Patient Education

The kidneys are a pair of bean-shaped organs, located just below the ribcage on either side of the spine. 

They help filter your blood by removing waste and excess fluids, but they do much more. 

The kidneys help maintain the balance of electrolytes in the body. In addition, hormones produced by the kidney help regulate your blood pressure, make red blood cells, and help keep your bones strong.

“Renal” is the medical term that refers to kidney function. 

“Renal function” refers to the state of the kidneys, and how well they filter blood. 

Two healthy kidneys provide 100% of your renal function.

Chronic kidney disease is a long, usually slow process where your kidneys gradually lose function. In the beginning, you may not notice any symptoms. 

Blood tests such as the BUN, creatinine and glomerular filtration rate or GFR are the most accurate ways to determine if you have chronic kidney disease and at which stage.

There are five stages of chronic kidney disease, with stage 1 normal kidney function.

The disease can take years to go from below normal kidney function (chronic kidney disease stage 1) to end-stage kidney failure at stage 5 where you need dialysis or a kidney transplant.

The chronic form is permanent kidney damage caused by diabetes, high blood pressure (hypertension), various kidney tissue infections (glomerulonephritis) and excessive use of some medications that may reduce long-term kidney function.

Since it may be possible to slow down the progression of the disease in early stages, it is vital to get an early diagnosis and to work closely with your doctor to find the right treatment.

It is possible to have kidney disease and have no symptoms for a long time. 

The damage to the kidneys can occur slowly and gradually, over many years, even decades. 

The most common causes of kidney damage include high blood pressure that is poorly managed and uncontrolled diabetes.

Kidney disease can have many different signs and symptoms that are non-specific, meaning, these same symptoms could also be signs of dysfunction in another body organ. 

Some non-specific symptoms of renal disease include: 

• Fatigue and Weakness
• Difficulty concentrating
• Trouble sleeping
• Dry, itchy skin
• Frequent urge to urinate
• Blood in the urine
• Urine is foamy
• Puffiness around the eyes
• Loss of appetite
• Swelling in the ankles
• Less urine
• Swelling in the hands, face and legs
• Shortness of breath
• Appetite loss, nausea and vomiting
• High Blood Pressure
• Feeling cold and tired

Several blood and urine screening tests can check for kidney damage and evaluate how well your kidneys are working. Nephrologists use several sophisticated tests.

Your urine can reveal a great deal about the functioning of your kidneys. Blood in the urine, called hematuria, can indicate kidney stones, a kidney injury or a urinary tract infection. Sometimes the urine is high in protein, called proteinuria or albuminuria. Larger amounts of protein in the urine can be a sign of early kidney disease. If not controlled, increased amount s of protein in the urine can lead to kidney damage.

Blood tests can reveal the amount of waste products such as urea, creatinine and nitrogen in the blood that indicate kidney disease and its stage.

The creatinine level indicates how well the tiny filters in the kidneys are doing their job filtering out wastes. This level is called the GFR, and the higher the number the better your kidneys are functioning.

Most people do not have symptoms of decreased kidney function until the GFR is 20–30, and they do not feel sick until it is 10–15.

Like knowing your blood pressure numbers, you should know your GFR.

When you have too few red blood cells in your bloodstream, less oxygen is being delivered to your heart, muscles, brain and other organs in your body. This makes you anemic with less energy and more fatigue.

Anemia is commonly associated with reduced kidney function.

Uremia (uremic syndrome) is a serious complication of both acute kidney injury and chronic kidney disease. It occurs when urea and other waste products buildup in the body because the kidneys are not able to eliminate them. These substances can become poisonous (toxic) to the body if they reach high levels.

Prolonged or severe fluid buildup may make the uremic syndrome worse and can cause:

• Nausea, vomiting and weight loss
• Changes in mental status, such as confusion, reduced awareness, agitation, psychosis, seizures and coma
• Abnormal bleeding, such as bleeding spontaneously or profusely from a very minor injury
• Heart problems, such as an irregular heartbeat, inflammation in the sac that surrounds the heart (pericarditis), and increased pressure on the heart
• Shortness of breath from fluid buildup

Kidney dialysis is usually needed to relieve the symptoms of uremic syndrome until normal kidney function can be restored.

You may reduce some of the progression of chronic kidney disease with lifestyle changes such as:

• Controlling high blood pressure and blood sugar
• Eating a healthy lower protein and lower salt diet
• Losing weight
• Stopping smoking
• Exercising
• Avoiding certain medications

As the disease progresses you may need dialysis or a kidney transplant.

Not necessarily. It could be a bladder rather than a kidney problem. When the kidneys make urine, it flows down a tube called the ureter and empties into your bladder. When the bladder becomes full, you may feel the urge to pass urine.

Some people with severe kidney disease makes urine that has a lot of water but does not contain much waste products.

This means the blood has a high level of waste products, including potassium.

The most common cause of renal failure in the U.S. is diabetes. The U.S. Renal Data System ranks the top causes of kidney failure as follows:

• Diabetes (43.8% of new cases of kidney failure)
• High blood pressure (26.8%)
• Glomerulonephritis (7.6%)
• Cystic diseases (2.3%)
• Urologic diseases (2.0%)
• Other causes, combined (17.5%)

Polycystic kidney disease (PKD) is a type of kidney disease that is genetic or inherited.

