Understanding Chronic Kidney Disease
The kidneys play a vital part in maintaining the healthy functioning of our body. Its filtration capacity allows the body to excrete unwanted wastes and at the same time, provides optimal fluid control for the body. In addition, the kidney also manages many other functions including the production of blood, controlling blood pressure as well as producing hormones that manage bone health.
Causes of Chronic Kidney Disease
In Malaysia, the main cause of kidney disease is type 2 diabetes mellitus and hypertension. Other reasons are much less common. Some of the rarer diseases are genetic, such as Polycystic Kidney Disease, where the kidney is filled with cysts that ‘push’ aside normal healthy functioning kidney tissue; some are immune conditions like IgA Nephropathy where the body produces an abnormal antibody that gets ‘trapped’ in the kidney causing damage; or Systemic Lupus Erythematosus, where antibodies attack normal body cells. Kidney stones can also lead to damage.
It is not unusual however, that a cause cannot be identified. In cases such as these, the kidney disease may possibly have been the result of infections acquired during a young age that has left the kidney with damage. The damage accumulates over time leading to slow deterioration of kidney function. Other possible reasons could be exposure to drugs, supplements or chemicals that injure the kidney.
What is important to understand is that often, the damage that occurs to the kidney is silent. This means that unlike having a heart attack, where the patient would complain of chest pain, kidney disease usually produces no symptoms at all until around 50-70% of health kidney tissue has been damaged. This makes getting regular examinations very important.
Symptoms of Chronic Kidney Disease
Kidney disease sufferers can have a myriad of symptoms. Some are quite generalized and nonspecific like fatigue, lethargy or appetite changes. More specific symptoms are nausea, vomiting, itching, having a metallic taste in the mouth, swelling of the extremities, difficulty breathing and a change in urine characteristics.
Risk Factors of Chronic Kidney Disease
You are more at risk of acquiring kidney disease if you have diabetes, high blood pressure, heart disease, high cholesterol or smoke. Age and weight are also risk factors. A family history of kidney disease should also make you more alert.
Defining Chronic Kidney Disease
Nephrologists think of the kidney in terms of it’s ability to filter or cleanse the blood of waste product (function) as well as the integrity of the kidney membrane cells, which act as a ‘filter’ (structure). Function is assessed by measuring a blood test called Creatinine. The higher the level of Creatinine in the body, the less the kidney is filtering. The integrity of the kidney filter is assessed by examining the urine. If there is blood or protein in the urine, this may suggest damage to the kidney ‘filter’. An ultrasound of the kidney can also be helpful.
If these abnormalities last for 3 months, it is termed ‘chronic’.
Classifying the Severity (Staging) of Chronic Kidney Disease
Nephrologists classify chronic kidney disease into categories of severity depending upon the functional ability of the kidney as measured by the Creatinine level in the blood. The most severe is Stage 5 whilst the least is Stage 1. Often, patients with Stage 5 kidney disease need to prepare themselves for the possibility of dialysis or transplantation in order to support the regular healthy functioning of the body.
Complications of Chronic Kidney Disease
Since the kidney performs many roles, if damaged, may result in a number of different conditions. Blood pressure and cholesterol can often worsen leading to an increase in heart disease and strokes. The buildup of toxins and waste products leads to anemia, poor bone health, hardening of the blood vessels, swelling of the body. Kidney patients often also suffer from poor nutrition.
Treatments for Chronic Kidney Disease
In general, treatment for patients with kidney disease is dependent upon the causal condition. Medications are used that can target the pathological processes that lead to kidney damage. In addition, dietary interventions can also be very helpful in slowing down the deterioration of the kidney. The core of dietary strategies for improving kidney health is in the reduction of protein intake so as to minimize the production of waste.
What happens if the kidney function continues to worsen?
Ultimately, when the kidney fails to function adequately to maintain the healthy functioning of the body, nephrologists will advise on using kidney support treatments. These treatments are known as dialysis. There are 2 categories of dialysis that are widely used, haemodialysis and peritoneal dialysis. Both have their pros and cons and the choice of which modality of dialysis is dependent upon a discussion between the patient and the doctor. The best choice for most kidney failure patients however, is to obtain a kidney transplant to restore normal kidney function.
Dr. Tan Li Ping 陈立品医生
MD (Canada), MPH (Malaya), FASN (USA)
Fellowship in Transplant Nephrology (USA)
Diplomate of the American Board of Internal Medicine (ABIM)
Certified in Internal Medicine and Nephrology (USA)
Internal Medicine & Nephrology