Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then removed in your urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes and wastes to build up in your body.
In the early stages of chronic kidney disease, you might have few signs or symptoms. You might not realize that you have kidney disease until the condition is advanced.
Treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the cause. But, even controlling the cause might not keep kidney damage from progressing. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.
Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or electrolyte problems. Depending on how severe it is, loss of kidney function can cause:
Signs and symptoms of kidney disease are often nonspecific. This means they can also be caused by other illnesses. Because your kidneys are able to make up for lost function, you might not develop signs and symptoms until irreversible damage has occurred.
Make an appointment with your doctor if you have signs or symptoms of kidney disease. Early detection might help prevent kidney disease from progressing to kidney failure.
If you have a medical condition that increases your risk of kidney disease, your doctor may monitor your blood pressure and kidney function with urine and blood tests during office visits. Ask your doctor whether these tests are necessary for you.
Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.
Diseases and conditions that cause chronic kidney disease include:
A normal kidney has about 1 million filtering units. Each unit, called a glomerulus, connects to a tubule, which collects urine. Conditions such as high blood pressure and diabetes take a toll on kidney function by damaging these filtering units and collecting tubules and causing scarring.
A healthy kidney (left) eliminates waste from the blood and maintains the body's balance. With polycystic kidney disease (right), fluid-filled sacs called cysts develop in the kidneys, causing them to grow larger and gradually lose their ability to function normally.
Factors that can increase your risk of chronic kidney disease include:
Chronic kidney disease can affect almost every part of your body. Potential complications include:
To reduce your risk of developing kidney disease:
As a first step toward diagnosis of kidney disease, your doctor discusses your personal and family history with you. Among other things, your doctor might ask questions about whether you've been diagnosed with high blood pressure, if you've taken a medication that might affect kidney function, if you've noticed changes in your urinary habits and whether you have family members who have kidney disease.
Next, your doctor performs a physical exam, checking for signs of problems with your heart or blood vessels, and conducts a neurological exam.
For kidney disease diagnosis, you might also need certain tests and procedures to determine how severe your kidney disease is (stage). Tests might include:
During a kidney biopsy, your doctor uses a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle is inserted through your skin and is often directed using the guidance of an imaging device, such as ultrasound.
Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.
Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease.
Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as diabetes mellitus or high blood pressure, has been controlled.
Kidney disease complications can be controlled to make you more comfortable. Treatments might include:
High blood pressure medications. People with kidney disease can have worsening high blood pressure. Your doctor might recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function.
High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you might need frequent blood tests to monitor your condition. Your doctor may also recommend a water pill (diuretic) and a low-salt diet.
Your doctor might recommend regular follow-up testing to see whether your kidney disease remains stable or progresses.
If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.
Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood.
In peritoneal dialysis, a thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from your body, carrying the waste with it.
Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors.
After a transplant, you'll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don't need to be on dialysis to have a kidney transplant.
For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).
During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney's urine tube (ureter) is connected to your bladder. Unless they are causing complications, your own kidneys are left in place.
As part of your treatment for chronic kidney disease, your doctor might recommend a special diet to help support your kidneys and limit the work they must do. Ask your doctor for a referral to a registered dietitian who can analyze your diet and suggest ways to make your diet easier on your kidneys.
Depending on your situation, kidney function and overall health, dietary recommendations might include the following:
Receiving a diagnosis of chronic kidney disease can be worrisome. To help you cope with your feelings, consider:
You'll likely start by seeing your primary care doctor. If lab tests reveal that you have kidney damage, you might be referred to a doctor who specializes in kidney problems (nephrologist).
To get ready for your appointment, ask if there's anything you need to do ahead of time, such as limit your diet. Then make a list of:
Take a family member or friend along, if possible, to help you remember the information you receive. Or use a recorder during your visit.
For chronic kidney disease, some basic questions to ask include:
Don't hesitate to ask other questions as they occur to you.
Your doctor is likely to ask you questions, such as: