Kidney Disease: Types, Causes, Symptoms, and Treatment

What is kidney Disease

Kidney disease occurs when the kidneys are unable to effectively filter the blood of toxins.

The kidneys are two bean-shaped organs located on either side of the spine, just below the ribcage. They are responsible for several vital functions in maintaining overall health, including filtering blood, regulating electrolyte and fluid balance, producing hormones that control blood pressure, and maintaining acid-base homeostasis. If the kidneys' filtering units, known as glomeruli, are impaired or obstructed, waste and fluid can accumulate in the body, leading to serious health complications. Thus, kidney disease encompasses a range of conditions that damage these essential organs, compromising their ability to function properly.

There are two main types of kidney disease: They are Acute and Chronic kidney Disease.
Acute kidney injury (AKI)is a sudden and severe loss of kidney function, often caused by infections, dehydration, or exposure to harmful substances. AKI can be serious but is typically reversible with prompt medical intervention.
In contrast, chronic kidney disease (CKD)is a long-term, progressive condition that often remains asymptomatic in its early stages. Over time, CKD can lead to kidney failure,at which point dialysis or a kidney transplant becomes necessary for survival.

While most individuals are born with two healthy kidneys, it is possible to live a healthy life with just one functioning kidney. Some people are born with only one kidney, while others may lose a kidney due to surgery or organ donation. However, when kidney function declines significantly in both kidneys, waste products and excess fluids build up in the body, leading to severe complications that can impact multiple organ systems.

Types of Kidney Disease

Kidney disease manifests in various forms, primarily classified as acute or chronic, with multiple underlying causes and varying degrees of severity.

Acute Kidney Injury

Acute kidney injury (AKI)occurs suddenly and is often reversible if treated promptly. This condition arises when the kidneys experience rapid damage due to infections, severe dehydration, medications, or other factors that impair kidney function. If the underlying cause is addressed, kidney function can typically be restored.

Chronic Kidney Disease (CKD)

Chronic kidney diseaseis a progressive condition in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. Over time, CKD leads to a buildup of toxins in the body, contributing to severe health complications such as high blood pressure,anemia,and heart disease.The leading causes of CKD include diabetes and hypertension. If left untreated, CKD can progress to end-stage renal disease (ESRD), requiring dialysis or a kidney transplant for survival. Approximately 1 in 7 adults in the United States have CKD, though many remain unaware of their condition.

Other Types of Kidney Disease

Beyond AKI and CKD, several other forms of kidney disease can affect renal function:

Polycystic Kidney Disease (PKD):A genetic disorder characterized by fluid-filled cysts developing in the kidneys, leading to impaired function and potential kidney failure.

Lupus Nephritis:An autoimmune condition where the immune system mistakenly attacks the kidneys, causing inflammation and potential damage.

Interstitial Nephritis:Often triggered by adverse reactions to medications, this condition leads to kidney inflammation and reduced filtering capacity. Discontinuing the offending medication can help restore kidney function.

GlomerulonephritisInflammation of the glomeruli, the kidney's filtering units, which can result from infections such as strep throat or immune system disorders, ultimately impairing kidney function.

APOL1-Mediated Kidney Disease:A genetic form of kidney disease that predominantly affects individuals of African, Afro-Caribbean, or Latino descent due to specific variations in the APOL1 gene.

Long-Lasting Viral Illnesses:Chronic infections such as HIV/AIDS, hepatitis B, and hepatitis C can contribute to kidney disease by directly affecting kidney cells or increasing the risk of kidney-damaging complications.

Pyelonephritis:A severe urinary tract infection that spreads to the kidneys, leading to scarring and potential long-term damage if recurrent.

Alport Syndrome:A rare genetic disorder affecting the kidneys, eyes, and ears, leading to kidney disease, vision problems, and hearing loss. The first sign is often blood in the urine.

Goodpasture Syndrome:A rare autoimmune disorder in which the immune system attacks both the kidneys and lungs, causing acute kidney failureand lung hemorrhages. Treatment typically includes immunosuppressants and plasmapheresis.

Signs & Symptoms of Kidney Disease

Kidney disease can manifest through a variety of symptoms, which may vary depending on the type and stage of the disease. Symptoms at each level include

Symptoms OF AKI

• Decreased urination
• Fatigue
• weakness
• Irregular heartbeats
• Chest pain or pressure
• Confusion
• Bone pain
• Nausea and vomiting
• Shortness of breath
• Swelling of the hands, ankles, or feet

Symptoms of CKD

• Urinating more or less
• Foamy urine
• Loss of concentration
• Fatigue and weakness
• Loss of appetite
• Trouble sleeping
• Muscle cramps
• Dry, itchy skin
• Restless legs
• Headaches
• Easy bruising
• Swelling of the ankles and feet

Diagnostic Investigations & Test

Diagnosing kidney disease involves a series of tests that assess kidney function and detect potential abnormalities.

Urine Tests
A urine test is one of the first steps in diagnosing kidney disease. This test checks for the presence of protein, specifically albumin, in the urine. High protein levels may indicate kidney damage. A key urine test used for kidney evaluation is the urine albumin-to-creatinine ratio (UACR), which compares the amount of albumin to creatinine in the urine. Abnormal levels suggest impaired kidney function.

