Kidney Disease, Chronic |گُردوں کی دائمی بیماری

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Kidney Disease, Chronic

Chronic kidney disease(renal disease) is a condition in which kidneys are gradually damaged overtime that prevent them to perform their normal functions. All of us have two kidneys, which are located a little lower to the rib cage on each side of the spinal cord. Kidneys are about the size of the fist and each kidney contains almost a million tiny structures called nephrons. Nephrons act as filtering units that filter the blood.  
Diagram showing human kidney anatomy illustration
Kidney Functions The main function of the kidneys are to remove the waste and excess water from the body that is passed in the form of urine.  Kidneys also perform several other important functions, such as maintaining chemical balance of the body (balancing sodium, potassium and phosphates), helps in keeping blood pressure controlled, make hormones that help in the production of red blood cells (erythrocytes).  Normally, about 100 to 120 liters of blood is filtered by both kidneys to produce 1- 2 liters of urine. When the kidneys are healthy, they help to filter the blood and remove waste and then this is removed from the body through the urine.  When someone has chronic kidney disease, the kidneys do not filter the blood well which results in waste building up in the body. In case of complete damage to kidneys (kidney failure), patient would require dialysis or kidney transplant to survive. There are measures which can be taken to keep our kidneys healthier for long period of time, such as:
  1. Consume diet with less salt
  2. Keep blood pressure controlled below 130/80
  3. Diabetic patients, maintain blood sugar level within the range
  4. Do not take unnecessary medicines, unless not prescribed by the physician

Since the damage to kidney occurs overtime, during the early stages of this disease, most people do not have symptoms.  However, as the disease progresses, the following symptoms may occur:

Symptoms of kidney disease

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  • Fatigue, feeling tired
  • Loss of appetite
  • Not being able to think clearly
  • Weakness
  • Not being able to sleep
  • Ankle and feet swelling
  • Needs to urinate frequently, especially at night
  • Muscle cramping in night and twitching
  • High blood pressure
  • Puffiness under the eyes, especially in the morning
  • Nausea and vomiting
  • Persistent itching

This condition is caused by issues that cause damage to the kidneys, such as:

Causes of kidney disease

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  • Diabetes (Type 1 diabetes or Type 2 diabetes)
  • High blood pressure
  • Glomerulonephritis (a group of condition where the tiny filtering units (nephrons) in the kidneys get inflamed or damaged)
  • Polycystic kidney disease (inherited disease, caused by the formation of cyst inside the kidney)
  • Kidney stones – obstruction and damaged to kidney tissues due the development of kidney stones - cause kidney pain
  • Repeated kidney infections – may damage the inside tissues of the kidneys

About two-third of chronic kidney disease cases are caused by diabetes and high blood pressure.

In addition to the causes, there are a few risk factors that increase the risk of developing chronic kidney disease and these include:

There are a few tests the doctor will perform to get an accurate diagnosis of chronic kidney disease.  Early diagnoses is very important to completely stop or slow down the damage to the kidneys. The following tests are used commonly for diagnosis:

  • Blood testing: The doctor will draw several vials of blood to look at different waste products in the blood, such as urea and creatinine - also to perform kidney function test
  •  Imaging testing: An ultrasound of kidneys are the most common because this allows the doctor to get more information about the size and structure of the kidneys.  CT scans are also commonly performed to get detailed images of the kidneys
  • Urine testing: This is done to look for abnormalities that may not show up in other testing
  • Kidney biopsy: This is a minor surgical procedure where a small piece of kidney tissue is taken and then sent to a laboratory.  This is generally a rather simple procedure where the area is numbed and a large needle is used to get a sample of tissue.  Several tests are done on the sample to learn more about overall kidney health

Treatment of chronic kidney disease

The treatment plan depends on what is causing the chronic kidney disease.  In addition to controlling the underlying condition, the signs and symptoms are also managed to help improve the quality of life.  To help treat the complications associated with this disease, the following may be done:

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  • Medication for high blood pressure:  Appropriate blood pressure medication should be used to lower the blood pressure and prevent kidney damage.  In addition, doctor may also prescribe a diuretic to help reduce sodium levels.
  •  Anemia medications: These medications help to keep iron at a healthy level.
  • Cholesterol medications: It is not uncommon for people with kidney disease to also have high cholesterol so these medications help to keep it under control.
  • Medications for swelling: Retaining water is common with kidney disease and this can lead to high blood pressure and leg and foot swelling.  Diuretics help to flush out excess water.
  • Vitamin D and calcium: Weak bones can occur with kidney disease, so taking these supplements help to protect the health of the bones.  Some medications for kidney disease also affect the bones, so these supplements help to prevent those side effects.

If chronic kidney disease has severely damage both kidneys, there are two primary treatments that may be necessary, including:

  • Dialysis: This is a procedure that does the work of the kidneys when they are no longer working enough.  It helps to remove excess fluids and wastes.
  • Kidney transplant: This involves getting a healthy kidney from someone else to replace the failed kidney.

Almost every part of the body can be affected by chronic kidney disease.  There is a wide range of potential complications, including:

  • Fluid retention in the limbs or lungs.  This can also raise blood pressure
  • Sudden increase in potassium.  This can be life-threatening because it affects the heart
  • Anemia (low red blood cells)
  • Kidney damage leading to kidney failure that is permanent
  • Increased risk of infection
  • Weak bones
  • Blood vessel and heart disease
  • Pregnancy complications 

Many people with kidney disease need to alter their diet to help reduce the risk of complications.  Common dietary changes include:

  • Lower potassium intake.  Common foods high in potassium include bananas, potatoes, tomatoes, oranges and spinach.
  • Lower salt intake.  Dietician will give specific recommendations depending on the severity of the disease.
  • Lower protein intake.  Dietician will give specific recommendations depending on how well the kidneys are functioning.
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