Main
- The filtering units of the kidneys are gradually replaced by scar tissue, so harmful substances accumulate unnoticed.
- Diabetes mellitus and persistent hypertension are the leading causes in which the kidneys are affected first.
- A blood test for creatinine with calculation of the glomerular filtration rate shows how effectively the kidneys cleanse the blood.
- Such patients are managed by a nephrologist, and in their absence, by a physician who provides a referral.
- Giving up smoking and controlling blood pressure slow the loss of kidney function, but require consistency.
What is chronic kidney disease
Chronic kidney disease is a condition in which the kidneys gradually lose their ability to filter the blood and perform their functions. The process is long-term, may develop unnoticed and requires medical supervision.
What happens in the body
Chronic kidney disease affects the system responsible for cleansing the blood of excess substances and fluid. The kidneys contain many small filtering units through which the entire volume of blood passes daily. In this condition, the filtering units are gradually damaged and replaced by scar tissue. As a result, harmful substances accumulate in the body, and the volume of fluid excreted decreases. A person may not notice the changes for a long time, because the remaining filters work under increased load. Over time, swelling, fatigue and changes in blood tests appear. Therefore, it is important to check kidney function regularly if there are diseases that can impair it.
What causes it
- Diabetes mellitus: elevated blood sugar levels damage the small vessels of the kidneys, and over time this impairs their filtering ability.
- Hypertension: persistently high blood pressure creates constant strain on the kidney vessels, causing their walls to gradually change.
- Glomerulonephritis: inflammation affects the glomeruli of the kidneys, and without control the process may become long-term with loss of function.
- Polycystic kidney disease: an inherited condition in which multiple cavities form in the kidney tissue, gradually displacing the working tissue.
- Long-term use of certain painkillers: regular use of such medicines creates additional strain on the kidney tissue and contributes to its damage.
- Atherosclerosis and other vascular diseases: narrowing of the vessels worsens the blood supply to the kidneys, which over time affects their function and general condition.
Who is affected more often
Chronic kidney disease is more common in people with long-standing metabolic and vascular diseases. Diabetes mellitus and persistently high blood pressure remain the leading conditions in which the kidneys are affected first. The attention group also includes people with inflammatory and inherited kidney diseases, as well as those who take painkillers for a long time. Age affects the risk: over the years, kidney tissue naturally loses part of its working capacity. Heredity also matters, especially if close relatives had kidney problems. In some people, the cause cannot be identified, and then monitoring becomes especially important. Therefore, if any of these circumstances apply, it is worth discussing regular kidney function testing with a doctor.
What symptoms can occur?
Chronic kidney disease may go unnoticed for a long time, so it is often discovered incidentally during an examination. Changes in how you feel can raise suspicion of the problem, and it is important to discuss them with a doctor in good time.
How it is noticed at the very beginning
In the early stages, chronic kidney disease often causes no noticeable symptoms, and the person feels as usual. The increased fatigue and weakness that appear are usually put down to tiredness after work or lack of sleep. Swelling of the legs, face or around the eyes is also easily explained by a long day on your feet or salty food. A change in the amount of urine — a decrease or an increase — is rarely seen as a reason for concern. Nausea and loss of appetite are often attributed to overwork or dietary lapses. Itchy skin and dryness are blamed on the weather or household care products. Breathlessness on exertion seems to be a consequence of reduced physical fitness rather than a signal from the kidneys. If such changes persist and recur, it is worth booking a routine appointment with a nephrologist or a general physician for an examination.
Signs that occur most often
- Increased fatigue and weakness: a person tires more quickly from usual tasks, and rest does not restore former energy, which interferes with work and everyday activities.
- Swelling of the legs, face or around the eyes: the skin looks puffy, the mark from shoes or a ring lasts longer than usual, and this is noticeable even without exertion.
- A change in the amount of urine: the volume becomes less or more than usual, which reflects impaired kidney function and requires a doctor's attention.
- Nausea and loss of appetite: food no longer brings pleasure, a distressing feeling of nausea appears, causing the person to lose weight and become weaker.
- Itchy skin and dryness: the skin itches and flakes for no apparent reason, and the scratching interferes with sleep and everyday activities.
- Breathlessness on exertion: usual walking or climbing stairs feels harder than before, and this is a reason to discuss the condition with a doctor.
When to seek help urgently
Examinations and tests
Examination for chronic kidney disease is built around blood and urine tests that show how the kidneys are working. Imaging and, if needed, a biopsy are added to them in order to understand the cause of the impairment.
How the examination begins
The examination begins with a conversation and a physical examination, during which the doctor clarifies the complaints, past illnesses and medications being taken. Then a blood test for creatinine is ordered, from which the glomerular filtration rate is calculated. This indicator reflects how effectively the kidneys clear the blood of metabolic products. In parallel, a general urine test and a protein test are taken, because loss of protein indicates damage to kidney tissue. Additionally, the level of electrolytes and other blood indicators is assessed in order to see shifts in the internal environment. If the cause remains unclear, the doctor may refer you for an ultrasound examination of the kidneys, and in certain cases discuss a biopsy. Keep all results and discharge summaries: they show how the indicators change over time, and this helps the doctor assess the situation more accurately.
What is ordered and what it shows
What is worth preparing for the appointment
- Discharge summaries: all medical documents from previous years, including doctors' conclusions and hospitalisation results, in order to reconstruct the picture.
- Tests: previous blood and urine results with dates, because they show how the indicators have changed over time.
- List of medications: the names of everything you take regularly, including supplements, as this affects the assessment of your condition.
