Chronic Kidney Disease

Believe it or not, the kidneys do much more then just produce urine! Your kidneys are important organs that perform many functions to keep your blood clean, free of toxins, and perfectly balanced.

About the kidneys

Most people have two kidneys. Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage. Every day, your kidneys process about 200 quarts of blood to filter out about 2 quarts of waste products and remove extra water. The waste and extra water become urine. The urine flows into the bladder through long thin tubes called ureters. Your bladder stores urine until you go to the bathroom and pass the urine.

What do the kidneys do?

Make urine
Filter and remove waste
Regulate body water and other chemicals in the blood such as sodium, potassium, calcium and phosphorus
Release of hormones that assist in the following functions:
- Control your blood pressure
- Helps to keep your bones healthy
- Stimulate the bone marrow to make red blood cells

The main task of the kidneys is to remove the potentially harmful waste products from your blood. Waste is formed when your body breaks down food, toxins, and drugs. Your body uses the food you eat for energy and self-repair. After your body has taken what it needs from the food, the waste is released to the blood. If your kidneys do not remove these wastes, the wastes build up to harmful levels in the blood and damage your body.

The actual filtering of wastes occurs in tiny units inside your kidneys called nephrons. Every kidney has about one million nephrons. In the nephron, a glomerulus—which is a tiny blood vessel, or capillary—intertwines with a tiny urine-collecting tube called a tubule. A complicated exchange takes place, as waste materials and water leave your blood and enter your urinary system.

At first, the tubules receive a combination of waste materials and chemicals that your body can still use. Your kidneys measure out chemicals like sodium, phosphorus, and potassium. They give back to the blood what is needed by the body. The rest will be eliminated in the urine. In this way, your kidneys regulate the body’s level of these substances. The right balance is necessary for life, but excess levels can be harmful.

In addition to removing wastes, your kidneys release three important hormones:

erythropoietin (eh-RITH-ro-POY-eh-tin), or EPO, which stimulates the bone marrow to make red blood cells
renin (REE-nin), which regulates blood pressure
calcitriol (kal-suh-TRY-ul), the active form of vitamin D, which helps maintain calcium for strong bones and for normal chemical balance in the body

What is renal function?

When your kidneys are working properly, and are free of disease, you have adequate renal (kidney) function. You can even live a normal, healthy life with just one kidney. It is important to understand that chronic kidney disease happens slowly and is usually caused by damage to the kidneys in the form of a disease. It may take months or years before your kidney function declines to the point of needing dialysis or a transplant. During the early stages of your kidney disease, your nephrologist (kidney doctor) will monitor the function of your kidneys. His or her goal is to keep your kidneys working as long as possible. Your doctor will prescribe certain things to help your body adjust to the slowing down of your kidney function.

Many people with reduced renal function have a kidney disease that will get worse. Health problems will develop and worsen as renal function declines. If your renal function drops below 15 percent, you cannot live long without some form of renal (kidney) replacement therapy—either dialysis or transplantation.

Why do kidneys fail?

Most kidney diseases attack the nephrons, causing them to lose their filtering capacity. Damage to the nephrons may happen quickly, as the result of injury or poisoning, but most kidney diseases destroy the nephrons slowly and silently. Only after years or even decades will the damage become apparent. Most kidney diseases attack both kidneys at the same time.

The two most common causes of kidney disease are diabetes and high blood pressure. If your family has a history of any kind of kidney problems, you may be at risk for kidney disease.

Diabetes (dy-uh-BEE-teez)

Diabetes is a disease caused by high levels of glucose (sugar) in the blood, which results when the body can’t make enough insulin or can’t use the insulin. Insulin is needed to maintain healthy glucose (sugar) levels in the blood. If glucose stays in your blood instead of breaking down, it can act like a poison. Over time, diabetes changes the blood vessels in the body, including the blood vessels that deliver blood to the kidneys. When the nephrons don’t get enough blood they are severely damaged. As a result, the blood can’t pass through the kidneys and the nephrons can’t filter wastes from the blood, or perform their other functions. Damage to the nephrons from unused glucose in the blood is called diabetic nephropathy. If you keep your blood glucose levels down, you can delay or prevent diabetic nephropathy. Monitoring your glucose (sugar) level and keeping your glucose (sugar) level in the normal range is the best way to prevent damage to the kidneys.

