End Stage Renal Disease

Kidney failure, also known as end-stage renal disease, happens when your kidneys gradually stop working properly. This gradual decline is called chronic kidney disease. Your kidneys are like tiny filters that remove waste and extra water from your blood and send it out as urine. When your kidneys stop working well, harmful levels of waste products, salts (electrolytes), and extra water build up in your body. This buildup can be very dangerous.

If you have kidney failure, you'll need either dialysis (a machine that filters your blood) or a kidney transplant to stay alive. Alternatively, you can choose a treatment approach focused on managing your symptoms and improving your quality of life, often called conservative care. This approach aims to help you live as comfortably as possible with kidney failure.

Kidney disease can sneak up on you. Early on, you might not notice anything wrong. But as the disease gets worse, you might experience some symptoms. These symptoms can include feeling nauseous or vomiting, losing your appetite, and feeling tired and weak.

You might also notice changes in how often you urinate. If fluid builds up around your heart, you could have chest pain. Fluid buildup in your lungs can cause shortness of breath. Swelling in your feet and ankles is another possible sign.

High blood pressure that's hard to control is also a common symptom. You might experience headaches, trouble sleeping, or have a harder time concentrating. Muscle twitches or cramps, persistent itching, and a metallic taste in your mouth are also possible.

Important Note: These symptoms can sometimes be caused by other illnesses. This is why they're not always clear signs of kidney disease. Your kidneys can sometimes compensate for the damage, meaning you might not have symptoms until the damage is severe and irreversible.

Because kidney disease can be tricky, it's important to see a doctor if you have any of these symptoms. If you have a health condition that puts you at higher risk for kidney disease, your doctor will likely check your kidney function with blood and urine tests, and monitor your blood pressure during regular checkups. Don't hesitate to ask your doctor if these tests are needed for you.

Kidney disease happens when something damages your kidneys, making them work less well over time. This damage can sometimes continue even after the initial problem is fixed. Several things can cause kidney disease:

• Diabetes: Both type 1 and type 2 diabetes can harm the kidneys. High blood sugar levels over time can damage the tiny filters in your kidneys.

• High Blood Pressure: High blood pressure puts extra strain on your kidneys. Over time, this strain can lead to damage.

• Inflammation of the kidneys: Conditions like glomerulonephritis and interstitial nephritis cause inflammation in parts of the kidneys. Glomerulonephritis affects the filtering units, while interstitial nephritis affects the tubes and surrounding areas. Inflammation can damage the kidney's ability to function properly.

• Inherited Kidney Diseases: Some people are born with conditions like polycystic kidney disease that can damage their kidneys over time. These conditions affect the structure and function of the kidneys.

• Blockages in the Urinary Tract: Problems like an enlarged prostate, kidney stones, or some cancers can block the flow of urine. This blockage can damage the kidneys.

• Urine Backflow: Vesicoureteral reflux is a condition where urine flows backward into the kidneys. This can cause damage and infection over time.

• Kidney Infections: Repeated kidney infections (pyelonephritis) can harm your kidneys. These infections need to be treated promptly to prevent long-term damage.

It's crucial to remember that these are just some of the possible causes of kidney disease. If you have concerns about your kidney health, it's important to talk to a doctor.

Several things can make chronic kidney disease (CKD) get worse faster and lead to kidney failure. These include:

• Poorly controlled diabetes: If your blood sugar levels aren't well managed, it puts extra strain on your kidneys. This strain can speed up the progression of CKD.

• Damage to the glomeruli: The glomeruli are tiny filters in your kidneys that remove waste from your blood. If these filters are damaged, your kidneys can't work as well, and CKD may worsen faster.

• Polycystic kidney disease: This is a genetic condition where cysts (fluid-filled sacs) grow in the kidneys. These cysts can damage the kidneys and lead to faster progression of CKD.

• High blood pressure: High blood pressure puts extra pressure on your blood vessels, including the ones in your kidneys. This extra pressure can damage the kidneys and increase the risk of CKD progressing to kidney failure.

• Smoking: Smoking damages blood vessels throughout the body, including those in the kidneys. This can harm the kidneys and speed up the progression of CKD.

• Certain ethnicities: People of Black, Hispanic, Asian, Pacific Islander, or American Indian descent have a higher chance of developing CKD and having it progress more quickly. This is likely due to a combination of factors, including genetics and lifestyle.

• Family history of kidney failure: If someone in your family has had kidney failure, you have a higher risk of developing CKD yourself and having it progress more quickly. This may be due to shared genetic predispositions.

• Older age: As you get older, your kidneys naturally become less efficient, and this can increase the likelihood of CKD progressing to kidney failure.

• Certain medications: Some medicines can be hard on the kidneys. Taking certain medications regularly could increase the risk of kidney damage and faster progression of CKD. It's important to talk to your doctor about any medications you are taking and any potential side effects on your kidneys.

