Understanding kidney diseases

Kidney disease can affect your body’s ability to clean your blood, filter extra water out of your blood, and help control your blood pressure. It can also affect red blood cell production and vitamin D metabolism needed for bone health.

You’re born with two kidneys. They’re on either side of your spine, just above your waist.

When your kidneys are damaged, waste products and fluid can build up in your body. That can cause swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath. Without treatment, the damage can get worse and your kidneys may eventually stop working. That’s serious, and it can be life-threatening.

What your kidneys do

Healthy kidneys:

Keep a balance of water and minerals (such as sodium, potassium, and phosphorus) in your blood

Remove waste from your blood after digestion, muscle activity, and exposure to chemicals or medications

Make renin, which your body uses to help manage your blood pressure

Make a chemical called erythropoietin, which prompts your body to make red blood cells

Make an active form of vitamin D, needed for bone health and other things

Acute kidney problems

If your kidneys suddenly stop working, doctors call it acute kidney injury or acute renal failure. The main causes are:

Not enough blood flow to the kidneys

Direct damage to the kidneys themselves

Urine backed up in the kidneys

Those things can happen when you:

Have a traumatic injury with blood loss, such as in a car wreck

Are dehydrated or your muscle tissue breaks down, sending too much protein into your bloodstream

Go into shock because you have a severe infection called sepsis

Have an enlarged prostate that blocks your urine flow

Take certain drugs or are around certain toxins that directly damage the kidney

Have complications during a pregnancy, such as eclampsia and pre-eclampsia

Autoimmune diseases, when your immune system attacks your body, can also cause an acute kidney injury.

People with severe heart or liver failure commonly go into acute kidney injury, as well.

Chronic kidney disease

When your kidneys don't work well for longer than 3 months, doctors call it chronic kidney disease. You may not have any symptoms in the early stages, but that's when it’s simpler to treat.

Diabetes (types 1 and 2) and high blood pressure are the most common culprits. High blood sugar levels over time can harm your kidneys. And high blood pressure creates wear and tear on your blood vessels, including those that go to your kidneys.

Other conditions include:

Immune system diseases (If you have kidney disease due to lupus, your doctor will call it lupus nephritis.)

Long-lasting viral illnesses, such as HIV/AIDS, hepatitis B, and hepatitis C

Pyelonephritis, a urinary tract infections within the kidneys, which can result in scarring as the infection heals. It can lead to kidney damage if it happens several times.

Inflammation in the tiny filters (glomeruli) within your kidneys. This can happen after a strep infection.

Polycystic kidney disease, a genetic condition where fluid-filled sacs form in your kidneys

Defects present at birth can block the urinary tract or affect the kidneys. One of the most common ones involves a kind of valve between the bladder and urethra. An urologist can often do surgery to repair these problems, which may be found while the baby is still in the womb.

Drugs and toxins, such as lead poisoning, long-term use of some medications including NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen, and IV street drugs can permanently damage your kidneys. So, can being around some types of chemicals over time.

What are the symptoms of kidney disease?

You might not notice any problems if you have chronic kidney disease that’s in the early stages. Most people don’t have symptoms at that point. That’s dangerous, because the damage can happen without you realizing it.

If your chronic kidney disease is already more advanced, you may:

Be vomiting or often feel like you’re going to

Pee more often than normal, or less often

See “foam” in your pee

Have swelling, particularly of the ankles, and puffiness around the eyes

Feel tired or short of breath all the time

Not feel like eating

Not be able to taste much

Have muscle cramps, especially in your legs

Have very dry, itchy skin

Sleep poorly

Lose weight for no obvious reason

 

If you’re at risk -- you have high blood pressure or diabetes, or if kidney disease runs in your family, for instance -- ask your doctor how often you’ll need to get tested. It’s very important to do this so your kidneys can work as well as possible.

What are the treatments for kidney disease?

If a condition is “chronic,” that means it’s a long-term condition. If you have chronic kidney disease, you and your doctor will manage it together. The goal is to slow it down so that your kidneys can still do their job, which is to filter waste and extra water out of your blood so that you can get rid of them when you pee.

First, your doctor will work to find out what caused the kidney disease. For instance, it can happen if you have diabetes or high blood pressure. You may work with a nephrologist, a doctor who specializes in kidney disease.