High Blood Pressure (also called hypertension)

High blood pressure is known as the “silent killer” and can lead to kidney disease. It can also be a sign that your kidneys are already impaired. The damaged vessels cannot filter wastes from your blood as they are supposed to. The only way to know whether your blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats. Blood pressure for healthy adults should be below 120/80 (expressed as “120 over 80”). In order to get your blood pressure within the target range, your doctor may prescribe blood pressure medication.

Glomerulonephritis (gloh-MEHR-yoo-low-nef-RY-tis)

Glomerulonephritis is a type of kidney disease that involves the glomeruli. The glomeruli are small, essential structures in the kidneys that supply blood flow to the small units in the kidneys that filter urine, called the nephrons. Glomerulonephritis is when the glomeruli become inflamed and impair the kidney’s ability to filter urine. As a result, the nephrons can’t filter the blood and the kidneys can’t carry out their other functions. There are many causes of glomerulonephritis.

Polycystic Kidney Disease (also called PKD)

Polycystic kidney disease is usually a genetic disease in which many grape-like, fluid filled cysts grow in the kidneys. These cysts slowly take over and replace much of the kidney. This causes reduced kidney function leading to kidney failure. Most patients with PKD have family members with PKD.

Kidney Infection or Pyelonephritis (PY-loh-nef-RY-tis)

Pyelonephritis is an infection most often caused by a germ that travels from the bladder to the kidneys. Severe or frequent infections of this type can cause damage to the kidneys leading to kidney failure.

Kidney Stones

A kidney stone is a hard mass that develops when calcium oxalate or other chemicals in the urine form crystals that stick together. These crystals may grow into stones ranging in size from a grain of sand to a golf ball. Kidney stones can form in the ureters (the tubes that carry urine from the kidneys to the bladder) and block the flow of urine. Then urine collects in the kidneys, which causes pressure and sometimes infection in the kidneys. Over time, this damages the kidneys and causes them to fail.

Systemic Lupus Erythematosus (sis-tem-ic LOO-pus eri-the-ma-toe-sus also called Lupus)

Lupus is an “autoimmune” disease. The immune system, which usually protects the body from disease, turns against the body, causing harm to organs and tissues. The immune system can cause inflammation and swelling of the blood vessels and organs of the body including the kidneys. If the kidneys become involved, they lose the ability to filter wastes out of the blood or carry out their other normal functions.

Other Causes of Kidney Disease

Renal failure is not always caused by a disease. Renal function can decline as the result of poisons, illegal drug use, or trauma, for example, a direct and forceful blow to your kidneys.

Defining Types of Renal Failure

What is Acute Renal Failure?

Acute renal failure occurs suddenly and is usually the result of an external insult such as accidental trauma, drug overdose, illness and/or severe blood loss. Acute renal failure may lead to permanent loss of kidney function; however, acute renal failure can often be reversed.

What is Chronic Kidney Disease?

Most kidney problems, however, happen slowly over a long period of time. You may have “silent” kidney disease for years. Gradual loss of kidney function is called chronic kidney disease (CKD) or chronic renal insufficiency. Those with CKD often go on to permanent kidney failure. The damage that results from chronic kidney disease cannot be reversed.

What are the signs of kidney disease?

When you are in the early stages of kidney disease, you usually do not feel sick at all. As kidney disease progresses you may feel one or more of the following symptoms.

Symptoms of kidney disease

Kidney disease may affect individuals differently depending on the cause of the kidney disease and the stage of your kidney disease. You may not experience all of the symptoms on this list but you may experience any combination of these symptoms:

Frequent thirst
Urinating more or less often
Passing very small amounts of urine
Swelling in the hands, feet and face
Puffiness around the eyes
Unpleasant taste in the mouth and urine-like odor to the breath
Feeling tired
Trouble breathing or short of breath
Loss of appetite
High blood pressure
Pale skin
Dry, itchy skin
Nausea and vomiting
Headache
Drowsiness or confusion
Darker color to skin
Muscle cramps
Trouble Sleeping
Inability to concentrate

What are the early stages of Kidney Disease?

