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Chronic renal disease (kidney disease)

Your kidneys are an important part of your body’s urinary system, filtering water but also waste products from your blood to make urine. These can be harmful if they aren’t removed from your body. If you have kidney disease and your kidneys don’t work properly, these substances can build up and cause long-term illness.

Kidney disease can be acute, meaning it comes on quickly, or chronic which is when it lasts for more than three months. Chronic kidney disease can lead to kidney failure and this can be life-threatening.

Chronic kidney disease affects around 11 in 100 women and six in 100 men in the UK. And your risk of getting it increases as you get older.

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Details

  • Symptoms Symptoms of chronic kidney disease

    It’s quite possible that you won’t have any symptoms of chronic kidney disease, especially in the early stages. If you do have symptoms, they may include:

    • feeling sick or vomiting
    • poor appetite
    • weight loss
    • swollen feet or ankles
    • feeling tired and weak
    • restless legs and cramp in your muscles
    • itchy skin
    • shortness of breath
    • bruises on your skin

    If you have any of these symptoms, speak to your GP.

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  • Diagnosis Diagnosis of chronic kidney disease

    If you have symptoms of chronic kidney disease, your GP will ask about them and examine you. You may need to give a blood or urine sample for testing. Your glomerular filtration rate (GFR) will be measured to see how well your kidneys are working. This is the rate at which your kidneys remove waste products.

    Your GP may test for kidney disease if you’re at high risk of developing it, even if you don’t have symptoms. This could be for a number of reasons, maybe because you’ve had problems with your kidneys before. Your GP will advise you if they think you need to be tested.

    Your GP may refer you to a nephrologist (a doctor who specialises in conditions that affect the kidneys).

    You may need to have more blood and urine tests, and possibly an ultrasound or CT scan. If the cause isn’t clear from these tests, your doctor may take a kidney biopsy. This is when a small sample of your kidney tissue is taken and sent to a laboratory for testing.

    Kidney failure is diagnosed if your kidneys are no longer working well enough on their own and you need treatment with dialysis or a transplant.

  • Treatment Treatment of chronic kidney disease

    Self-help

    Your doctor may advise you to make some changes to your lifestyle, such as:

    • reducing your salt intake
    • stopping smoking
    • only drinking alcohol within the recommended limits
    • taking regular exercise
    • keeping to a healthy weight

    Don’t take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, unless your doctor prescribes them for you. Your doctor may ask you to cut down on the amount of certain foods you eat, or advise you to drink only a set amount of fluid.

    Medicines

    If your doctor can pinpoint a specific cause for your condition, you may need medicines to treat this.

    Some medicines can affect how well your kidneys work. So if this is a possibility for you, your doctor may advise you stop taking them.

    If you have high blood pressure, you may need to take medicines to reduce this. These might include angiotensin converting enzyme (ACE) inhibitors. Your doctor may also recommend medicines to reduce your risk of cardiovascular disease. These include statins to reduce high cholesterol and antiplatelets to reduce the risk of blood clots.

    You may need to take other medicines if you get complications of chronic kidney disease. One example is anaemia which can be treated with iron supplements.

    Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice.

    Non-surgical treatments

    If your GP refers you to a specialist, you may be treated in hospital – some treatments can only be done here.

    Dialysis

    If your kidneys aren’t working, you may need to have dialysis. This is an artificial way of getting rid of waste and excess water from your blood. You may only need dialysis for a short time, but if your condition is more severe, you may need to have it for the rest of your life.

    There are two types of dialysis: haemodialysis and peritoneal dialysis. If you have haemodialysis, your blood passes through a machine to filter and clean it.

    Peritoneal dialysis uses your peritoneum as a filter. This is a thin lining on the inside of your tummy (abdomen). It surrounds and supports the structures in this area, such as your stomach and liver. Like your kidneys, your peritoneum contains tiny arteries and veins, which makes it a useful filter. During dialysis, fluid is passed into the space that surrounds your peritoneum (the peritoneal cavity). As blood moves through your peritoneum, waste products move from your blood and into the dialysis fluid, which is then drained away.

    The type of dialysis you have will depend on how severe your condition is and your personal choice.

    Surgery

    Another treatment option if your kidneys aren’t working is a kidney transplant. This is when your kidneys are removed in an operation and replaced with a kidney from a donor. This treatment isn’t suitable for everybody – talk to your doctor about whether it’s an option for you.

    If you do have a kidney transplant, you’ll need to take medicines for the rest of your life. This is because your body’s natural defence system won’t recognise the new kidney as part of your body so the medicines stop it attacking it.

  • Kidney treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including kidney treatment.

