Chronic kidney disease (CKD) slowly gets worse over months or years. You may not notice any symptoms for some time. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.
The final stage of CKD is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.
Most people will have high blood pressure at all stages of CKD. During an exam, your health care provider may also hear abnormal heart or lung sounds in your chest. You may have signs of nerve damage during a nervous system exam.
A urinalysis may show protein or other changes in your urine. These changes may appear 6 to 10 months or more before symptoms appear.
Tests that check how well the kidneys are working include:
Controlling blood pressure will slow further kidney damage.
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
The goal is to keep blood pressure at or below 130/80 mm Hg.
Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as:
DO NOT smoke.
Eat meals that are low in fat and cholesterol.
Get regular exercise (talk to your doctor or nurse before starting to exercise).
Take drugs to lower your cholesterol, if needed.
Keep your blood sugar under control.
Avoid eating too much salt or potassium.
Always talk to your kidney specialist before taking any over-the-counter medicine. This includes vitamins, herbs and supplements. Make sure all of the providers you visit know you have CKD. Other treatments may include:
Medicines called phosphate binders, to help prevent high phosphorous levels
Extra iron in the diet, iron pills, iron given through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions to treat anemia
Extra calcium and vitamin D (always talk to your provider before taking)
Fogarty DG, Tall MW. A stepped care approach to the management of chronic kidney disease. In: Taal MW, Chertow GM, Marsden PA et al, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.
Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290. PMID: 15114537 www.ncbi.nlm.nih.gov/pubmed/15114537.
Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154(8):541-8. PMID: 21403055 www.ncbi.nlm.nih.gov/pubmed/21403055.
Charles Silberberg, DO, private practice specializing in nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.