In 2002, the National Kidney Foundation published treatment guidelines that identified five stages of CKD based on declining glomerular filtration rate (GFR) measurement and the presence of kidney damage. It is understood that the GFR measurement is the best indicator of how well the kidneys are working. As the GFR number decreases, so does kidney function. Your doctor can calculate your glomerular filtration rate, in essence, how much kidney function you have, from the results of your blood creatinine test, your age, race, gender and other factors.

The GFR chart shows the five stages of CKD as they relate to the GFR. Each stage of CKD is described in terms of how kidney function is affected. Then, the treatment stage recommends different actions based on the stage of kidney disease.

YOU are the most important member of the healthcare team! You can take an active role in your care by learning all you can and cooperating fully with your treatment plan. You and your family should not be afraid to ask questions. Each person on the health care team is there to help you feel your best. Management of chronic kidney disease (CKD) is a team effort. Working with you will be your doctor, who will prescribe medications and manage your medical problems, and other professionals who may participate in educating you regarding your condition. Members of your CKD team (at this stage) will include:

You
Your Primary Care Physician or Family Doctor
Your Nephrologist
Your Nurse

Primary Care Physician or Family Doctor

Your family doctor is an important team member you already know. Your doctor may be a general practitioner, an internist, or a family practice doctor. Your primary care doctor takes care of your general health and may continue treat your specific conditions such as diabetes, arthritis, high blood pressure, heart problems, and other medical concerns. He or she may have been the one that diagnosed your kidney disease. It is important that you keep your regularly scheduled visits with your family doctor and communicate any changes in your treatment plan even when you begin to see your nephrologist.

Nephrologist (kidney specialist or doctor)

Your nephrologist is a doctor who has had special training on how to treat kidney disease. Your nephrologist (kidney doctor) will work with you and the rest of the healthcare team. A plan to treat your disease and manage your health will be developed based on your symptoms, special tests, and lab reports. You will see your nephrologist on a regular basis. Your nephrologist will monitor your health. He or she will make changes to your health care plan as needed to help you stay healthy.

Nurse

The experienced registered nurse (RN), licensed professional nurse (LPN) or advanced registered nurse practitioner (ARNP) is trained in the care of patients with chronic kidney disease. The nurse will review your lab results with you, monitor your vital signs and complete an assessment each visit. He or she will provide you with the education and information you will need to take care of yourself so that you can make the best choices in regards to your treatment plan. Your nurse is an excellent person to answer questions about CKD and daily care.

You may find it helpful to have a notebook where you write down questions for your healthcare provider. If you’re like most people, you have questions that you think of at home, and then when you see your doctor, it’s hard to remember those questions. A notebook that you carry with you can be a good way to make sure your questions are answered.

Proper Nutrition is Important.

Proper nutrition is especially important to you now that you have been diagnosed with decreased kidney function. By maintaining a proper nutritional plan, you may be able to extend the function of your kidneys and your overall health. A proper nutritional plan can help build muscle, prevent infection and can help you feel and look better. Remember that no single nutritional plan is right for everybody. Your blood work will reflect what nutrients you need to increase and which nutrients you need to limit. Your doctor will recommend a well-rounded nutritional plan that is individualized for your needs. Well-rounded nutrition means that you focus on getting key nutrients such as protein, vitamins, minerals and calories.

Protein Should be Monitored.

Starting now, you will probably hear a lot of talk about protein. Protein is needed by the body in order to help build muscle, repair tissue and fight infection. With kidney disease, you may need to eat less of certain types of proteins. By regulating the amount and types of protein you eat, your kidneys process less protein waste, which reduces the amount of waste build up in your blood. Excess protein wastes in your blood can also cause nausea, loss of appetite, vomiting, weakness, taste changes and itching. Your doctor will help you determine how much and which types of protein should be in your diet. Higher quality proteins can be found in animal products such as meat, poultry, fish and eggs. If you have high cholesterol or heart disease, your doctor may recommend eating protein rich foods that are more heart friendly. Heart friendly proteins include chicken breast, lean red meats, low cholesterol egg products, low fat soy products, and low fat dairy products. Lower quality proteins are found in vegetables and grains. You may be advised that a well-rounded diet should include both kinds of protein.