Understanding these risk factors can help you and your doctor take steps to manage your kidney health and slow the progression of CKD.

Kidney damage is permanent. If your kidneys are harmed, they can't repair themselves. This damage can lead to a wide range of problems throughout your body.

Common Complications:

• Fluid Buildup: Your body might hold onto extra water, causing swelling in your arms and legs. This extra fluid can also build up in your lungs (pulmonary edema), making it hard to breathe. High blood pressure is also a common result of fluid retention.

• Potassium Imbalance: Your blood might have too much potassium (hyperkalemia). This can harm your heart's ability to beat properly and can be life-threatening.

• Heart Problems: Kidney damage often leads to heart disease, increasing your risk of heart attack or stroke.

• Weak Bones: Kidney disease can weaken your bones, making them more fragile and increasing the risk of fractures.

• Anemia: Kidney disease can cause a shortage of red blood cells, leading to anemia (tiredness and weakness).

• Sexual Health Issues: Kidney problems can affect your sex drive, cause erectile dysfunction in men, or reduce fertility in both men and women.

• Brain Issues: The central nervous system can be affected by kidney damage, potentially causing problems with focus, changes in mood, or even seizures.

• Weakened Immunity: Your immune system might not work as well, making you more susceptible to infections.

• Heart Inflammation: The sac around your heart (pericardium) may become inflamed (pericarditis).

• Pregnancy Risks: Women with kidney disease face increased risks during pregnancy for themselves and their unborn babies.

• Poor Nutrition: Kidney disease can make it difficult to absorb nutrients, leading to malnutrition.

• Kidney Failure: Eventually, the damage to your kidneys can become so severe that your kidneys stop working properly (end-stage kidney disease). This usually requires either dialysis (a machine that filters your blood) or a kidney transplant to survive.

Taking care of your kidneys when you have kidney disease can involve several simple lifestyle changes. These changes can help slow down the progression of the disease.

Healthy Habits for Kidney Health

• Maintain a Healthy Weight: Keeping a healthy weight is important for overall health, and it can significantly impact kidney health. Being overweight or obese puts extra stress on your kidneys. Talk to your doctor or a registered dietitian about a healthy weight for you and a plan to achieve it.

• Stay Active: Regular physical activity, most days of the week, is crucial. Aim for at least 30 minutes of moderate-intensity exercise, like brisk walking or swimming. This helps control your weight, blood pressure, and blood sugar levels, all of which are beneficial for your kidneys.

• Balanced Diet: A balanced diet is key. It's important to limit protein intake, as this can put extra strain on your kidneys. Focus on eating a variety of nutritious foods that are low in sodium. A registered dietitian can help you create a meal plan that meets your specific needs.

• Manage Blood Pressure: High blood pressure is a major risk factor for kidney disease. Working with your doctor to manage your blood pressure through lifestyle changes (like diet and exercise) and medications, if needed, is very important.

• Medication Adherence: Taking your medications as prescribed is vital. This applies to all medications, not just those related to kidney disease. If you have questions or concerns about your medications, talk to your doctor.

• Regular Cholesterol Checks: High cholesterol can damage your kidneys over time. Annual cholesterol checks are important for early detection and management. If needed, your doctor may recommend lifestyle changes or medications to help lower your cholesterol levels.

• Control Blood Sugar: If you have diabetes, controlling your blood sugar is essential for preventing further kidney damage. Work closely with your doctor to manage your blood sugar levels through diet, exercise, and medication, if necessary.

• Avoid Tobacco: Smoking and using tobacco products are harmful to your entire body, including your kidneys. Quitting smoking is one of the best things you can do for your health.

• Regular Checkups: Regular appointments with your doctor are crucial for monitoring your kidney function and overall health. This allows your doctor to detect any problems early and adjust your treatment plan as needed.

By making these healthy choices, you can help protect your kidneys and improve your overall health and well-being. Remember to always discuss any changes to your diet or lifestyle with your doctor or a registered dietitian.

Understanding Kidney Biopsies and Disease

A kidney biopsy is a procedure where a doctor takes a tiny piece of kidney tissue using a needle. This tissue sample is then sent to a lab to be examined under a microscope. The needle is often guided by an imaging tool like ultrasound, to help ensure it's inserted precisely.

Doctors use several methods to diagnose kidney problems, including kidney disease. They might ask about your family's and your own medical history, and perform physical and neurological exams. They will likely order various tests, including:

• Blood tests: These check the levels of waste products like creatinine and urea in your blood. High levels of these can indicate kidney problems.
• Urine tests: These look for protein (albumin) in your urine. Protein in the urine can also be a sign of kidney damage.
• Imaging tests: X-rays, ultrasounds, MRIs, or CT scans can help doctors see the structure and health of your kidneys, looking for any abnormalities.
• Kidney biopsy: As mentioned before, removing a small tissue sample allows doctors to examine the kidney tissue under a microscope to see the extent of any damage and the type of kidney disease present.

