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Chronic Kidney Disease

The kidneys are two bean-shaped organs that are located
toward your back, on either side of your spine, just underneath
the rib cage.

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Chronic Kidney Disease

What are the kidneys?

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The kidneys are two bean-shaped organs that are located toward your
back, on either side of your spine, just underneath the rib cage. A kidney is
about as big as a st. The kidneys do several things. They are responsible
for making urine by ltering wastes and extra water out of the body. The
kidneys also produce certain necessary hormones (erythropoietin, renin,
and calcitriol) and help to regulate blood pressure by producing life-
sustaining chemicals. During one day, the kidneys clean out 200 quarts of
blood.

In each kidney, there are about one million nephrons. These small
nephrons are the kidney parts that do the cleaning. A nephron has a
glomerulus, which is a small blood vessel, and a tubule, which collects urine.

Related Institutes & Services

Glickman Urological & Kidney Institute

The Glickman Urological & Kidney Institute offers innovative treatments in
urology and nephrology, including minimally invasive, scarless options for
urologic procedures and medical management of kidney disease.

What is kidney disease?

Kidney function, also called renal function, describes how well the kidneys
work. If a person has two healthy kidneys, he or she is said to have 100
percent kidney function. If the kidneys lose even 30 percent to 40 percent
of function, one might not even notice. A person can live with just one
healthy kidney. However, when kidney function falls below 25 percent,
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serious problems develop. A person with less than 10 percent to 15

percent kidney function will need to have treatment to replace kidney
function. The treatment choices are dialysis, a process to cleanse the
blood and body, or a kidney transplant.

What causes kidney disease?

Kidney diseases occur when the nephrons are damaged and cannot lter
the blood. The damage can happen quickly, such as when it is caused by
injury or toxins. However, most damage occurs over a period of time. High
blood pressure (hypertension) and diabetes are the two most common
causes of the progressive type of damage to the nephrons and the
resulting kidney failure (chronic kidney disease or CKD). CKD is also
known as chronic renal insuf ciency.

Who is at risk for chronic kidney disease?

People with diabetes

People with high blood pressure
People with a family history of kidney disease
People who often use painkillers, including over-the-counter products
such as aspirin and ibuprofen

What are the symptoms of chronic kidney disease?

In the early stages, there usually are no symptoms. As the disease

worsens, symptoms may include:
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Changes in how often you need to urinate

A feeling of tiredness or drowsiness
Loss of appetite
Swelling of hands and feet
A feeling of itchiness
Numbness
Feeling of nausea or vomiting
Muscle cramps
Darkness of skin

How is kidney disease diagnosed?

Often, kidney diseases are discovered through routine testing of blood or

urine. According to the National Kidney Foundation, three tests are
recommended for testing for kidney disease:

Measuring blood pressure (Blood pressure levels are not only a factor in
causing kidney disease, but may also indicate the presence of kidney
disease.)
Testing urine for the presence of albumin or other proteins
Measuring serum creatinine to provide for a calculation of glomerular
ltration rate (GFR)

In addition, measuring the level of urea nitrogen in the blood can also be
useful.

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If these tests come back with an indication of kidney disease, your health
care provider may order additional testing. These may include imaging
tests, such as ultrasound, magnetic resonance imaging (MRI), and
computerized tomography (CT) scans. If the health care provider needs
additional information, he or she may order a kidney biopsy. This
procedure means that a needle is used to retrieve a piece of kidney tissue
in an operation using local anesthesia.

How is chronic kidney disease treated?

There is no cure for chronic kidney disease, but steps may be taken in early
CKD to preserve a higher level of kidney function for a longer period of
time. People who have reduced kidney function should:

Make and keep regular doctor visits; a nephrologist (kidney specialist)

might be recommended.
Keep their blood sugar under control (for diabetics).
Avoid taking painkillers and other medications that may make kidney
disease worse.
Keep blood pressure levels under control.
Consult a dietitian regarding useful changes in diet. This may include
limiting protein, eating to reduce blood cholesterol levels, and limiting
sodium (salt) and potassium intake.
NOT smoke.
Treat anemia if present.

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Because there is no cure for CKD, people who are in the later stages of the
disease must consider options. Complete kidney failure, left untreated,
will result in death. Options for patients in the end stages of CKD include
dialysis and kidney transplantation.

What is dialysis?

Dialysis is a procedure that uses machines to remove waste from the body
when the kidneys are no longer able to perform this function. There are
two major types of dialysis.

Hemodialysis

The hemodialysis machine has a dialyzer to clean the blood of waste

products, excess water, and excess salt. The blood is then returned to the
body. Hemodialysis is performed for three to four hours three times a
week. This is done primarily at a clinic or hospital, but efforts are being
made to implement home hemodialysis treatments.

Peritoneal dialysis

In peritoneal dialysis, the dialysis solution is introduced into the patients

abdomen. The solution captures waste and then is removed via catheter.
Fresh solution is added to continue the process of cleaning. This type of
dialysis can be performed by the patients themselves. There are two types
of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD),
which involves a change in dialysis solution four times per day; and
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continuous cycling peritoneal dialysis (CCPD). The latter procedure uses a

machine to automatically ll, remove wastes, and re ll the uid during the
nighttime.

What is kidney transplantation?

Kidney transplantation involves placing a healthy kidney into the body

where it can perform all of the functions that a failing kidney cannot.
Kidneys for transplantation come from two sources: living donors and
deceased (non-living) donors. Living donors are usually immediate family
members or sometimes spouses. This is possible because a person can live
well with one healthy kidney.

Deceased donor kidneys usually come from people who have willed their
kidneys before their death by signing organ donor cards. All donors are
carefully screened to make sure there is a suitable match and to prevent
any transmissible diseases or other complications.

References:

National Kidney Foundation: About Chronic Kidney Disease

National Institute of Diabetes and Digestive and Kidney Diseases -
Chronic Kidney Disease: What Does it Mean for me?
TDonate Life America. Understanding Donation: types of Organ
Donation

Copyright 1995-2017 The Cleveland Clinic Foundation. All rights

reserved.
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This information is provided by the Cleveland Clinic and is not intended to

replace the medical advice of your doctor or health care provider. Please consult
your health care provider for advice about a speci c medical condition. This
document was last reviewed on: 9/23/2015...#15096

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