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Chronic renal disease (kidney disease)


Expert reviewer, Raj Persad, Consultant Urologist, February 2017
Next review due May 2020

Your kidneys are responsible for filtering out waste products from your body and getting rid of them in the form of urine. They also play a part in making red blood cells, balancing the amount of fluid in your cells and controlling your blood pressure. So, if your kidneys don’t work properly, it can lead to a number of serious long-term health problems.


An image showing the location of the bladder and surrounding structures

About chronic kidney disease

Chronic kidney disease is when the condition lasts for three months or longer. It’s sometimes called chronic renal failure. Around one in ten people have the condition, and the chance of developing it increases as you get older.

If you have chronic kidney disease, you may also have other long-term diseases. For example, you’re more likely to develop cardiovascular disease if you have chronic kidney disease. If you have type 2 diabetes, you’re at a higher risk of developing chronic kidney disease if you’re diabetes isn’t controlled well. Chronic kidney disease can be life-threatening.

Symptoms of chronic kidney disease

Chronic kidney disease is often diagnosed when you’ve already had it for some time, because there are usually no symptoms. It’s often discovered when you have a routine check-up for another health problem. Or it can be found when you have a regular check-up for another condition, such as type 2 diabetes.

If you do have symptoms, they may include:

  • feeling sick or being sick
  • losing weight
  • swollen feet or ankles
  • feeling tired and weak
  • itchy skin
  • impotence (erectile dysfunction)

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

Diagnosis of chronic kidney disease

Chronic kidney disease, as with conditions such as diabetes, may be picked up at a routine check-up or at an appointment for another health condition you may have.

If you have a long-term health condition, such as high blood pressure or diabetes, your GP will regularly test you to see how well your kidneys are working. Your GP will also test you for kidney problems if there is kidney disease in your family.

If your GP thinks you may have kidney disease, they will do several tests. These can show how well your kidneys work, what the cause of any problem may be, and whether kidney disease has caused other health issues.

Your GP will arrange for you to have the following tests.

  • Blood tests, including one for GFR. GFR stands for glomerular filtration rate, which shows how much blood is filtered by your kidneys over a set time. It also measures a chemical called creatinine. This is a waste product produced by your muscles, which is cleared out of your body by your kidneys. You’ll be asked not to eat any meat for 12 hours before the test. The results of this test can help your doctor to see how severe the kidney disease is. See our FAQs about stages of kidney disease for more information.
  • Urine tests, including one to check for any blood or protein.

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

You may also need to have an ultrasound, magnetic resonance imaging (MRI) scan or computer tomography (CT) scan to find out the cause of your kidney disease. You might also have a kidney biopsy. This is when a small sample of your kidney tissue is taken and sent to a laboratory for testing.

Treatment of chronic kidney disease

Chronic kidney disease gradually gets worse over time, so treatment focuses on slowing this down. Your doctor will work with you to keep your kidneys working as well as possible, for as long as possible. You will also need treatment to prevent any complications and to manage other conditions such as high blood pressure.

At any point throughout treatment, you might be asked to wear a blood pressure monitor for 24 hours to check that your blood pressure is being controlled well.

The treatment you need will depend on how severe your kidney disease is.

Self-help

There are things you can do to help your kidneys work at their best. These include:

  • making some changes to the foods you eat, including eating less salt
  • stopping smoking
  • only drinking alcohol within the recommended limits
  • being regularly active
  • 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.

Medicines

Your doctor will ask you to take medicines to keep your kidneys working as well as possible and to prevent complications. You will be asked to take medicines that:

  • lower and control your blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors
  • reduce your chances of developing heart disease or having a stroke, including medicines called statins which lower and control your cholesterol levels
  • treat any underlying cause of your condition, such as diabetes and kidney infections
  • ease symptoms, such as tiredness
  • keep vitamins and minerals, such as vitamin D and calcium, at the right levels in your body

Some medicines can affect how well your kidneys work. Your doctor and pharmacist can check any other medicines you’re taking and tell you if you need to stop them.

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

Dialysis

If you have severe kidney disease and your kidneys aren’t working, you’re likely to need dialysis. This acts like an artificial kidney, and gets rid of waste and excess water from your blood.

There are two types of dialysis: haemodialysis and peritoneal dialysis.

Haemodialysis is when your blood passes through a machine to filter and clean it. You need to have this done three times a week and it takes about four hours to have dialysis each time. You can have this type of dialysis done at home or in hospital.

Peritoneal dialysis uses your peritoneum as a filter. This is the thin lining on the inside of your tummy (abdomen). 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 into the dialysis fluid, which is then drained away. You can have peritoneal dialysis at home – a relative or carer can be trained to help you do this yourself. Peritoneal dialysis has to be done every day.

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

Surgery

If you have severe kidney disease and your kidneys aren’t working, the other treatment option you have is a kidney transplant. This is when a kidney from a donor is put into your body. If you do have a kidney transplant, you’ll need to be closely monitored and take medicines for the rest of your life. This is because your body can reject a kidney that has come from someone else.

