Chronic Kidney Disease

June 10, 2008 - 7:30am

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Chronic Kidney Disease

(Chronic Renal Failure; Chronic Renal Disease; Chronic Renal Insufficiency)

Chronic kidney disease is a condition in which the kidneys are not working correctly. It is caused by damage to tiny structures within the kidneys called nephrons (pronounced nef-RONS). About 20 million Americans have chronic kidney disease and 500,000 individuals with end-stage renal disease. In the early stages, chronic kidney disease does not cause symptoms; therefore, most people don’t know they have the condition.

The kidneys are bean-shaped organs located in the lower back just below the rib cage. Each kidney is about the size of a fist. The two kidneys filter blood, catch needed substances, return them to the circulation, and dispose of wastes in the urine. If the kidneys don’t filter properly, wastes build up in the blood. The kidneys also maintain the balance of water in the body and release hormones. These hormones keep the bones strong, control blood pressure, and help the body make red blood cells. If your kidneys stop working, your bones may become weak, your blood pressure may increase, and your red blood cell count may decrease.

Anatomy of the Kidneys

Stages

Chronic kidney disease is a progressive condition. Doctors use stages to describe how serious it is. The stage is based on the glomerular filtration rate (GFR).

Stage	Glomerular Filtration Rate (GFR)
1	Over 90 mL/min (normal)
2	60 to 89 mL/min (mild decrease)
3	30 to 59 mL/min (moderate decrease)
4	15 to 29 mL/min (severe decrease)
5	under 15 mL/min (kidney failure or end-stage renal disease)

Causes

The two most common causes of chronic kidney disease are diabetes and hypertension.

Diabetes ]]>type 1]]> and ]]>2]]> occurs when the body doesn’t process the sugar in the blood well. The amount of sugar (also called glucose) in the blood increases. High blood glucose damages the kidneys, as well as the heart, blood vessels, and eyes.
]]>Hypertension]]> (or high blood pressure) occurs when there is high pressure within the arteries of the body. Hypertension damages the kidneys. Chronic kidney disease can also cause hypertension.

Other conditions that can cause chronic kidney disease include:

Inherited diseases, such as ]]>polycystic kidney disease]]> (a condition that causes cysts to form in the kidneys)
Diseases of the immune system, such as ]]>lupus]]>
]]>Kidney stones]]> , tumors, or in men, an ]]>enlarged prostate]]> , causing obstructive kidney diseases
Recurrent ]]>urinary tract infections]]>
Prolonged use of medications, such as ibuprofen, aspirin, phenacetin
Bilateral renal artery stenosis
Viruses: ]]>hepatitis B]]> , ]]>hepatitis C]]> , or ]]>HIV]]>
Tubular interstitial nephritis

Complications

Chronic renal failure can cause many complications, including:

]]>Kidney failure]]> or end-stage renal disease (requirring ]]>dialysis]]> or kidney transplant)
Hypertension (high blood pressure)
]]>Coronary heart disease]]> and ]]>heart attacks]]>
]]>High lipid (fats and cholesterol) levels]]> in the blood
Weak bones
Anemia (low red blood cell count)
Weak immune system

]]>What are the risk factors for chronic kidney failure?]]>
]]>What are the symptoms of chronic kidney failure?]]>
]]>How is chronic kidney failure diagnosed?]]>
]]>What are the treatments for chronic kidney failure?]]>
]]>Are there screening tests for chronic kidney failure?]]>
]]>How can I reduce my risk of chronick kidney failure?]]>
]]>What questions should I ask my healthcare provider?]]>
]]>Where can I get more information about chronic kidney failure?]]>

References:

About chronic kidney disease (CKD): a guide for patients and their families. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/atozItem.cfm?id=145 . Accessed July 30, 2005.

Are you at risk for chronic kidney disease? National Kidney Foundation website. Available at: http://www.kidney.org/atoz/atozItem.cfm?id=134 . Accessed July 30, 2005.

Information for patients and the public. National Kidney Disease Education Program website. Available at: http://www.nkdep.nih.gov/patients/kidney_disease_information.htm . Accessed July 30, 2005.

Luke RG. Chronic renal failure. In: Goldman L, Ausiello D, eds. Cecil Textbook Of Medicine 22nd ed. Philadelphia, PA: Saunders; 2004.

National Kidney Foundation. Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42:S1-201.

National Kidney Foundation. Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1-266.

National Kidney Foundation. Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004; 43:S1-S29.

Snyder S, Pendergraph B. Detection and evaluation of chronic kidney disease. Am Fam Physicians. 2005;72:723-732.

Last reviewed November 2008 by ]]>Adrienne Carmack, MD]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.