Chronic kidney disease is defined by kidney damage lasting for over 3 months. Usually, the damage is long-lasting and progressive in such cases. Most patients do not fully understand how common chronic kidney disease really is: in these United States, 1 out of every 9 adults have chronic kidney disease. Chronic kidney disease affects both kidneys, and if nothing is done, often leads inexorably towards early death (usually from associated heart disease) or kidney failure (making dialysis or kidney transplantation necessary).
We do not fully understand why kidney damage is especially severe in some people, or why the usual protective mechanisms of the kidneys fail in others. Research suggests that such kidneys develop an unusual degree of scarring, leading to poor function, and finally to kidney failure. Generally, we have found that chronic kidney disease is more common in Blacks and Hispanics, as well as in the elderly, males, diabetics and hypertensives. Those that have a blood-related family member on dialysis are also at higher risk.
To track the progression of chronic kidney disease, we grade the severity from stage I to stage V. During the early stages of I and II, most patients are unaware they have any kidney problems, and are usually lacking in symptoms. Most kidney problems are therefore detected at stages III and IV, at which point the disease has progressed considerably. At stage V disease, dialysis or transplantation is imminent.
Whatever the stage of kidney disease, everything ought to be done to stop its further progression. If that is not possible, at the very least, progression of kidney disease has to be slowed down. Fortunately, we now have several strategies that work to slow down the ravages of kidney disease. Most of these remedies were discovered from painstaking research carried out in animals, but later proven in humans too!
First, blood pressure must be tightly controlled, preferably under 130/80 mmHg, and is some select cases, even lower. For that to happen, each patient must be motivated to regularly check their blood pressures at home, take their prescribed medications, and call up their doctor if the blood pressure is not below that target.
Secondly, anemia should be treated where possible, though there is still some controversy as to what hemoglobin level is “best” in kidney disease.
It is equally important to reduce the degree of protein leakage through the kidneys. Therefore, your doctor would periodically collect your urine to test for protein leakage. You can help by also observing your urine, as frothy or foamy urine is often an early indicator of protein leakage. Other proven strategies include better control of blood sugar levels, salt restriction in the diet, reduction of fatty foods, drinking adequate amounts of fluid, regular exercises, and weight regulation. Several medications have also been found to help slow the “burning fire” of kidney disease, and the 3 most important are ACE inhibitors (such as Altace), Angiotensin Receptor Blockers (such as Diovan) and statins (such as Lipitor).
Finally, avoid anything that could possibly worsen your kidney function. That means avoidance of “direct” or “second hand” smoke, not using illicit drugs such as cocaine, being very carefully with over-the-counter medications, and making sure (bladder) infections are treated early at all times. I urge all my patients to never self-medicate: most drugs are indeed poisons, and often the toxicity is directed against the kidneys!
In the future, we would have developed new drugs to recover lost kidney function. There are promising findings already, and a lot of research is still ongoing. As those roll out, be sure we will keep you informed.