What are the kidneys?

The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste products, but also by balancing levels of electrolyte levels in the body, controlling blood pressure, and stimulating the production of red blood cells.

The kidneys are located in the abdomen toward the back, normally one on each side of the spine. They get their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the renal veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)

When blood flows to the kidney, sensors within the kidney decide how much water to excrete as urine, along with what concentration of electrolytes. For example, if a person is dehydrated from exercise or from an illness, the kidneys will hold onto as much water as possible and the urine becomes very concentrated. When adequate water is present in the body, the urine is much more dilute, and the urine becomes clear. This system is controlled by renin, a hormone produced in the kidney that is part of the fluid and blood pressure regulation systems of the body.

Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels rise and the body starts to manufacture more red blood cells.

After the kidneys filter blood, the urine is excreted through the ureter, a thin tube that connects it to the bladder. It is then stored in the bladder awaiting urination, when the bladder sends the urine out of the body through the urethra.

Chronic kidney disease occurs when damage to the kidneys causes

reduced kidney function. Kidney disease has usually been present for many years and may slowly get worse over time. Chronic kidney disease can be mild, moderate, or severe. Mild to moderate chronic kidney disease may not cause symptoms. The kidneys are usually able to adapt and function well enough so that noticeable symptoms of kidney failure do not occur. Severe chronic kidney disease causes noticeable symptoms, such as electrolyte imbalances and fluid buildup (edema). Many people who have severe chronic kidney disease may eventually develop kidney failure and will need dialysis or a kidney transplant.

What causes chronic kidney disease?

Chronic kidney disease is caused by damage to the kidneys. The most common causes of this damage are: High blood pressure. High blood sugar (diabetes). Other things that can lead to chronic kidney disease include: Kidney diseases and infections, such as polycystic kidney disease, pyelonephritis, and glomerulonephritis, or a kidney problem you were born with. A narrowed or blocked renal artery. The renal artery carries blood to the kidneys. Long-term use of medicines that can damage the kidneys. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and celecoxib (Celebrex).

What are the symptoms?

You may start to have symptoms only a few months after your kidneys begin to fail. But most people don't have symptoms early on. In fact, many don't have symptoms for as long as 30 years or more. This is called the "silent" phase of the disease. How well your kidneys work is called kidney function. As your kidney function gets worse, you may:

Urinate less than normal. Have swelling from fluid buildup in your tissues. This is called edema Feel very tired or sleepy. Not feel hungry, or you may lose weight without trying. Often feel sick to your stomach (nauseated) or vomit. Have trouble sleeping. Have headaches or trouble thinking clearly

Complications
Chronic kidney failure can affect almost every part of your body. Potential complications may include: Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema) Heart and blood vessel disease (cardiovascular disease) Anemia Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures Decreased immune response, which makes you more vulnerable to infection Pregnancy complications that carry risks for the mother and the developing fetus Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

Diet
When you have chronic kidney disease, you need to make changes in your diet, including:

Limiting fluids Eating a low-protein diet (this may be recommended) Restricting salt, potassium, phosphorous, and other electrolytes Getting enough calories if you are losing weight

Getting the Right Amount of Calories

Getting enough calories is important to your overall health and wellbeing. Calories are found in all the foods you eat. They are important because they:

give your body energy help you stay at a healthy weight help your body use protein for building muscles and tissues.

Because your recommended diet may limit protein, you may also be cutting down on an important source of calories. As a result, you may need to get extra calories from other foods.

What are healthy food choices?

The following are the foods and nutrients you will have to consider to help relieve symptoms, control blood pressure and maintain health. These are protein, energy foods, sodium, potassium, phosphorus, calcium and Vitamin D.

Protein
Foods like meat, sh, poultry, eggs, tofu and milk are high in protein. Protein builds, repairs and maintains your body tissues. It also helps your body ght infections and heal wounds. As your body breaks down protein foods, a waste called urea is formed. If this is not eliminated, too much urea in the blood may cause tiredness, nausea,headaches and a bad taste in your mouth. But if you eat too little protein, you may lose muscle and weight, lack energy and have difculty ghting infections. Therefore, you need to eat enough protein for your body while limiting the amount of urea formed. In the early stages of chronic kidney disease, you may need to limit the amount of protein you eat. If you need to start dialysis treatments, you may have to eat more protein than before, especially if you are on peritoneal dialysis. Your registered dietitian will recommend the correct amount of protein for you based on your size, kidney function and treatment regimen.

Energy foods
Energy (or calories) is found in most foods, particularly starches, sugars, grains, fruits,vegetables, fats and oils. Energy foods provide the fuel (calories) you need to do your daily activities and help you maintain a healthy body weight. If you are getting fewer calories from protein because you are controlling your protein intake, youll nee d to get more calories from other food sources. The registered dietitian can suggest the

right energy foods to meet your needs, and, if you have diabetes, to help control your blood sugar.

Sodium (salt)
Sodium affects your body uids and blood pressure. You need to control your salt intake andavoid foods with a high sodium content. These include processed foods like deli meats, canned foods, convenience and fast foods, salty snacks and salty seasonings. Many prepared foods also have a lot of hidden salt in them learn to read food labels and always look for lower sodium foods.To enhance the taste of unsalted food, you can use unsalted spices, fresh or dried herbs, vinegar and lemon.

Potassium
Potassium is a mineral which helps your nerves and muscles work well. You need some potassium for good health, but too much can be dangerous. If the potassium level in your blood is too high or too low, it can affect your heartbeat. A very high level can cause the heart to stop beating.Some people in the early stages of CKD (pre-dialysis stages) dont need to limit their potassium intake, while others do need to watch it. Examples of high potassium foods are potatoes, squash, bananas, oranges, tomatoes, dried peas and beans.

Phosphorus (phosphate)
Phosphorus is a mineral which helps keep your bones strong and healthy. It may be referred to as phosphorus or phosphate. As kidney function declines, your blood phosphate level will rise, causing itchy skin or painful joints, and loss of calcium from your bones. Therefore, you may need to limit the amount of high and moderate phosphorus foods you eat. These include milk, cheese and other milk products, and protein foods such as meat, sh and poultry. However, you still need milk products and protein foods for overall good nutrition.

Calcium & Vitamin D

Calcium and Vitamin D are needed for strong bones and are carefully regulated by healthy kidneys. Damaged kidneys may not be able to activate Vitamin D into a usable form. When your kidneys are no longer working well, your doctor will advise you about starting calcium and activated Vitamin D supplements. .