Chronic Kidney Disease
Chronic kidney disease or chronic renal failure is one of the complications of diabetes. The main function of the kidney is filtering blood and excretion of wasteful components. When the kidney is damaged, it starts to reduce its function. Every kidney function will be affected. Damage to the kidney will progress over time into the end-stage renal disease. In that stage kidney will shut down.
There are many causes of renal failure. In fact, every disease which affects kidneys will cause chronic renal failure if it damages kidneys over a longer period of time.
Worldwide the most common cause of kidney failure is diabetes mellitus. Almost half of diagnosed cases of chronic renal disease suffer from diabetes. Good diabetes management will reduce the risk of chronic damage to the kidney but it will not be eliminated. It can occur even in patients who control their diabetes well. The damage to the kidneys is proportional to severity of diabetes. High blood sugar will reduce the diameter of kidney blood vessels and damage them.
Other common causes are hypertension, inflammation of kidneys ( nephritis, pyelonephritis or glomerulonephritis), polycystic kidney disease, vesicoureteral reflux, enlarged prostate.
There are risk factors which can increase the possibility of renal failure. Some of them are reversible and you can affect them like smoking and obesity. But some risk factors can't be changed like age, race, abnormal structure of kidneys, positive family history.
High blood pressure and diabetes mellitus are the most common causes of damage to the kidney.
Most of the patients will not have any symptoms until the kidney is too damaged. Symptoms are caused by decreased renal functioning.
At the beginning of the disease, the kidneys will let protein molecules pass their filters and go into the urine. In this first stage, the concentration of albumins in urine are low and it is named microalbuminuria.In further stages, kidneys will release even more albumins into the urine. This is named macroalbuminuria. Excretion of proteins will damage kidneys and they will not be able to filter blood properly. Waste molecules will not be excreted.
The most often symptoms are high blood pressure, nausea, vomiting, fatigue, decreased the frequency of urination, swelling of feet, itching, chest pain, changes in mental sharpness, muscle cramps. Symptoms like loss of weight, malnutrition, muscle weakness can be caused by metabolic acidosis.
Patients with diabetes will probably develop symptoms of renal disease in the first decade of disease. After 15 to 25 years, they can expect symptoms of renal failure.
Kidney damage can progress to end-stage renal disease can cause complications. Pulmonary edema is caused by excessive fluids which are accumulated in body because of weaker excretion. Some electrolytes will be accumulated in blood. The most dangerous one is potassium which in high concentration can cause heart problems. Pericarditis is another known complication of chronic renal failure. Electrolyte imbalance will also cause problems with bones, it can cause osteopenia and osteoporosis which are often cause of fractures. Anemia is one of the most common complications.
The first step in diagnosis is a detailed patient history. It should include symptoms and signs which patient has, medications he's taking, family history. Elevated levels of urea and creatinine in the blood can indicate kidney problems. Urine is very important in the diagnosis of chronic renal failure. It may contain substances which can lead to the cause of disease. Ultrasound and other imaging techniques can be used to show the structure of the kidney. In some cases, a kidney biopsy is needed for proper diagnosis.
Patient which suffer from diabetes should have regular check-ups for symptoms of kidney disease.
Estimated glomerular filtration rate (eGFR) is important in following of disease development. In renal damage, it is under 60 mL/min/1.73 m2 for at least 3 months. It can be calculated using serum creatinine levels. Patients with diabetes should check their eGFR once per year.
Glomerular filtration rate is used for staging of chronic renal disease into 5 main stages. As the disease progresses, glomerular filtration rate reduces. In the final stage, it is reduced under 15 mL/min/1.73 m 2.
First three stages are usually asymptomatic. Symptoms occur in stage 4 of renal disease when glomerular filtration rate is significantly reduced.
Urine albumin can also be used for diagnosis. In the case of normal functioning kidneys, urine albumin level will be low and creatinine level will be high. On the other hand, in renal damage becomes chronic, urine albumin level will be high. Urine albumin level should be checked also once per year in diabetes patients.
Treatment methods of chronic renal failure depend on the cause. Symptoms can be treated but the goal should be to eliminate the cause. For example, if a chronic renal failure has been caused by diabetes then you should focus on managing your diabetes instead of treating symptoms of diabetes, such as frequent urination.
In the case of complications, there are medicines which can be used to treat them and to help to prevent further deterioration. In the case of anemia, erythropoietin which is a hormone can be used to boost up production of red blood cells. Vitamin D and calcium are used for prevention of bone fractures due to osteoporosis. A lot of people complain about swelling of feet and ankles. More severe cases can be treated using diuretics which will increase urine volume. It can also be used for the treatment of lung edema. Low potassium diet can prevent excessive accumulation of potassium in the body.
In the case of end-stage kidney disease, the situation is different. In this case, kidneys are irreparable. Only two treatment options are dialysis and kidney transplantation.
There are two types of dialysis. In hemodialysis, blood is drained from human body using arteriovenous fistula into a machine which filters the blood and removes waste products. After that clean blood is brought back into the body. In most cases, hemodialysis is needed every two days.
In the case of peritoneal dialysis, the dialysis solution is introduced into the abdominal cavity. It will help in absorption of waste products. After a few days, that solution is drained out of the abdominal cavity.
Second treatment option for end-stage kidney disease is kidney transplantation. In this case, the diseased kidney will be replaced with a healthy kidney from a donor or cadaver. The bad side of kidney transplantation is a possibility of rejection of donor's kidney.
The most important steps in prevention of chronic renal disease are the management of other diseases which can lead to chronic renal failure. You should quit smoking. It is also important to be careful when taking pain-killers. You should not use doses higher than recommended because they may damage kidneys.
Since the most important risk factor for diabetic patients is high blood pressure, it should be reduced to a minimum. Medicines should be used to lower blood pressure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are medicines of choice for this category of patients. Lisinopril is one of the ACE inhibitors. It will lower blood pressure, but it will also have protective effects on kidney itself. Losartan, which is ARB, will have the same effect on kidneys.
Patients with diabetes should not eat too many proteins in their food. As the chronic kidney disease progress, they should reduce intake of proteins.
It is very important for diabetic patients to control diabetes well. All measures should be taken to maintain blood sugar levels in normal range. If they manage to keep their diabetes well controlled, it will reduce the chance of developing symptoms of chronic kidney disease by a half.
Regular checking of A1c levels is strongly recommended. Visit your physician and check if you require adjusting your therapy. Follow strict diet plan and avoid sedentary lifestyle.
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