  • Causes Causes of chronic kidney disease

    There are many possible causes of kidney disease. Some things that put a strain on your kidneys and increase your risk of developing chronic kidney disease include:

    • high blood pressure (hypertension)
    • diabetes
    • inflammation in the blood vessels in your kidneys
    • cysts in your kidneys (polycystic kidneys)
    • kidney stones
    • taking certain medicines, such as lithium or non-steroidal anti-inflammatory drugs (NSAIDs)
    • in men, an enlarged prostate that restricts the flow of urine
    • a condition called reflux nephropathy, where urine passes back up from your bladder towards your kidneys, instead of coming out of your body
  • Complications Complications of chronic kidney disease

    As kidney disease gets worse, you can develop:

    • high blood pressure (hypertension)
    • cardiovascular disease – meaning any condition that affects your heart or blood vessels
    • damage to your nerves
    • malnutrition – this is when you’re not getting the right nutrients you need
    • weak bones
    • anaemia
    • erectile dysfunction (in men)
    • a decreased libido, which is when you don’t feel like having sex
  • Prevention Prevention of chronic kidney disease

    It isn’t always possible to prevent chronic kidney disease but you can take some steps to lessen the risk of it developing. For example, it’s important to get any health problems, such as diabetes or high blood pressure, checked by your GP. If you get treatment for conditions like these early, it will reduce the chance of them causing chronic kidney disease.

    It’s also important to stay as healthy as possible. Take steps to stay a healthy weight, eat a balanced diet, only drink alcohol within the recommended limits, keep active and quit smoking.

    Talk to your GP about any medicines you're taking and whether they could increase the risk of kidney disease.

  • Considerations Special considerations

    If you’re pregnant, your kidneys have to work harder to remove the waste products you and your baby produce. This can have an effect on kidney disease. So if you have chronic kidney disease and are thinking about getting pregnant, it’s important to talk it through with your doctor.

  • FAQs FAQs

    What do the different stages of chronic kidney disease mean?

    Answer

    The stages of chronic kidney disease are a way of monitoring how well your kidneys are working.

    Explanation

    Stages of chronic kidney disease are defined by the glomerular filtration rate (GFR). This measures how well your kidneys filter waste products out of your body and is measured as ml/min/1.73m. This stands for millilitres (ml) per minute (min) per overall kidney function (1.73m). These stages are used only as a guide and can differ from person to person.

    • Stage 1. The GFR may be normal so you have kidney disease but your kidney is still functioning as it should. A normal GFR is about 90ml/min/1.73m.
    • Stage 2. Your GFR is reduced but only mildly. It may be between 60 and 89ml/min/1.73m.
    • Stage 3. This is a moderate reduction in GFR and is usually between 30 and 59ml/min/1.73m. This stage is sometimes split into stages 3A (45 to 59) and 3B (30 to 44).
    • Stage 4. This is when you have a severe reduction in GFR, which is usually between 15 and 29ml/min/1.73m.
    • Stage 5. This is kidney failure and your GFR is less than 15ml/min/1.73m. You may need dialysis at this stage. This is also sometimes called end-stage kidney disease.

    You’ll often only get symptoms if you have stage four or five chronic kidney disease. Measuring these stages can help your doctor plan your treatment.

    How quickly do you progress to end-stage kidney disease?

    Answer

    This is different for everybody and depends partly on the cause of your chronic kidney disease. It can also depend to some degree on how well you take care of yourself and how soon you get treatment.

    Explanation

    It’s difficult to predict how quickly chronic kidney disease can progress as it can be caused by many things. This means it can develop at different rates depending on each cause. Not everyone with chronic kidney disease will get worse.

    If you have certain health conditions, such as cardiovascular disease and diabetes, control these as well as possible because they can make kidney disease worse. Smoking is also linked to chronic kidney disease getting worse.

    It’s important to get the treatment you need as soon as possible. Your doctor will give you some guidance to help you take steps to stop chronic kidney disease getting worse.

    It’s also important to eat a healthy, balanced diet and to keep physically active. Not drinking more alcohol than the recommended daily limits and stopping smoking will help you stay as well as possible too. Take any medicines your doctor has prescribed for you.

    Which form of dialysis is best: peritoneal dialysis or haemodialysis?

    Answer

    You usually only need dialysis if you have end-stage kidney disease. Talk with your doctor about which type of dialysis is best for you.

    Explanation

    If you have end-stage kidney disease, you’re likely to need dialysis. It’s often a haemodialysis machine that comes to mind when dialysis is mentioned. But there is also another type.