These tests, and potentially others, may be repeated over time to monitor how your kidney disease is progressing.

Stages of Kidney Disease

Kidney disease often progresses through several stages. A key measure of kidney function is the Glomerular Filtration Rate (GFR). GFR measures how well your kidneys filter blood. It's measured in milliliters per minute (mL/min). As the GFR decreases, so does your kidney function.

The GFR can help determine the stage of kidney disease you have. Doctors also look at the presence of protein in your urine. Here's a simplified breakdown of kidney disease stages:

| Stage | GFR (mL/min) | Kidney Function | |---|---|---| | 1 | 90 or above | Healthy | | 2 | 60-89 | Mild loss of function | | 3a | 45-59 | Mild to moderate loss of function | | 3b | 30-44 | Moderate to severe loss of function | | 4 | 15-29 | Severe loss of function | | 5 | Less than 15 | Kidney failure |

What is End-Stage Renal Disease (ESRD)?

End-stage renal disease (ESRD) happens when your kidneys are no longer functioning well enough to support your body's needs. This usually occurs when your GFR drops to less than 15% of normal. In this stage, you need specialized care and often dialysis or a kidney transplant.

Getting Help

If you have concerns about your kidneys, or are experiencing symptoms, talk to your doctor. Early diagnosis and management are crucial to slowing the progression of kidney disease and improving your overall health. If you have been diagnosed with end-stage renal disease, you will need ongoing medical care from a team of specialists.

Understanding Kidney Failure Treatments

Kidney failure, also known as end-stage renal disease, can be managed in several ways. One option is a kidney transplant.

Kidney Transplant:

A kidney transplant replaces a person's failing kidneys with a healthy one from a living or deceased donor. This is often the preferred treatment over dialysis, as it allows the person to live a more normal life.

How it Works:

During the surgery, the donor kidney is placed in the lower abdomen. Blood vessels from the new kidney are connected to blood vessels in the lower abdomen, near a leg. The kidney's tube (ureter) is connected to the bladder. The person's original kidneys are usually left in place unless they cause problems.

The Process:

Finding a suitable donor, whether living or deceased, is a crucial step. Matching the donor's kidney to the recipient's is important. The surgery is followed by several days in the hospital. After discharge, regular checkups are necessary to monitor recovery. Medication is often required to prevent the body from rejecting the new kidney and to reduce complications. With a successful transplant, the new kidney filters the blood, eliminating the need for dialysis.

Dialysis:

Dialysis is a process that helps the body when the kidneys are unable to function properly. It removes extra fluid and waste products from the blood, balances electrolytes, and helps control blood pressure. There are two main types:

1. Peritoneal Dialysis:

This type uses the lining of the abdomen (peritoneum) as a filter. A catheter is placed in the abdomen to allow a special fluid to flow in and out, drawing out excess fluids and waste. The process happens in the home, with fluid exchanges happening regularly.

2. Hemodialysis:

In hemodialysis, a machine filters the blood. The blood is run through a filter (artificial kidney) that removes excess fluids, chemicals, and waste. The cleaned blood is then returned to the body. This treatment is often done at a medical center, but can sometimes be done at home. To perform hemodialysis, access to a vein is needed. This can be achieved through a surgically created fistula (joining two blood vessels) or a graft (a tube connecting blood vessels). In emergencies, a catheter may be temporarily inserted into a large vein.

Palliative Care:

If a kidney transplant or dialysis isn't chosen, palliative care can help manage symptoms and improve quality of life. This care focuses on comfort, symptom relief, and planning for the end of life. Palliative care can be used in conjunction with either dialysis or transplantation. Without dialysis or transplant, kidney failure leads to death, sometimes quickly, or over months or years.

Learning you have kidney failure can be overwhelming, even if you've been managing kidney disease for a while. Dealing with dialysis treatments can be tough. Here are some ways to cope:

Connect with others: Talking to people who understand what you're going through can be incredibly helpful. People with end-stage kidney disease often share similar experiences and feelings. Ask your doctor about support groups in your area. You can also find local support groups through organizations like the American Association of Kidney Patients, the National Kidney Foundation, or the American Kidney Fund. Connecting with others facing similar challenges can provide valuable emotional support and practical advice.

Maintain your routine: Try to keep up with your usual activities as much as possible. If you can, continue working and enjoying your hobbies. This will help maintain a sense of normalcy and stability during this challenging time.

Stay active: Regular physical activity, with your doctor's approval, can be beneficial for managing fatigue and stress. Aim for at least 30 minutes of activity most days of the week. Even light exercise can make a difference. Discuss suitable activities with your doctor to ensure they align with your current health condition.

Talk to someone you trust: Sharing your feelings with a friend, family member, faith leader, or counselor can be very helpful. Your doctor may be able to recommend a social worker or counselor who specializes in helping people with chronic illnesses. Talking about your emotions is a crucial part of managing stress and coping with a serious health condition.