You’ll take medicines and may need to change your diet. If you have diabetes, it needs to be managed. If your kidneys don’t work anymore, you might need dialysis (in which a machine filters your blood) and you could talk with your doctor about whether a kidney transplant would help.

Medications

High blood pressure makes chronic kidney disease more likely. And kidney disease can affect your blood pressure. So your doctor may prescribe one of these types of blood-pressure medicines:

“ACE” inhibitors, such as:

Captopril

Enalapril

Fosinopril

Lisinopril

Ramipril

Azilsartan

Eprosartan

Irbesartan

Losartan

Olmesartan

Valsartan

Along with controlling blood pressure, these medicines may lower the amount of protein in your urine. That could help your kidneys over time.

You might also need to take a medicine to help your body make erythropoietin, which is a chemical that prompts your body to make red blood cells. So you might get a prescription for darbepoetin alfa (Aranesp) or erythropoietin (Procrit, Epogen) to curb anemia.

Medicines to avoid

If your kidneys don’t work well, check with your doctor before you take any medications, including over-the-counter drugs (medicines you can get without a prescription.)

Your doctor may tell you to avoid certain pain relievers such as aspirin, ibuprofen, naproxen (Aleve) and celecoxib (Celebrex). These drugs, which doctors call “NSAIDs” (nonsteroidal anti-inflammatory drugs), could play a role in kidney disease.

If you take a type of heartburn drug called a “proton pump inhibitor (PPI),” you may also want to know that some studies show a link between those medicines and chronic kidney disease. Your doctor may want to check on whether you need these medicines, or if a different dosage or something else might work better for you.

Diet

Your doctor may put you on a special diet that’s lower in sodium, protein, potassium, and phosphate.

This diet helps because if your kidneys are damaged, it’s harder for them to get those nutrients out of your blood. The special diet means that your kidneys don’t have to work as hard.

You may also have limits on how much water can be in the foods you eat, and how much you drink.

A kidney diet specialist, called a renal dietitian, can help. Your doctor can refer you to one.

Your doctor may also advise you to take specific amounts of vitamins and minerals, such as calcium and vitamin D.

If you have diabetes or high blood pressure, you’ll need to follow your doctor’s diet advice if you have either or both of these conditions, as well as kidney disease.

With diabetes, it’s important to make the right food choices so that your blood sugar levels stay under control throughout the day.

And if you have high blood pressure, you may need a low-salt diet to help manage it.

Dialysis

If your kidneys don’t work well anymore, you’ll need dialysis to do their job.

Hemodialysis uses a machine with a mechanical filter to help cleanse your blood. You can get this done at a dialysis center, or at home (after you or a caregiver learn how).

The at-home version of the machine may seem like it would give you more freedom. But it takes longer than those that dialysis centers use. You have to do it six days a week, about 2 1/2 hours per day, instead of three times a week at a clinic. There is also the option of hemodialysis treatment at night.

Before you start hemodialysis, you’ll need surgery to make a place of access for the machine. Your surgeon may connect an artery and vein in your arm through a “fistula.” This is the most common type of access. It needs several months to heal before you can start hemodialysis.

If you need to start dialysis sooner than that, the surgeon might be able to make a synthetic graft instead of a fistula.

If neither of those options will work -- for instance, if you need to start dialysis right away -- you may get a dialysis catheter that goes into the jugular vein in your neck.

When you get hemodialysis, another tube connects the machine to your access point, so that your blood go through the dialysis machine to get cleaned and pumped back into your body. This will take several hours.

Peritoneal dialysis is a different form of dialysis. It uses the lining of the abdomen, or peritoneal membrane, to help clean the blood.

First, a surgeon implants a tube into your abdominal cavity. Then, during each treatment, a dialysis fluid called dialysate goes through the tube and into your abdomen. The dialysis fluid picks up waste products and drains out after several hours.

You’ll need several cycles of treatment -- sending in the fluid (or “instilling” it), time for the fluid to work in your abdomen, and drainage -- every 24 hours. Automated devices can now do this overnight, which may give you more independence and time during the day for usual activities.

If you do it during the day, you may need to do the whole cycle several times.

Both types of dialysis have possible problems and risks, including infection. You’ll want to talk with your doctor about the pros and cons of each option.

