Nephrology

Keep kidney disease in check

Kidneys may not be the most glamorous organs in your body, but the work they do is essential to your health. When kidney problems occur, chronic kidney disease (CKD) and kidney failure—also known as end-stage renal disease—could be in your future. Fortunately, kidney disease can be prevented or delayed with early detection and treatment.

Damage to the body's cleaning system

Kidneys are blood-cleansing organs. They remove waste from the body in the form of urine and filter toxins from the blood. They also help create red blood cells, regulate blood pressure and build strong bones.

CKD occurs when the kidneys are damaged and become less able to do their job. According to the National Kidney Foundation (NKF), diabetes and high blood pressure are the most common causes of kidney damage, followed by diseases that cause inflammation and damage to the kidney's filtering units.

Other disorders, including frequent urinary tract infections, kidney stones and tumors, can also be responsible.

Without treatment, CKD may lead to complications like anemia (a lack of oxygen-carrying red blood cells) and nerve damage.

CKD also increases the risk for heart and blood vessel disease. Eventually, it may lead to kidney failure, which requires dialysis—filtering blood with a machine or through an abdominal tube to remove waste—or a kidney transplant.

Risk factors

Two risk factors for CKD are diabetes and high blood pressure, according to the NKF. Other risk factors include being older and having a family history of CKD.

CKD is also more common in African Americans, Hispanic Americans, Asians, Pacific Islanders and American Indians than in whites.

Signs of trouble

Most people don't have symptoms of CKD in the early stages of the disease. The following symptoms, however, might indicate kidney failure and warrant medical attention:

• Feeling more tired than usual.
• A poor appetite.
• Trouble sleeping.
• Dry, itchy skin.
• Night-time muscle cramping.
• Swollen feet and ankles.
• Puffy eyes, especially in the morning.
• A need to urinate more often than normal, especially at night.

Early detection is key

You should also ask your doctor about special tests to screen for kidney disease if you have diabetes, high blood pressure or a family member with kidney disease, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Your doctor will check for high blood pressure and order laboratory tests to look for protein and creatinine in your urine. (Creatinine is a waste product.)

If protein shows up in your urine three times over three months, that's a sign of CKD. When creatinine levels in your blood are high, the test will tell how much kidney function you have and how advanced your disease is.

If your results are positive for CKD, your doctor has several tools to pinpoint the cause. An ultrasound or CT scan of your kidneys and urinary tract could show a kidney stone or tumor that can be treated.

In some cases, small pieces of kidney tissue may be removed (biopsy) to check kidney damage.

If you aren't already seeing a kidney specialist (nephrologist), your doctor may recommend it at this time.

Keep your kidneys healthy

Whether or not you have CKD, you can help maintain good kidney health by exercising regularly, drinking plenty of fluids, not smoking and maintaining your recommended weight.

If you have CKD you should follow your doctor's treatment plan closely. Your plan could include these recommendations from the NIDDK:

• Control blood sugar if you have diabetes.
• Maintain your blood pressure as recommended by your doctor.
• Eat less protein and salt. Work with your healthcare team to make sure your diet contains healthy amounts of the nutrients you need.
• Keep cholesterol levels in a healthy range.

It's also important to see your doctor for regular checkups.

Reviewed 6/11/2022

Understanding kidney cancer

Kidney cancer develops when abnormal cells form in the kidney and start reproducing quickly. These abnormal cells eventually form a mass, or tumor, that grows into and destroys healthy kidney tissue.

Cancer that starts in the kidneys may also invade nearby organs, such as the liver, colon or pancreas. Cells sometimes break away from the original tumor and spread to farther parts of the body, usually the bones or lungs.

Types of kidney cancer

There are several types of kidney cancer, according to the American Cancer Society (ACS).

Renal cell carcinoma is the most common type. About 90% of all kidney cancers are renal cell carcinomas.

Transitional cell carcinoma occurs in the kidney area that leads to the bladder.

Wilms tumor is a kidney cancer that develops in children.

Renal sarcoma is a rare form of kidney cancer that starts in the kidney's blood vessels or connective tissue.

Symptoms

Kidney cancer is often found when symptoms develop. The symptoms can include:

• Blood in the urine.
• Pain in the side or lower back.
• A lump or mass in the side or abdomen.
• Fatigue.
• Sudden weight loss for no apparent reason.
• Fever.
• Anemia.

These symptoms could be caused by a less serious condition, but they're worth checking out. Early treatment is always best.

Risk factors

The cause of kidney cancer remains unknown, but a few risk factors have been identified. According to the ACS, the National Cancer Institute and the National Kidney Foundation, risk factors may include:

• Smoking cigarettes.
• Advanced kidney disease, especially if it requires dialysis, a treatment that removes wastes from the blood. People need dialysis when their kidneys don't function well enough to do this work.
• Von Hippel-Lindau (VHL) syndrome. This rare disease runs in families.
• Exposure to asbestos, cadmium, trichloroethylene or certain other chemicals at work.
• Family history of kidney cancer.
• High blood pressure.
• Obesity.
• Gender. Men get this cancer more often than women.
• Race. Black people are slightly more likely than white people to develop kidney cancer.

Treatment

Surgery is the most common treatment for kidney cancer. This may involve removing part or all of the kidney and sometimes nearby tissues and glands. Other treatment options include:

• Arterial embolization, which means cutting off the blood supply to the tumor by blocking the artery that leads to the kidney.
• Chemotherapy, which means using medicines to destroy or damage cancer cells.
• Radiation therapy, which means using high-energy rays to destroy cancer cells.
• Immunotherapy, which means using medicines that boost the immune system's ability to identify and destroy cancer cells.
• Targeted therapies or medicines that target specific parts of cancer cells or specific steps in the process of tumor growth.
• Pain relievers to ease the symptoms of advanced cancer.

Reviewed 3/20/2023

Treating end-stage renal disease

End-stage renal disease (ESRD) is the final stage of the progressive decline of the kidneys. It is also called kidney failure.

Without the filtering action of the kidneys, wastes and excess fluids are retained in the body. Necessary hormones and chemicals aren't produced.

ESRD treatment does the work the failed kidneys can no longer perform. Machines, chemicals and donor organs are recruited to do the kidneys' work. ESRD patients can't survive without these treatments.

There are three major treatment options for end-stage renal disease:

Hemodialysis

In hemodialysis, a machine draws your blood, cleans and filters it, and returns it to your body.

Hemodialysis can be done at home or at a dialysis center. It lasts several hours per treatment and is typically done three or more times a week, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Peritoneal dialysis

For this treatment, a cleansing solution called dialysate drips into your abdomen through a tube. The solution remains in your abdomen for several hours while it draws in wastes and toxins through the abdominal lining. The dirty solution is then drained from your abdomen, and the abdomen is refilled with fresh dialysate.

This treatment may also be done with a machine that automatically fills and drains the solution from your abdomen. The machine may be used at night while you sleep or at other regular times.

Kidney transplantation

In transplantation, you get a new kidney from a donor. If the transplant is successful, the new kidney will process and filter your blood as effectively as your own kidneys did when they were healthy.

You may go on a waiting list for a kidney donor, or a friend or family member can donate a kidney.

Reviewed 11/7/2022