Serum Creatinine Test
This test measures the level of creatinine, a waste product produced by muscle metabolism. Elevated creatinine levels may indicate reduced kidney function.

Estimated Glomerular Filtration Rate (eGFR)
Uses serum creatinine levels, age, sex, and body size to estimate how efficiently the kidneys filter waste. An eGFR below 60 mL/min/1.73m² for three months or more suggests chronic kidney disease.

Ultrasound
Uses sound waves to create images of the kidneys, detecting abnormalities such as cysts, stones, or blockages.

Magnetic Resonance Imaging (MRI)

Kidney Biopsy
A kidney biopsy may be necessary in cases where the cause of kidney disease is unclear. During this procedure, a small sample of kidney tissue is collected and examined under a microscope to determine the extent of damage and identify underlying conditions such as glomerulonephritis or kidney cancer.

Treatment of Kidney Disease

Treatment for kidney disease depends on its underlying cause, severity, and progression. While some forms of kidney disease are treatable, chronic kidney disease (CKD) has no cure. The primary goal of treatment is to manage symptoms, slow disease progression, and prevent complications.

Medications for Kidney Disease

Certain medications help manage kidney disease and its complications. Since high blood pressure is a leading cause and consequence of kidney disease, doctors often prescribe blood pressure medications such as:

ACE Inhibitors:These help relax blood vessels and reduce pressure on the kidneys. Examples include:

• Lisinopril (Prinivil, Zestril)
• Ramipril (Altace)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)

Angiotensin II Receptor Blockers (ARBs):These medications help lower blood pressure and protect kidney function. Examples include:

• Eprosartan (Teveten)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Azilsartan (Edarbi)
• Olmesartan (Benicar)
• Valsartan (Diovan)

Other medications used in kidney disease treatment include:

• Cholesterol-lowering drugs - Help reduce cardiovascular risks associated with CKD.
• Iron supplements and erythropoiesis-stimulating agents - Help manage anemia in CKD patients.
• Diuretics - Help reduce swelling and excess fluid buildup.
• Calcium and vitamin D supplements - Support bone health and prevent bone-related complications.

Treatment for Early-Stage Kidney Disease

For patients diagnosed in the early stages of CKD, treatment focuses on slowing disease progression through:

• Managing blood pressure - Keeping blood pressure under control to protect kidney function.
• Controlling cholesterol levels - Reducing the risk of cardiovascular complications associated with kidney disease.
• Treating anemia - Treating low iron levels to combat fatigue and weakness.
• Reducing fluid buildup - Using diuretics to help the kidneys remove excess fluid from the body.
• Supporting bone health - Taking supplements to prevent kidney-related bone disease.

Treatment for End-Stage Kidney Disease

When CKD progresses to end-stage renal disease (ESRD), the kidneys lose their ability to function effectively, requiring more intensive treatments such as dialysis or a kidney transplant.

Dialysis

Dialysis is a life-sustaining treatment that helps remove waste, excess fluids, and toxins from the blood when the kidneys can no longer perform this function. There are two main types of dialysis:

• Hemodialysis:Involves using a machine to filter the blood outside the body. Patients typically undergo this treatment multiple times per week at a dialysis center or at home.
• Peritoneal dialysis:Uses the lining of the abdomen (peritoneum) as a natural filter. A cleansing fluid is introduced into the abdomen, which absorbs waste and is then drained.

Kidney Transplant

A kidney transplant is the preferred treatment option for patients with ESRD. This procedure involves replacing a diseased kidney with a healthy donor kidney. While a transplant can restore kidney function, recipients must take lifelong immunosuppressant medications to prevent organ rejection

Despite the risks associated with transplantation, such as infection or rejection, it offers a better quality of life and longevity compared to long-term dialysis

Nursing Management of Kidney Disease

Below are recommended practices for the treatment of kidney disease

• Check vital signs 4 hourly and record
• Weigh your patient daily
• Blood test to assess potassium levels and report any changes
• Keep daily fluid intake and output chart
• Observe the level of consciousness of your patient
• Explain the reasons for fluid restriction to your patient
• Monitor electrolyte balance

• Adequate protein/low protein provision in diet
• Restrict potassium intake (avoid banana) in diet
• Sodium restriction and phosphate
• Give high carbohydrate diet fluid restriction (500 - 600ls plus previous 24-hour fluid loss)

• Bath your patient
• Take care of the bony prominences
• Meticulous mouth care, apply jelly to lips to prevent cracks Care for hands and feet and hair

• Put patient to rest especially in the acute phase.
• Ensure patient's bed is free from creases
• Open windows for fresh air or switch on fans (if not contraindicated)
• Turn your patient frequently as required to prevent bed sores

Complications of Kidney Disease

Kidney disease can lead to a range of serious complications that can impact overall health and quality of life

• End-Stage Renal Disease (ESRD)
• Cardiovascular Disease
• Electrolyte Imbalances such as hyperkalemia, hyponatremia
• Fluid Overload
• Infections
• Gastrointestinal Issues
• Mental Health Issues
• Anemia
• Bone disease

Preventions of Kidney Disease

• Stop smoking, if you smoke
• Manage your weight
• Exercise regularly
• Get enough sleep
• Limit alcohol intake
• Drinking enough water to stay hydrated
• Opt for heart-healthy foods, such as fruits, vegetables, whole grains and fat-free dairy or low-fat diet