kidneys fail, the build-up of waste in your blood can cause severe itching. Patients also accumulate excessive phosphorus which contributes to itching. Uremic frost is a description for crystallized urea deposits that can be found on the skin of those affected by advanced kidney failure.

In states of prolonged kidney failure, high levels of urea are secreted by sweat glands in the skin. As water evaporates off of the skin, it results in crystallization of the remaining urea. Making the appropriate dietary changes including avoidance high protein and phosphate rich foods can reduce itching.

5. Metallic Taste in Mouth/Ammonia Breath

A build-up of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice you stop liking to eat things you used to love. You may also lose weight due to lack of appetite.

6. Nausea and Vomiting

A severe build-up of waste in the blood (uremia) can also cause nausea and vomiting. It is hard to keep anything down once kidney disease progresses because the stomach is inflamed.

7. Shortness of Breath

Trouble catching your breath can be related to the kidneys. Extra fluid in the body can build up in the lungs and anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath. In both situations the shortness of breath results in the inability to lie down flat. Attempts to lay down flat in bed provoke a sensation of drowning. A short walk to fetch mail from the mail box can be a hard to accomplish mission.

8. Feeling Cold

Accumulation of uremic wastes can cause decreased core body temperature (hypothermia). People have difficulty tolerating cold winter months. Also anemia related to kidney failure can make you feel cold all the time, even in a warm room.

9. Dizziness and Trouble Concentrating

Toxins accumulating in your body interfere with normal brain functions resulting in memory problems, trouble with concentration and dizziness. Previously easily accomplished tasks like balancing a check book, solving crossword puzzles may no longer be possible.

10. Flank Pain

The most common causes of chronic kidney disease (CKD) do not cause any pain. And, many times pain near the kidneys is not caused by a kidney problem. But some people who have CKD do have pain in the upper back (where the kidneys are located ). Rare causes of this pain include polycystic kidney disease (PKD), which causes large, fluid-filled cysts on the kidneys, medullary sponge kidney, kidney infections and kidney stones.

Testing for Kidney Disease

Once people become aware of their increased risk, they should take steps to find out the state of their kidney’s health and get tested. This testing is especially important for populations at higher risk for kidney disease, such as African Americans, Asian Americans and Hispanics.

  • Measure the level of serum creatinine in your blood to estimate your glomerular filtration rate (GFR)
  • Measure the level of protein in your urine (increased levels of protein show your kidneys are not working right)
  • Check for diabetes and high blood pressure
  • Glomerular filtration rate (GFR) is a blood test which measures how much blood your kidneys filter each minute). A GFR of 60 or higher is in the normal range. A GFR below 60 may mean you have kidney disease. You can't recover lost GFR in many cases, but you can try to keep it from going lower.
  • Urine Protein—a urine test checks for protein in your urine, which can be a sign of kidney disease. Protein can leak into the urine when the filters in the kidneys are damaged.

Treating Kidney Disease 

If one or both kidneys fail completely and the damage can't be reversed, the condition is called kidney failure or end-stage renal disease (ESRD). When this occurs, your kidneys can no longer filter wastes well enough to keep you healthy. Treatments for kidney failure include dialysis or transplantation. There are two major types of dialysis:

  • In hemodialysis, blood is run through an external filter and clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week.
  • In peritoneal dialysis, the inside lining of your belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles. This kind of dialysis is needed daily but can be performed at home, while you sleep.

A kidney transplant is a surgical operation that places a functioning kidney from a donor into your body. The transplanted kidney takes over the work of the kidneys that failed, and you no longer need dialysis. In most parts of the country the waiting list to get a transplanted kidney ranges from 3-5 years or longer. Many people with kidney disease do not qualify for a transplant as they have additional medical issues, which make them unsuitable. After a transplant medications called “immunosuppressants” are necessary to prevent rejection. Immunosuppressants cause an increased risk of infections and cancer, thus close supervision is required by the patient’s doctor.