Kidney transplant

If your kidney disease is advanced, you could talk with your doctor about whether a kidney transplant could be an option.

A "matching" kidney may come from a living family member, from someone who’s alive and isn’t a relative, or from an organ donor who has recently died. It’s major surgery, and you may go on a wait list until a donated kidney becomes available.

A successful transplant would mean that you don’t have to get dialysis. After your transplant, you will need to take medicines so that your body accepts the donated kidney.

A kidney transplant might not be right for you if you have other medical conditions. Your age might also be an issue. And you may need to go on a wait list until a kidney is available. You’d get dialysis until your transplant can happen.

A kidney from a living donor will generally last 12 to 20 years. One that’s donated from someone who recently died may last 8 to 12 years. If you have “end stage” renal (kidney) disease, doctors consider a transplant to be the best option, if you’re a good candidate.

Can you prevent kidney disease?

To lower your chances of getting kidney disease, you’ll actually want to focus on two other conditions: diabetes and high blood pressure. They’re two of the biggest threats to your kidneys.

Many people have diabetes and/or high blood pressure and don’t know it. So if it’s been a while since your last checkup, you may want to schedule one.

If your doctor tells you that you’ve got diabetes or hypertension (another name for high blood pressure), work to bring it under control. That will spare your kidneys from the extra wear and tear that high blood sugar levels or high blood pressure cause over time.

The things you do to take care of your heart and weight -- like eating a healthy diet, not smoking, limiting alcohol, staying active, and taking any medicines your doctor prescribes -- also are good for your kidneys. So keep your healthy habits going strong!

Get Tested Regularly

If your odds for kidney disease are higher than most -- that is, if you have diabetes or high blood pressure, or if kidney problems run in your family -- you may need to get regular tests to see how well your kidneys work.

Urine tests show if you have too much protein, glucose (sugar), or blood in your urine.

Blood pressure readings check whether your blood pressure is elevated.

Fasting blood glucose tests (taken after you haven’t eaten for several hours) measure your blood sugar.

Another blood test that can be used to determine diabetes is a hemoglobin A1C, which will show your average blood sugar level over the past 2 to 3 months.

Creatinine tests measure the amount of waste from muscle activity. When the kidneys don’t work properly, creatinine levels rise.

These tests won’t prevent kidney disease. But if you find out that you have a problem when it’s still in the early stages, it could help you prevent kidney failure.