- Measurements: records of home measurements of blood pressure and weight, if you keep them, they help to notice hidden changes.
- Questions: write down in advance what you want to clarify with the doctor, so as not to forget anything important during the conversation.
Which doctor should I see?
This section explains which doctor to consult for chronic kidney disease, what happens at the first appointment and what areas of care the treatment consists of.
Which specialist manages this condition
Chronic kidney disease is managed by a nephrologist, or, in their absence, by a physician. The nephrologist assesses kidney function using blood and urine tests, checks blood pressure and determines how reduced the filtration is. The physician manages the patient if the disease is detected for the first time and basic testing is needed. They also refer the patient to a nephrologist when the condition requires clarification or becomes more complex. At the first appointment, the doctor asks about complaints, past illnesses and medications being taken. Then they examine the patient, measure blood pressure and compare the results with previous tests. Next, they determine which tests need to be repeated and how often to be monitored. If a specialist is not available nearby, it is worth starting with a physician: they will give a referral and will not leave the condition without monitoring.
What the treatment consists of
- Blood pressure and sugar control: the doctor selects therapy that keeps these values within the target range, because their fluctuations accelerate kidney damage.
- Diet: limiting salt, protein and potassium as recommended by the specialist reduces the load on the kidneys and helps to contain the progression of the disorders.
- Anaemia and mineral metabolism: these are treated separately, as a disruption in these areas increases weakness and affects the condition of the bones.
- Monitoring and tests: regular visits to the nephrologist and repeat tests show whether the process is slowing down or speeding up.
- Replacement therapy: dialysis or a kidney transplant are discussed at the terminal stage, when the kidneys can no longer cope on their own.
What depends on the patient themselves
The regularity of monitoring determines how predictably chronic kidney disease will develop. If you come to the doctor at the appointed times and take tests, the specialist will notice changes in time and adjust the care. Missed visits lead to deterioration being noticed late, when there are fewer opportunities to influence the process. Home monitoring of blood pressure and sugar gives the doctor an accurate picture between appointments, rather than fragmentary data. Following the diet as recommended by the specialist only works with consistency: one-off restrictions do not give the desired effect. Records of how you feel and your values help to notice the connection between your condition and everyday habits. A patient who understands their tasks and carries them out is less likely to end up in hospital unexpectedly. Therefore, it is worth clarifying with the doctor in advance what to measure at home and when to come for the next check-up.
What helps prevent an exacerbation?
Preventing an exacerbation of chronic kidney disease is helped by everyday control of risk factors and timely treatment of conditions that can damage the kidneys. Below is what exactly depends on the person themselves and how regular monitoring reduces the likelihood of deterioration.
What is changed in habits
Everyday habits directly affect the load on the kidneys and the rate of changes in their tissue. Giving up smoking reduces damage to the vessels supplying the renal glomeruli, and therefore slows the loss of their function. Maintaining a healthy weight reduces the risk associated with excess body weight and the accompanying rise in blood pressure. Cautious use of painkillers and other agents capable of damaging the kidneys reduces the additional toxic load on the organ. Timely treatment of urinary tract infections prevents inflammation from spreading to the kidney tissue. Limiting salt in the diet helps keep blood pressure within more stable limits. Sufficient drinking supports normal urine flow and reduces the risk of stagnation that provokes inflammation. Discuss with your attending physician all the agents you take on a regular basis, even over-the-counter ones, in order to exclude an unnecessary load on the kidneys.
What should be kept under control
- Blood pressure: it is measured regularly, because a persistent rise gradually damages the kidney vessels and accelerates deterioration.
- Blood sugar level: elevated sugar damages the renal glomeruli, so it is important to keep it within target limits.
- Urinary tract infections: they are treated in a timely manner, since neglected inflammation can spread to the kidney tissue.
- Painkillers: they are used cautiously and as prescribed by a doctor, since some of these agents are toxic to the kidneys.
- Weight and smoking: controlling body weight and giving up tobacco reduce the overall load on the body and the kidneys.
- Preventive check-ups with a general practitioner: regular check-ups help notice a problem at an early stage, when it is not yet felt.
How often to see a doctor
Regular visits to a general practitioner are needed even when you feel well and nothing is troubling you. Chronic kidney disease often runs unnoticed, and changes in test results appear earlier than complaints. During the check-up the doctor assesses blood pressure, weight and general condition, and also clarifies which agents the person takes on a regular basis. Urinary tract infections that have occurred are discussed separately, because it is important to treat them in a timely manner. If close relatives have had problems with the kidneys or with blood pressure, this should be reported to the doctor. Missed visits lead to deterioration being detected late, when there are fewer opportunities to influence the course. Together with the doctor, draw up a clear monitoring schedule and stick to it, even if the condition seems stable.
What is worth remembering
Chronic kidney disease is a condition in which the function of the organ declines gradually and remains unnoticed for a long time. Below is the main thing worth keeping in mind after getting acquainted with the topic.
Key takeaways
Chronic kidney disease develops slowly, and a person's well-being may remain familiar for a long time, so relying only on how you feel is unreliable. Regular tests help to suspect a problem, as they show kidney function long before complaints appear. Many people learn about the condition by chance, during an examination for another reason, and perceive the result as a formality. Meanwhile, it is early detection that gives time to influence the course of the disease and preserve the organ's function for longer. One should not postpone a visit to the doctor after abnormal test results, even if nothing is bothering you. Chronic kidney disease does not always require urgent measures, but it always requires careful attention and monitoring. A reasonable step is to discuss the results, risk factors and a further plan with the doctor, rather than looking for explanations on your own.