Polycystic means “many cysts,” and this disorder is characterized by cysts in both kidneys (bilateral renal cysts). These cysts can grow and cause the kidneys to get larger while replacing the normal tissue.

This can ultimately result in chronic kidney disease and kidney failure over time.

GFR, which stand for glomerular filtration rate, estimates kidney function.

If your GFR is 26, that means your kidneys are working at approximately 26% of the normal rate.

There are five stages of chronic kidney disease: 

• Stage 1: Normal kidney function, but there are signs that point to kidney disease. At Risk, GFR > 90
• Stage 2: Mildly decreased kidney function, GFR 60-89 and there are signs that point to kidney disease
• Stage 3: Moderately reduced kidney function, GFR 30-59.
• Stage 4: Severely reduced kidney function, GFR 15-29.
• Stage 5: Very severe reduction in kidney function; GFR < 15, end stage renal failure

Kidney disease alters the body’s ability to balance fluid intake.

People with kidney diseases have to be very careful about their fluid intake.

Patients who do not monitor their fluid intake can gain weight and develop edema (swelling) because they are retaining water.

This extra fluid can cause higher blood pressure, breathing difficulties, and/or heart problems.

Hemodialysis is a process that removes waste products and extra fluids from the blood – a job usually performed by healthy kidneys – and it’s one of the options for treating renal failure. 

Peritoneal dialysis is another treatment option that filters the wastes and fluids, but it does so by using the lining of your belly (the peritoneum). 

Dialysis is usually tried first when renal failure occurs. These options do not cure renal failure, but they can improve the quality of life, and extend the lifespan for someone in renal failure. 

The last resort option is a kidney transplant, whereby the patient receives a kidney from a living or recently deceased donor. This can be a cure; however, the organ may be rejected, and the patient will need to be on immunosuppressant medications for the rest of their life.

How long you can live with CKD depends on your age, other health problems, and how involved you become in your care. 

Most people with early CKD will never have kidney failure. Others will reach kidney failure and may live for decades with dialysis or kidney transplants.

There are major advances in today’s healthcare. We have better drugs, know more about how to slow down kidney failure, and have updated dialysis machines. But the most important factor is still the person who has the disease. people who become partners in their care live longer. So, ask questions, and explore with your doctor and care team the best way for you to help manage your disease.

How good your life can be with CKD depends on YOU! 

In the early stages, CKD may have symptoms that are so subtle you may not even notice them. In later stages, fatigue, itching, loss of appetite, and other symptoms can reduce your quality of life—if you don’t act. How? All of these symptoms can be treated.

You can keep a good quality of life by following your treatment plan. For example, taking your medications in the right doses at the right times may help slow your kidney disease. 

Your quality of life with CKD depends on your attitude, and how you accept the changes and take control of your health and your life.

Yes, you can live long and live well with dialysis. Many people—even those with loved ones on dialysis—don’t know that there are many types of dialysis. You can choose a treatment that lets you keep doing all or most of the things you value.

People who are very sick before they start dialysis are often surprised to find that they feel much better a few weeks or months later. The unknown you imagine is often much scarier than the reality. Learn all you can, and talk to people who are doing well—like people who do their treatments at home, or while they sleep. 

You’ll see that you can have a good life on dialysis.

Even healthy people complain of being tired. But people with CKD can be so exhausted that they fall asleep during the day—even after 8 to 10 hours of sleep at night. 

One reason for fatigue can be anemia, a shortage of oxygen-carrying red blood cells. People with CKD often have anemia because damaged kidneys make less of a hormone called erythropoietin (epoetin, or EPO). EPO tells the bone marrow to make new red blood cells. Without a fresh supply of red blood cells, the body has less oxygen. This makes you more tired and cold, and less able to focus and fight disease. If your fatigue is due to anemia, your doctor may prescribe iron and injections of a man-made form of EPO.

There are a number of treatments, including medications, lifestyle and dietary changes, that may help keep your kidneys working longer. 

People can even get transplants before having dialysis, especially if they have a willing living donor.

Yes! Most people find that disability pays much less than working—but their bills don’t go away just because they’re ill. 

If you have CKD and a job, try to keep it if you can, or find a new one. 

Work can make you feel like you’re still you, and that you are still helping to support your family. Work may also be a vital part of your social life. 

If your job comes with a health plan, it can also help you get good care and pay for prescription drugs.

If you find that you feel too tired to work, see your doctor! Fatigue can be caused by anemia, which can be treated.

No two people are alike. Asking questions is the best way to find out about your health.

You’ll also find a few basic ideas below, and you can add your own. If you write your questions and show the list to your doctor, you may be more likely to get them answered. Write down the answers, too—or have someone come along to help you remember the answers.

• What percent of kidney function do I have now?
• What is the cause of my kidney problem?
• What are my lab tests results right now?
• What can I do to keep my kidneys working as long as possible?
• What treatment can I get for my symptoms? (List symptoms)
• What are the next steps for my treatment?
• Will I need dialysis or a transplant? If so, how long might it be until I do?