    During haemodialysis, a needle is inserted into your arm and attached by a tube to a haemodialysis machine. Your blood is drawn into the haemodialysis machine and then goes back into your body after it has been filtered to remove waste products.

    Haemodialysis is usually done in a clinic or hospital, but it may be possible to have it at home. You can read or watch TV while you’re having it and a nurse will make sure that everything is working properly.

    Peritoneal dialysis uses your peritoneum as a filter. This is a thin lining on the inside of your tummy (abdomen). It surrounds and supports everything in this area of your body, such as your stomach and liver. Your peritoneum contains tiny arteries and veins, which makes it a natural filter.

    In peritoneal dialysis, a tube (catheter) is inserted into your tummy near your belly button and into the space that surrounds your peritoneum. This is called the peritoneal cavity. Two bags are connected to the catheter. One bag is placed high up and passes fresh fluid into your tummy. The other bag is placed near the floor to allow fluid containing waste products that have been filtered out through the peritoneal membrane to collect. This process is called continuous ambulatory peritoneal dialysis (CAPD).

    CAPD may be used at the same time as a machine that fills and drains your tummy (usually while you’re sleeping). This is called continuous cycling peritoneal dialysis (CCPD) or automated peritoneal dialysis (APD).

    You can usually have peritoneal dialysis at home so you don’t need to go to a clinic or hospital. This makes it more convenient than haemodialysis and you can also take the bags with you if you go away. You will need training in how to use the equipment to make sure you can manage your dialysis well on your own. There is a risk of infection so you’ll need to be really careful about keeping things clean and hygienic.

    Ask your doctor for advice on which type of dialysis is best for you.

    What is end of life care?

    Answer

    This is care you’ll receive if you decide you no longer want treatment or your kidney disease is so severe it can’t be treated. It’s also called palliative care.

    Explanation

    How you’re cared for in either of these situations is up to you.

    If you can’t have a kidney transplant or be treated with dialysis, you may choose to have end of life care. This will treat your symptoms to make you more comfortable. Talk to your doctor for information about end of life care. They can help guide you to ensure you make the choices that are right for you. You can agree a plan and talk this through together.

  • Resources Resources

    Further information

    Sources

    • Chronic kidney disease. Medscape. www.emedicine.medscape.com, published 27 August 2014
    • Renal failure (chronic). BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 25 May 2011
    • Solitary kidney. National Kidney and Urologic Diseases Information Clearinghouse. www.kidney.niddk.nih.gov, published 25 September 2013
    • The kidneys and how they work. National Kidney and Urologic Diseases Information Clearinghouse. www.kidney.niddk.nih.gov, published 21 May 2014
    • The urinary tract and how it works. National Kidney and Urologic Diseases Information Clearinghouse. www.kidney.niddk.nih.gov, published 22 January 2014
    • Chronic kidney disease (chronic renal failure). PatientPlus. www.patient.co.uk/patientplus, reviewed 16 October 2012
    • Acute kidney injury. PatientPlus. www.patient.co.uk/ patientplus, reviewed 13 September 2013
    • Chronic kidney disease. National Institute for Health and Care Excellence (NICE), July 2014. www.nice.org.uk
    • Map of Medicine. Chronic kidney disease. International View. London: Map of Medicine; 2012 (Issue 3)
    • Reflux nephropathy. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Anaemia in chronic kidney disease. PatientPlus. www.patient.co.uk/patientplus, reviewed 23 April 2014
    • Peritoneal dialysis. National Institute for Health and Care Excellence (NICE), July 2011. www.nice.org.uk
    • Dialysis. National Kidney Disease Education Program. www.nkdep.nih.gov, published 1 March 2012
    • Treatment methods for kidney failure: hemodialysis. National Kidney and Urologic Diseases Information Clearinghouse. www.kidney.niddk.nih.gov, published 25 June 2014
    • Renal disease and pregnancy. Medscape. www.emedicine.medscape.com, published 21 September 2013
    • Kidney failure: eat right to feel right on hemodialysis. National Kidney and Urologic Diseases Information Clearinghouse. www.kidney.niddk.nih.gov, published 20 November 2013
    • Choosing not to treat with dialysis or transplant. National Kidney Disease Education Program. www.nkdep.nih.gov, published 10 July 2013
    • Keep your kidneys healthy. National Kidney Disease Education Program. www.nkdep.nih.gov, published 4 June 2014
    • Treatment methods for kidney failure: Peritoneal dialysis. National Kidney and Urologic Diseases Information Clearinghouse. www.kidney.niddk.nih.gov, published 2 September 2010
    • Map of Medicine. End of life care in adults. International View. London: Map of Medicine; 2014 (Issue 3)
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