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Chronic kidney disease
Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency. With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease. Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive. Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.

Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it. Acute kidney failure is often reversible, with complete recovery of kidney function. Some patients are left with residual damage and can have a progressive decline in kidney function in the future. Others may develop irreversible kidney failure after an acute injury and remain dialysis-dependent.

==== '''Table 1. Stages of Chronic Kidney Disease''' ====


 * GFR is glomerular filtration rate, a measure of the kidney's function.

Chronic Kidney Disease Causes Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.

Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States. High blood pressure (hypertension), if not controlled, can damage the kidneys over time. Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis. Polycystic kidney disease is an example of a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts. Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys. Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage. Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease. Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.

If you have any of the following conditions, you are at higher-than-normal risk of developing chronic kidney disease. Your kidney functions may need to be monitored regularly.

Diabetes mellitus type 1 or 2 High blood pressure High cholesterol Heart disease Liver disease Amyloidosis Sickle cell disease Systemic Lupus erythematosus Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia Vesicoureteral reflux (a urinary tract problem in which urine travels the wrong way back toward the kidney) Require regular use of anti-inflammatory medications A family history of kidney disease

How Common is Chronic Kidney Disease?

Chronic kidney disease is a growing health problem. A report by the Centers for Disease Control (CDC) determined that 16.8% of all adults above the age of 20 years have chronic kidney disease. Thus, one in six individuals has kidney disease. By disease stage, the prevalence is as follows: stage 1, 3.1%; stage 2, 4.1%; stage 3, 7.6%; stage 4; and stage 5, 0.5%. There are over 500,000 persons on dialysis or who have received kidney transplants. The prevalence of chronic kidney disease has increased by 16% from the previous decade. The increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have contributed to this increase in kidney disease. Chronic kidney disease is more prevalent among individuals above 60 years of age (39.4%). Kidney disease is more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.

Chronic Kidney Disease Symptoms The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left. Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease. Effects and symptoms of chronic kidney disease include;

need to urinate frequently, especially at night (nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood pressure; fatigue and weakness (from anemia or accumulation of waste products in the body); loss of appetite, nausea and vomiting; itching, easy bruising, and pale skin (from anemia); shortness of breath from fluid accumulation in the lungs; headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome; chest pain due to pericarditis (inflammation around the heart); bleeding (due to poor blood clotting); bone pain and fractures; and decreased sexual interest and erectile dysfunction.

When to Seek Medical Care Several signs and symptoms may suggest complications of chronic kidney disease. Call your health care practitioner if you notice any of the following symptoms:

Change in energy level or strength Increased water retention (puffiness or swelling) in the legs, around the eyes, or in other parts of the body Shortness of breath or change from normal breathing Nausea or vomiting Lightheadedness Severe bone or joint pain Easy bruising Itching

If you have diabetes, high blood pressure, or kidney problems, see your health care practitioner right away if you know or suspect that you are pregnant. See your health care practitioner as recommended for monitoring and treatment of chronic conditions such as diabetes, high blood pressure, and high cholesterol. The following signs and symptoms represent the possibility of a severe complication of chronic kidney disease and warrant a visit to the nearest hospital emergency department.

Change in level of consciousness - extreme sleepiness or difficult to awaken Fainting Chest pain Difficulty breathing Severe nausea and vomiting Severe bleeding (from any source) Severe weakness

Chronic Kidney Disease Treatment Self-Care at Home Chronic kidney disease is a disease that must be managed in close consultation with your health care practitioner. Self-treatment is not appropriate.

There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications. This is a complex process and must be individualized, generally with the help of your health care practitioner and a registered dietitian.

The following are general dietary guidelines:

Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you. Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure. Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake. Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes. Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.

Other important measures that you can take include:

carefully follow prescribed regimens to control your blood pressure and/or diabetes; stop smoking; and lose excess weight.

In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:

Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example]) Fleets or phosphosoda enemas because of their high content of phosphorus Laxatives and antacids containing magnesium and aluminum such as magnesium hydroxide (Milk of Magnesia) and famotidine (Mylanta) Ulcer medication H2-receptor antagonists: cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease) Decongestants such as pseudoephedrine (Sudafed) especially if you have high blood pressure Alka Seltzer, since this contains large amounts of salt Herbal medications

If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your health care practitioner as recommended for follow-up and monitoring. Control Your Blood Pressure — keep your blood pressure below 130/85 (adults) with weight loss and exercise, a low sodium/low fat diet, reducing stress, and taking your blood pressure medication correctly. For some patients, the target blood pressure is lower (125/75). Controlling high blood pressure may delay the progression of kidney disease by slowing damage to the kidneys.

Ask Your Doctor About Anemia — Anemia—a shortage of red blood cells—starts very early in kidney failure. Anemia can cause you to feel tired and worn out, and can damage your heart. Heart disease is the leading cause of death in people with kidney problems. Ask your doctor about medications such as epoetin (EPO) and iron to treat anemia.

Control Your Blood Sugar Levels — if you have diabetes, stay at a healthy weight, exercise, and take medications as prescribed to keep your blood glucose in the "normal" range. Tight control of blood sugar can help slow the progression of kidney disease. Your HbA1c levels, which measure your blood sugar control over a period of 3 months, should be less than 6.5%.

Exercise — with your doctor's permission, start a regular exercise program to control weight and keep your heart healthy and blood vessels working as well as possible. It is very important to keep your muscles and joints in good working order. Although written for people on dialysis, Exercise: A Guide for People on Dialysis has useful information to help anyone with a chronic illness increase physical activity. Chronic Kidney Disease Prevention Chronic kidney disease cannot be prevented in most situations. You may be able to protect your kidneys from damage, or slow the progression of the disease by controlling your underlying conditions such as diabetes mellitus and high blood pressure.

Kidney disease is usually advanced by the time symptoms appear. If you are at high risk of developing chronic kidney disease, see your health care practitioner as recommended for screening tests. If you have a chronic condition such as diabetes, high blood pressure, or high cholesterol, follow the treatment recommendations of your health care practitioner. See your healthcare practitioner regularly for monitoring. Aggressive treatment of these diseases is essential.

Avoid exposure to drugs especially NSAIDs (nonsteroidal antiinflammatory drugs), chemicals, and other toxic substances as much as possible. ommended for follow-up and monitoring.