Understanding kidney diseases

Kidney disease can affect your bodys ability to clean your blood, filter extra water out of your blood, and help control your blood pressure. It can also affect red blood cell production and vitamin D metabolism needed for bone health. Youre born with two kidneys. Theyre on either side of your spine, just above your waist. When your kidneys are damaged, waste products and fluid can build up in your body. That can cause swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath. Without treatment, the damage can get worse and your kidneys may eventually stop working. Thats serious, and it can be life-threatening. What your kidneys do Healthy kidneys: Keep a balance of water and minerals (such as sodium, potassium, and phosphorus) in your blood Remove waste from your blood after digestion, muscle activity, and exposure to chemicals or medications Make renin, which your body uses to help manage your blood pressure Make a chemical called erythropoietin, which prompts your body to make red blood cells Make an active form of vitamin D, needed for bone health and other things Acute kidney problems If your kidneys suddenly stop working, doctors call it acute kidney injury or acute renal failure. The main causes are: Not enough blood flow to the kidneys Direct damage to the kidneys themselves Urine backed up in the kidneys Those things can happen when you: Have a traumatic injury with blood loss, such as in a car wreck Are dehydrated or your muscle tissue breaks down, sending too much protein into your bloodstream Go into shock because you have a severe infection called sepsis Have an enlarged prostate that blocks your urine flow Take certain drugs or are around certain toxins that directly damage the kidney Have complications during a pregnancy, such as eclampsia and pre-eclampsia Autoimmune diseases, when your immune system attacks your body, can also cause an acute kidney injury. People with severe heart or liver failure commonly go into acute kidney injury, as well. Chronic kidney disease When your kidneys dont work well for longer than 3 months, doctors call it chronic kidney disease. You may not have any symptoms in the early stages, but thats when its simpler to treat. Diabetes (types 1 and 2) and high blood pressure are the most common culprits. High blood sugar levels over time can harm your kidneys. And high blood pressure creates wear and tear on your blood vessels, including those that go to your kidneys. Other conditions include: Immune system diseases (If you have kidney disease due to lupus, your doctor will call it lupus nephritis.) Long-lasting viral illnesses, such as HIV/AIDS, hepatitis B, and hepatitis C Pyelonephritis, a urinary tract infections within the kidneys, which can result in scarring as the infection heals. It can lead to kidney damage if it happens several times. Inflammation in the tiny filters (glomeruli) within your kidneys. This can happen after a strep infection. Polycystic kidney disease, a genetic condition where fluid-filled sacs form in your kidneys Defects present at birth can block the urinary tract or affect the kidneys. One of the most common ones involves a kind of valve between the bladder and urethra. An urologist can often do surgery to repair these problems, which may be found while the baby is still in the womb. Drugs and toxins, such as lead poisoning, long-term use of some medications including NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen, and IV street drugs can permanently damage your kidneys. So, can being around some types of chemicals over time. What are the symptoms of kidney disease? You might not notice any problems if you have chronic kidney disease thats in the early stages. Most people dont have symptoms at that point. Thats dangerous, because the damage can happen without you realizing it. If your chronic kidney disease is already more advanced, you may: Be vomiting or often feel like youre going to Pee more often than normal, or less often See foam in your pee Have swelling, particularly of the ankles, and puffiness around the eyes Feel tired or short of breath all the time Not feel like eating Not be able to taste much Have muscle cramps, especially in your legs Have very dry, itchy skin Sleep poorly Lose weight for no obvious reason If youre at risk -- you have high blood pressure or diabetes, or if kidney disease runs in your family, for instance -- ask your doctor how often youll need to get tested. Its very important to do this so your kidneys can work as well as possible. What are the treatments for kidney disease? If a condition is chronic, that means its a long-term condition. If you have chronic kidney disease, you and your doctor will manage it together. The goal is to slow it down so that your kidneys can still do their job, which is to filter waste and extra water out of your blood so that you can get rid of them when you pee. First, your doctor will work to find out what caused the kidney disease. For instance, it can happen if you have diabetes or high blood pressure. You may work with a nephrologist, a doctor who specializes in kidney disease. Youll take medicines and may need to change your diet. If you have diabetes, it needs to be managed. If your kidneys dont work anymore, you might need dialysis (in which a machine filters your blood) and you could talk with your doctor about whether a kidney transplant would help. Medications High blood pressure makes chronic kidney disease more likely. And kidney disease can affect your blood pressure. So your doctor may prescribe one of these types of blood-pressure medicines: ACE inhibitors, such as: Captopril Enalapril Fosinopril Lisinopril Ramipril Azilsartan Eprosartan Irbesartan Losartan Olmesartan Valsartan Along with controlling blood pressure, these medicines may lower the amount of protein in your urine. That could help your kidneys over time. You might also need to take a medicine to help your body make erythropoietin, which is a chemical that prompts your body to make red blood cells. So you might get a prescription for darbepoetin alfa (Aranesp) or erythropoietin (Procrit, Epogen) to curb anemia. Medicines to avoid If your kidneys dont work well, check with your doctor before you take any medications, including over-the-counter drugs (medicines you can get without a prescription.) Your doctor may tell you to avoid certain pain relievers such as aspirin, ibuprofen, naproxen (Aleve) and celecoxib (Celebrex). These drugs, which doctors call