Renal or Kidney Disease

What do kidneys do?
People usually have two kidneys, each about the size of a fist. Kidneys are located just above the waist in the back and are partially protected by the ribs. Only the lower portion of the kidneys extends below the lower ribs. The body breaks down food and water and produces waste as a part of daily living. The job of kidneys is to get rid of those waste products. Each kidney has about a million tiny filters that clean the blood and make urine. The kidneys also help control many other bodily functions, including blood pressure, how much blood is make, calcium balance, bone health and the balance of several chemicals in the blood including potassium and acid. 

Who is most at risk for developing kidney disease?
People who are at highest risk for kidney disease are those with diabetes, high blood pressure or a family member with kidney disease. 

How would I know if I have kidney disease?
Since many kidney diseases do not cause symptoms in the early stages, your doctor can do screening tests to see if you have kidney disease. The main tests for kidney disease are blood tests to measure the level of creatinine, blood pressure checks and checking the urine for protein or other abnormalities. If screening tests suggest the presence of kidney disease, a visit with a nephrologist (kidney disease specialist) is appropriate. 

What is GFR?
Glomerular filtration rate (GFR) calculates the blood creatinine level based on a patient's age, gender and race. As the kidneys begin to slow, the amount of creatinine in the blood will increase. Part of this test is to monitor the amount of fluid the kidneys filter during a specific amount of time. 

What is chronic kidney disease?
Chronic kidney disease (CKD) is a permanent, progressive decline in the function of the kidneys. CKD progress is classified in five stages as the rate of GFR continues to decrease. CKD does not occur suddenly or all at once and may take years to reach Stage 5. When caught early enough, a person can make lifestyle changes to help slow the progress.

What are the five stages of CKD and their symptoms?

Chronic kidney disease patients considered Stages 1 through 3 are seen by their physician. Stage 4 CKD patients will receive services and treatment at the Nephrology Clinic until the illness progresses to Stage 5. At this point, the patient will begin receiving dialysis services.

Stage 1 and Stage 2 
Stages 1 and 2 have few symptoms. Often early stages are identified by testing for abnormally high levels of creatinine or urea in the blood, through MRIs, CT scans or other images of the kidneys, or evidence of blood or protein in the urine. 

GFR functions for Stage 1 CKD measures are greater than 90 ml/min for two to three consecutive months. GFR functions for Stage 2 range from 60-89 ml/mm. 

Stage 3 
In Stage 3, anemia, the reduction of red blood cells, and/or bone disease may develop. Patients who are classified as Stage 3 should be seeing a nephrologists, a physician that specializes in the kidneys, to help monitor blood pressure and glucose. During this stage, patients should educate themselves on recommendations for prolonging kidney functions. 

GFR functions for Stage 3 range from 30 to 59 ml/mm.

Stage 4 
The kidneys have severely reduced function. At this point, a patient will begin to prepare for dialysis or a kidney transplant. Other treatment options are available and patients should research and consult their nephrologist about their best option. 

GFR functions for Stage 4 range from 15 to 29 ml/mm.

Treatment Options for Stage 4 CKD patients
The two main categories of treatment options are dialysis and transplantation. The two methods of dialysis are hemodialysis and peritoneal dialysis.

Hemodialysis
Hemodialysis is one method of regulating levels of important body chemicals and removing waste products and excess fluid from the body. A hemodialysis machine uses the blood to separate waste products and excess fluid from the body. Hemodialysis requires a surgical placement of an "access device" to connect your circulatory system to the kidney machine. Access devices can be either internal (under the skin) or external perm catheters (partially on top of the skin).

During the treatment, blood will flow from your access through the tubes and dialyzer, and then return back to you. Hemodialysis treatments usually take three to four hours and are done three days per week. During the treatment you can read, write, sleep, talk or watch TV.

Home Peritoneal Dialysis 
Peritoneal dialysis uses the lining of your abdomen to filter your blood. This lining is called the peritoneal membrane. A special solution (dialysate) is placed into the peritoneal cavity (abdomen) through a catheter (a plastic tube which has been surgically placed). 

This solution remains in your peritoneal cavity for approximately four to five hours. During this time, the waste products from your blood pass through the peritoneal membrane into the dialysate. When the process is complete, the fluid is drained from your body through the catheter. This is done at home three to four times a day. It can also be done at night with the use of a cycler (a machine which performs the exchanges automatically).

Transplantation 
Depending on your age and medical condition, kidney transplantation may be a treatment alternative for you. Transplantation is a surgical operation in which you receive a kidney from a living related donor (parent, sibling or child), living non-related donor (spouse or friend), or a person who has just died.


Stage 5 or Renal Failure 
The kidneys have lost almost all of their functions and are unable to remove wastes, extra fluid and toxins from the blood. Dialysis or a transplant is needed for the patient to stay alive. Stage 5 is classified as end stage renal disease (ESRD). 

Symptoms of Stage 5 CKD or ESRD may include:

  • Nausea and vomiting
  • Difficulty concentrating
  • Swelling
  • Higher than normal blood pressure
  • Changes in skin color
  • Itching
  • Making little or no urine
  • Extreme fatigue
  • Headaches

GFR functions fall below 15 ml/mm.

Renal Failure
There are two types of renal failure, acute and chronic. The main differences between them are how rapidly the process occurs, the cause of kidney failure and the duration of the failure. Acute kidney failure is a temporary decline in kidney function which can often be corrected. It may be caused by specific types of kidney disease, severe infections, chemical or drug poisoning, surgery, injury or blockage of kidneys.

Chronic renal failure is also referred to as end stage renal disease (ESRD) and occurs from the destruction of kidney tissues over a long period of time due to certain diseases. A person can have decreased function of the kidney causing chronic renal failure and not realize it until the disease is in its final stages.

The kidney function in chronic renal failure as a rule is irreversible. Therefore, when kidney damage results in severe reduction of kidney function, dialysis or transplantation becomes necessary to sustain life. Common causes of kidney failure include: diabetes mellitus, high blood pressure, glomerulonephritis and polycystic kidney disease.

Patient Information for Stage 5 CKD
Treatment Expectations

Maintaining your independence is encouraged by participation in your treatment. You will take your temperature, weigh yourself, wash your access arm, apply pressure to your needle sites after the treatment, get water or ice chips, etc. If you are unable to do these things, assistance will be provided.

Diet
When you begin dialysis, a dietitian will review the diet the physician or nurse practitioner has ordered. What you eat and drink plays an important role in the management of your kidney disease and dialysis treatment.

Long Term Care Planning
You are expected to participate in your plan of care with a team of professionals including a nephrologist, transplant surgeon, nurse, social worker, dietitian, pastoral care member and pharmacist. A "primary nurse" is assigned to coordinate this plan of care. It is then reviewed and updated with you and your family or caregiver.

The long term program is based on a medical, nutritional and social evaluation so you and your family achieve and maintain a meaningful lifestyle within the limitations of this illness. Through this joint effort, you continue to receive the most appropriate modality of treatment. The long term program is documented by the health care team initially and updated annually.

Patient Links
The following links will help provide patients of chronic kidney disease educational information:
Life Options - resources to help with quality of life, rehab and other issues
Home Dialysis Central - resources bringing together all self-care treatment options
Kidney School - learning modules for patient education
American Association of Kidney Patients - resources for CKD patients and their families to deal with the illness