Chronic kidney disease (CKD) is when the kidneys stop working as well as they should over a long period of time. When they are working normally, the kidneys filter the blood and remove waste and excess salt and water.

In people with chronic kidney disease, the kidneys slowly lose the ability to filter the blood. In time, the kidneys can stop working completely. That is why it is so important to keep chronic kidney disease from getting worse.

A number of conditions can increase ones risk of developing chronic kidney disease, including; poorly controlled diabetes mellitus, high blood pressure, diseases of the kidney itself (such as chronic glomerulonephritis, cysts in the kidney) and also having a positive family history of kidney disease.

Most people with chronic kidney disease do not have symptoms until the kidney function is severely impaired. The problem is often discovered when blood or urine tests, done for other reasons, show one or more of the abnormalities suggestive of kidney disease.

Even when kidney failure is advanced, most people still make a normal or near-normal amount of urine; this is sometimes confusing. Urine is being formed but it does not contain sufficient amounts of the body’s waste products.

With advanced kidney disease, you may develop edema (swelling of the feet, ankles, or legs), of appetite, increased sleepiness, nausea, vomiting, confusion and difficulty thinking. Patients often develop high blood pressure, blood chemistry (electrolyte) abnormalities, anemia (a decrease in red blood cells, which can cause fatigue and other symptoms), and bone disease.

People with advanced kidney failure may develop a group of symptoms including loss of appetite, nausea, vomiting, swelling around the heart, nerve problems, and changes in mental status, including drowsiness, seizures, or coma which can lead to death.

The doctor will find out if one has a kidney disease by taking history of the patient’s complaints, physical examination, and may use several tests to diagnose chronic kidney disease and determine if there is a treatable underlying cause. Blood tests, urine tests and some radiology imaging tests are done to look out for features of kidney disease and any possible causes. Sometimes, a small piece of kidney tissue (biopsy) is removed and examined under a microscope. The biopsy helps to identify abnormalities in kidney tissue that may be the cause of kidney diseases.

Once diagnosed with chronic kidney disease, the first step towards better management of the condition is to determine the underlying cause. Some causes are reversible, including use of medications that impair kidney function, blockage in the urinary tract, or decreased blood flow to the kidneys. Treatment of reversible causes may prevent chronic kidney disease from worsening.

Management of chronic kidney disease is best done with the assistance of a nephrologist, a doctor who specializes in kidney diseases. Early referral to a nephrologist decreases the chance of developing complications associated with chronic kidney disease.

People in the early stages of chronic kidney disease can take medicines to keep the disease from getting worse, and it is very important that one takes them every day as directed.

Hypertension, or high blood pressure, is present in 80 to 85 percent of people with chronic kidney disease. Maintaining good blood pressure control is the most important goal for trying to slow progression of the disease.

People with chronic kidney disease are at risk for anemia and hence some drugs are usually prescribed to prevent anemia.

Changes in one’s diet may be recommended to control or prevent some of the complications of chronic kidney disease; most important is low salt diet to help control the blood pressure.

Some people with chronic kidney disease progressively worsen over time and will eventually need dialysis. Dialysis is done using machines to remove toxic wastes from blood of someone with diseased kidneys.

An important component of treatment for patients with chronic kidney disease is planning for dialysis in advance. Although kidney transplantation is the treatment of choice in chronic kidney disease, many people must wait months or years for a kidney to become available, hence dialysis will likely be needed, often for an extended period before the transplant.

Dr. Ian Shyaka

Resident in Surgery, Rwanda Military Hospital,

iangashugi@gmail.com