This treatment isn’t suitable for everybody – talk to your doctor about whether it’s an option for you.

Causes of chronic kidney disease

The main causes of chronic kidney disease are diabetes and high blood pressure. Other possible causes include:

  • some medicines, such as lithium and ciclosporin
  • recurrent kidney stones
  • inherited conditions, such as polycystic kidney disease
  • recurrent infections as a child, which damage or scar the kidneys

Complications of chronic kidney disease

As kidney disease gets worse, you can develop complications, including:

  • severe kidney disease, which needs treatment with dialysis or a kidney transplant
  • high blood pressure (hypertension)
  • cardiovascular disease, including heart disease and stroke
  • damage to your nerves
  • malnutrition – this is when you’re not getting the nutrients you need
  • weak bones
  • anaemia

Prevention of chronic kidney disease

If you have health problems such as diabetes or high blood pressure, which can lead to chronic kidney disease, it’s important to be regularly checked by your GP. If you get treatment for conditions like these early, it can reduce your likelihood of developing chronic kidney disease.

Special considerations

Your GP and consultant will encourage you to self-manage your condition as much as you’re able to. This means understanding your condition well, monitoring your progress and working with health professionals to make decisions about your care.

Living with chronic kidney disease can be challenging and difficult, particularly if you’re having dialysis. If you’re finding it hard to cope or need support, ask your doctor or specialist nurse for help. They can refer you for one-to-one support or counselling. There are support groups for people with kidney disease.

Frequently asked questions

  • When you’re first diagnosed, and as your condition changes, your doctor will use a ‘stage’ to describe how well your kidneys are working. The stages go from 1 to 5 and describe mild, moderate or severe kidney disease. Stage 1 is very mild kidney disease and stage 5 is severe kidney disease when your kidney isn’t working at all (kidney failure).

    If you have mild-to-moderate chronic kidney disease, you’ll usually be treated by your GP. If you have more severe disease (stages 4 and 5), you’ll be treated by a nephrologist at a hospital.

    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.

  • This is difficult to answer, as it’s different for everybody. Not everyone will get to end-stage kidney disease.

    Kidney disease doesn’t always get worse gradually, so it’s hard to predict when and if you’re likely to need dialysis or a kidney transplant. Whether or when you’ll get to end-stage kidney disease depends on what’s causing the condition, how well your condition is managed and controlled, and your general health.

    If you’re diagnosed early, and have the right treatment and regular check-ups, you can prevent complications and slow down the development of the condition.

  • Deciding which type of dialysis to have can be difficult, and each has pros and cons for every individual. There are tools called decision aids that can help you to decide what’s right for you, and your doctor and nurse can give you more information and advice. You can talk to your doctor about which is likely to work best for you and what the benefits and side-effects might be.

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

    In peritoneal dialysis, a tube is permanently put into your tummy, which goes into the space that surrounds your peritoneum. A dialysis solution is put into your abdomen. The waste products from your body pass from your blood into the fluid and then the fluid is drained out again.

    This process takes about 20 minutes and is called continuous ambulatory peritoneal dialysis (CAPD). It can be done while you’re awake or asleep. When you’re making a choice about treatment, there are certain things to consider. Here are some main things to think about.

    • Whether you or a carer will be able to do the treatment for you.
    • How the dialysis will fit into your daily life, including work, study, family commitments and your leisure time.
    • Whether you’ll have dialysis at home, and if so whether you may need to make changes to your home.
    • How far you’ll need to travel for treatment and for how long.


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Related information

    • Kidney anatomy. Medscape. emedicine.medscape.com, updated October 2013
    • Chronic kidney disease. BMJ Best Practice. bestpractice.bmj.com, last updated October 2016
    • Cardiovascular disease in chronic kidney disease. Medscape. www.medscape.com, published 2013
    • Chronic kidney disease in adults: assessment and management. National Institute for Health and Care Excellence (NICE), January 2015. www.nice.org.uk
    • Chronic kidney disease. PatientPlus. patient.info/patientplus, last checked September 2014
    • Map of Medicine. Chronic kidney disease. International View. London: Map of Medicine; 2016 (Issue 3)
    • Assessing renal function. PatientPlus. patient.info/patientplus, last checked June 2015
    • Edey, MM. Male sexual dysfunction and chronic kidney disease. Front Med 2017. doi: 10.3389/fmed.2017.00032
    • Personal communication, Raj Persad, Consultant Urologist, Spire Bristol Hospital, February 2017
    • Chronic kidney disease – not diabetic. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2016
    • Renal replacement therapy and transplantation. PatientPlus. patient.info/patientplus, last checked May 2016
    • Basic science. Oxford handbook of colorectal surgery (online). Oxford Medicine Online. oxfordmedicine.com, published October 2011
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  • Reviewed by Alice Rossiter, Specialist Health Editor, May 2017
    Expert reviewer, Raj Persad, Consultant Urologist, February 2017
    Next review due May 2020



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