NSAIDs (nonsteroidal anti-inflammatory drugs), could play a role in kidney disease. If you take a type of heartburn drug called a proton pump inhibitor (PPI), you may also want to know that some studies show a link between those medicines and chronic kidney disease. Your doctor may want to check on whether you need these medicines, or if a different dosage or something else might work better for you. Diet Your doctor may put you on a special diet thats lower in sodium, protein, potassium, and phosphate. This diet helps because if your kidneys are damaged, its harder for them to get those nutrients out of your blood. The special diet means that your kidneys dont have to work as hard. You may also have limits on how much water can be in the foods you eat, and how much you drink. A kidney diet specialist, called a renal dietitian, can help. Your doctor can refer you to one. Your doctor may also advise you to take specific amounts of vitamins and minerals, such as calcium and vitamin D. If you have diabetes or high blood pressure, youll need to follow your doctors diet advice if you have either or both of these conditions, as well as kidney disease. With diabetes, its important to make the right food choices so that your blood sugar levels stay under control throughout the day. And if you have high blood pressure, you may need a low-salt diet to help manage it. Dialysis If your kidneys dont work well anymore, youll need dialysis to do their job. Hemodialysis uses a machine with a mechanical filter to help cleanse your blood. You can get this done at a dialysis center, or at home (after you or a caregiver learn how). The at-home version of the machine may seem like it would give you more freedom. But it takes longer than those that dialysis centers use. You have to do it six days a week, about 2 1/2 hours per day, instead of three times a week at a clinic. There is also the option of hemodialysis treatment at night. Before you start hemodialysis, youll need surgery to make a place of access for the machine. Your surgeon may connect an artery and vein in your arm through a fistula. This is the most common type of access. It needs several months to heal before you can start hemodialysis. If you need to start dialysis sooner than that, the surgeon might be able to make a synthetic graft instead of a fistula. If neither of those options will work -- for instance, if you need to start dialysis right away -- you may get a dialysis catheter that goes into the jugular vein in your neck. When you get hemodialysis, another tube connects the machine to your access point, so that your blood go through the dialysis machine to get cleaned and pumped back into your body. This will take several hours. Peritoneal dialysis is a different form of dialysis. It uses the lining of the abdomen, or peritoneal membrane, to help clean the blood. First, a surgeon implants a tube into your abdominal cavity. Then, during each treatment, a dialysis fluid called dialysate goes through the tube and into your abdomen. The dialysis fluid picks up waste products and drains out after several hours. Youll need several cycles of treatment -- sending in the fluid (or instilling it), time for the fluid to work in your abdomen, and drainage -- every 24 hours. Automated devices can now do this overnight, which may give you more independence and time during the day for usual activities. If you do it during the day, you may need to do the whole cycle several times. Both types of dialysis have possible problems and risks, including infection. Youll want to talk with your doctor about the pros and cons of each option. Kidney transplant If your kidney disease is advanced, you could talk with your doctor about whether a kidney transplant could be an option. A matching kidney may come from a living family member, from someone whos alive and isnt a relative, or from an organ donor who has recently died. Its major surgery, and you may go on a wait list until a donated kidney becomes available. A successful transplant would mean that you dont have to get dialysis. After your transplant, you will need to take medicines so that your body accepts the donated kidney. A kidney transplant might not be right for you if you have other medical conditions. Your age might also be an issue. And you may need to go on a wait list until a kidney is available. Youd get dialysis until your transplant can happen. A kidney from a living donor will generally last 12 to 20 years. One thats donated from someone who recently died may last 8 to 12 years. If you have end stage renal (kidney) disease, doctors consider a transplant to be the best option, if youre a good candidate. Can you prevent kidney disease? To lower your chances of getting kidney disease, youll actually want to focus on two other conditions: diabetes and high blood pressure. Theyre two of the biggest threats to your kidneys. Many people have diabetes and/or high blood pressure and dont know it. So if its been a while since your last checkup, you may want to schedule one. If your doctor tells you that youve got diabetes or hypertension (another name for high blood pressure), work to bring it under control. That will spare your kidneys from the extra wear and tear that high blood sugar levels or high blood pressure cause over time. The things you do to take care of your heart and weight -- like eating a healthy diet, not smoking, limiting alcohol, staying active, and taking any medicines your doctor prescribes -- also are good for your kidneys. So keep your healthy habits going strong! Get Tested Regularly If your odds for kidney disease are higher than most -- that is, if you have diabetes or high blood pressure, or if kidney problems run in your family -- you may need to get regular tests to see how well your kidneys work. Urine tests show if you have too much protein, glucose (sugar), or blood in your urine. Blood pressure readings check whether your blood pressure is elevated. Fasting blood glucose tests (taken after you havent eaten for several hours) measure your blood sugar. Another blood test that can be used to determine diabetes is a hemoglobin A1C, which will show your average blood sugar level over the past 2 to 3 months. Creatinine tests measure the amount of waste from muscle activity. When the kidneys dont work properly, creatinine levels rise. These tests wont prevent kidney disease. But if you find out that you have a problem when its still in the early stages, it could help you prevent kidney failure.