Chronic Renal Disease
What is chronic kidney disease? — Chronic kidney disease (CKD) is when the kidneys stop working as well as they should. When they are working normally, the kidneys filter the blood and remove waste and excess salt and water (figure 1).
In people with CKD, the kidneys slowly lose the ability to filter the blood. In time, the kidneys can stop working completely. That is why it is so important to keep CKD from getting worse.
What are the symptoms of CKD? — At first, CKD causes no symptoms. As the disease gets worse, it can:
Make your feet, ankles, or legs swell (doctors call this "edema")
Give you high blood pressure
Make you very tired
Damage your bones
Is there anything I can do to keep my kidneys from getting worse if I have CKD? — Yes, you can protect your kidneys by:
Taking blood pressure and other medicines every day, if your doctor or nurse prescribes them to you
Keeping your blood sugar in a healthy range, if you have diabetes
Changing your diet, if your doctor or nurse says you should
Quitting smoking, if you smoke
Losing weight, if you are overweight
Avoiding medicines known as "nonsteroidal antiinflammatory drugs," or NSAIDs. These medicines include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). Check with your doctor, nurse, or kidney specialist before starting any new medicines – even over-the-counter ones.
What are the treatments for CKD? — People in the early stages of CKD can take medicines to keep the disease from getting worse. For example, many people with CKD should take medicines known as "ACE inhibitors" or "angiotensin receptor blockers." If your doctor or nurse prescribes these medicines, it is very important that you take them every day as directed. If they cause side effects or cost too much, speak to your doctor or nurse about it. He or she might have solutions to offer.
What happens if my kidneys stop working completely? — If your kidneys stop working completely, you can choose between 3 different treatments to take over the job of your kidneys. Your choices are described below.
You can have kidney transplant surgery. That way, the new kidney can do the job of your own kidneys. If you have a kidney transplant, you will need to take medicines for the rest of your life to keep your body from reacting badly to the new kidney. (You only need 1 kidney to live.)
You can have your blood filtered by a machine. This treatment is called "hemodialysis," but many people call it just "dialysis." If you choose this approach, you will need to be hooked up to the machine at least 3 times a week for a few hours for the rest of your life. Before you start, you will also need to have surgery to prepare a blood vessel for attachment to the machine.
You can learn to use a special fluid that has to be piped in and out of your belly every day. This treatment is called "peritoneal dialysis." If you choose this type of dialysis, you will need surgery to have a tube implanted in your belly. Then you will have to learn how to pipe the fluid in and out through that tube.
How do I choose between the different treatment options? — You and your doctor will need to work together to find a treatment that's right for you. Kidney transplant surgery is usually the best option for most people. But often there are no kidneys available for transplant.
Ask your doctor to explain all of your options and how they might work for you. Then talk openly with him or her about how you feel about all of the options. You might even decide that you do not want any treatment. That is your choice.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15405 Version 22.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.