Chronic Kidney Disease

BY Kiran Padigala, MD Published on October 19, 2021

Introduction:  Kidneys are a pair of organs in our abdomen which are responsible for removing impurities from blood and excrete in urine. They also maintain a healthy balance of electrolytes. These electrolytes are sodium, potassium, phosphorus and acid-base equilibrium in our body. In a healthy individual these functions usually maintain through a urine output of 2-3 L a day. When kidney function declines due to common health conditions like high blood pressure and diabetes, we call it Chronic (long term) kidney failure. Almost 14% of the world population has chronic kidney disease, this is causing a great burden on the families and health system of the countries. 

Estimating Kidney Function:  Medical professionals estimate an individual's kidney function by conducting simple blood tests, such as testing the serum creatinine, BUN (Blood urea nitrogen), and eGFR (estimated Glomerular function rate). Normal serum creatinine is 1 mg/dl, and we see higher numbers depending on the degree of kidney damage. Also, normal BUN is about 20 and can be made to elevate in people with kidney disease. eGFR is used to classify kidney disease into stages. It is also used to adjust medications and make decisions regarding kidney dialysis and transplantation. 

Stages of Chronic Kidney Disease:  
How to Slow down progression of kidney damage:

    • Control your blood pressure. Maintain your blood pressure within a healthy range may help slow the progression of kidney disease. 

    • Keep checking your blood glucose, it will help control your diabetes.

    •Keep your diet in check.

    • Ensure to drink at least 2-3 L of fluids daily (mostly water). This will change as kidney disease advances and people in stage 4/5 kidney disease may be placed on a fluid restriction. 

    • Be cautious when taking over-the-counter supplements and medicines especially NSAIDs like ibuprofen, Naprosyn, etc. 

Symptoms of stage 5 kidney disease (ESRD):

Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred. Possible stage 5 kidney disease symptoms and signs include:

  • Uremia (waste buildup in your blood)
  • Fatigue—possibly caused by anemia
  • Shortness of breath
  • Nausea or vomiting
  • Swelling in your hands/legs/eyes/lower back
  • Lower back pain

Treatment Options when Kidneys fail: 

Firstly, When eGFR is less than 15ml/min we call it stage 5 kidney disease. At this point an individual may need to prepare for a kidney transplant or dialysis. Additionally, in some countries these preparations start early. Moreover, dialysis decisions are not made strictly on numbers but they also look at overall picture of the individual, like electrolytes, fluid balance and general health and activity status.  In fact, there are two types of kidney transplant. Living donation from a friend or family member or from a cadaver (from a dead person ).

 Dialysis is available in two forms. 

Peritoneal dialysis - Here, uses the blood vessels in the lining of the abdomen, the body's natural filter, along with a solution called dialysate to filter and clean blood. In this, the body never leaves the blood. Typically, people do peritoneal dialysis on a daily basis.

Hemodialysis - In this, a dialysis, machine filters the blood to remove toxins and excess fluid. The machine allows the blood to flow in, filters it, and returns it back to the body. Individuals can perform hemodialysis at home or a dialysis center.


Kiran Padigala, MD

Nephrologist, Dallas, Texas, USA.

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