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Chronic kidney disease

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure

Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body.

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Kidney anatomy
Kidney - blood and urine flow
White nail syndrome

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Causes

Chronic kidney disease (CKD) slowly gets worse over months or years. You may not notice any symptoms for some time. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.

The final stage of CKD is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.

Diabetes and high blood pressure are the 2 most common causes and account for most cases.

Many other diseases and conditions can damage the kidneys, including:

CKD leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including:

Symptoms

The early symptoms of CKD are the same as for many other illnesses. These symptoms may be the only sign of a problem in the early stages.

Symptoms may include:

Symptoms that may occur when kidney function has gotten worse include:

Exams and Tests

Most people will have high blood pressure at all stages of CKD. During an exam, your health care provider may also hear abnormal heart or lung sounds in your chest. You may have signs of nerve damage during a nervous system exam.

A urinalysis may show protein or other changes in your urine. These changes may appear 6 to 10 months or more before symptoms appear.

Tests that check how well the kidneys are working include:

CKD changes the results of several other tests. You will need to have the following tests as often as every 2 to 3 months when kidney disease gets worse:

Other tests that may be done to look for the cause or type of kidney disease include:

This disease may also change the results of the following tests:

Treatment

Controlling blood pressure will slow further kidney damage.

Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as:

Always talk to your kidney specialist before taking any over-the-counter medicine. This includes vitamins, herbs and supplements. Make sure all of the providers you visit know you have CKD. Other treatments may include:

Your provider may have you follow a special diet for CKD.

All people with CKD should be up-to-date on the following vaccinations:

Support Groups

Some people benefit from taking part in a kidney disease support group.

Outlook (Prognosis)

Many people are not diagnosed with CKD until they have lost most of their kidney function.

There is no cure for CKD. If it worsens to ESD, and how quickly, depends on:

Kidney failure is the last stage of CKD. This is when your kidneys can no longer support our body's needs.

Your provider will discuss dialysis with you before you need it. Dialysis removes waste from your blood when your kidneys can no longer do their job.

In most cases, you will go to dialysis when you have only 10 to 15% of your kidney function left.

Even people who are waiting for a kidney transplant may need dialysis while waiting.

Possible Complications

Complications may include:

Prevention

Treating the condition that is causing the problem may help prevent or delay CKD. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke.

Related Information

Electrolytes
Acute kidney failure
End-stage kidney disease
Diabetes
High blood pressure
Glomerulonephritis
Polycystic kidney disease
Alport syndrome
Reflux nephropathy
Obstructive uropathy
Kidney stones
Analgesic nephropathy
Prerenal azotemia
Pericarditis
Cardiac tamponade
Heart failure - overview
Ulcers
Anemia
Hepatitis B
Hepatitis C
Immune response
Incidence
Peripheral neuropathy
Seizures
Dementia
Broken bone
Metabolism
High potassium level
Miscarriage
Infertility
Itching

References

Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010;362(1):56-65. PMID: 20054047 www.ncbi.nlm.nih.gov/pubmed/20054047.

Fogarty DG, Tall MW. A stepped care approach to the management of chronic kidney disease. In: Taal MW, Chertow GM, Marsden PA et al, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.

Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290. PMID: 15114537 www.ncbi.nlm.nih.gov/pubmed/15114537.

Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2012;2(4):279-335. www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO-Anemia%20GL.pdf.

Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int Suppl. 2012;2:337-414. www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO_BP_GL.pdf.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3:1-150. www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf.

McCullough PA. Interface between renal disease and cardiovascular disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 88.

Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010;362(14):1312-24. PMID: 20375408 www.ncbi.nlm.nih.gov/pubmed/20375408.

Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154(8):541-8. PMID: 21403055 www.ncbi.nlm.nih.gov/pubmed/21403055.

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Review Date: 9/22/2015  

Reviewed By: Charles Silberberg, DO, private practice specializing in nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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