Vitamins and Minerals are Essential.

Most people get the vitamins and minerals they need by eating a variety of foods each day. However, the limitations that may be required in your diet due to your decreased kidney function can make getting adequate amounts of some vitamins and minerals challenging. You may need to take vitamin and mineral pills in order to supplement what is not in your nutritional plan. Ask your doctor before taking any herbal supplements or herbal remedies! When taking vitamins and minerals you should be sure that you only take what your doctor recommends! Just because you may find the vitamins, minerals, and popular herbal supplements in a store does not mean they are safe, especially for people with kidney disease. Most people with CKD already take multiple medications. Adding any additional medication, especially herbal supplements, raises the risk of drug interactions and possible harmful effects.

You Need Calories.

In this day and time most people are counting calories and trying to lose weight. This is not necessarily the focus for your calorie counting. Instead, you should view calories as fuel. The calories you eat will provide your body with the energy you need to live. You want to eat enough calories to keep a healthy weight. You also want to eat enough calories to give you the energy you need to be active throughout your day. If you do not get enough calories, your body will break down your muscles (protein) to use for fuel. When this happens your body may not have enough fuel to use for other important bodily functions. This can increase your chances of experiencing complications. A renal diet may include simple sugars (such as jelly beans and hard candies), low cholesterol and low saturated fats to provide needed calories. If you are a diabetic, your doctor will discuss the safe use of sugar or will discuss better options for calories in your nutritional plan.

Manage Your Cholesterol By Choosing Healthy Fats!

Cholesterol is important for some of our bodily functions, but it is unhealthy if we have increased amounts of the bad cholesterol. Too much bad (LDL) cholesterol in the blood is a major risk factor for heart disease. Cholesterol is a fat-like substance that can build up on the insides of your blood vessels. The buildup can cause stroke and heart attacks. Too much cholesterol in your blood may be the result of a high-fat diet. It is important to work with your doctor to choose foods that are lower in fat and cholesterol.

Diet and Exercise Will Help Manage Triglycerides.

Another form of fat in your bloodstream is triglycerides. People with CKD often have high triglyceride levels which can also increase your risk for heart attack and stroke. Your triglyceride level will be checked along with your cholesterol level in a lipid profile. Elevated triglycerides can be due to obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates. Therefore, it is also important to limit your alcohol intake and increase your exercise.

Sodium (Na) Should Be Limited.

Sodium is found in table salt and many processed foods. Too much sodium in your diet can contribute to excessive thirst and high blood pressure. Your doctor will monitor your blood pressure. Controlling blood pressure is important in managing kidney disease. Sodium restriction is recommended if your blood pressure is high or if you are retaining water in your body. Retaining excess water in your body can cause high blood pressure, swelling of the ankles, and swelling of the fingers and eyes. Controlling your sodium intake can help to slow your kidney disease and keep your kidneys healthier longer. Your doctor may advise you to lower your sodium intake. Here are a few common items with high sodium content:

Processed meats (ham, bacon, sausage, and cold cuts)
Canned food and frozen dinners (unless marked as low sodium)
Certain seasonings (salt, soy sauce, Teriyaki sauce, garlic salt, and onion salt)
Salt substitutes should not be used because they contain large amounts of potassium which can also be dangerous

Potassium (K) May Need to Be Regulated.

Potassium is used by the body to help your nerves and muscles (especially the heart) work properly. Potassium is found in leafy vegetables, fruits and fruit juices, tomatoes and potatoes. Excess amounts of potassium are removed by the kidneys. The wrong amount of potassium in the body can be dangerous.

Too much potassium can make your heart beat irregularly or even stop without warning. Some medications can also increase the potassium levels in those with CKD. Your potassium level may be normal and will not require any limitations. Your doctor will monitor your potassium level by looking at your blood tests and making adjustments if needed.

Phosphorus is a mineral that works with calcium to keep your bones healthy and strong. It is also needed by the body to maintain normal nerve and muscle function. Phosphorus is found in most foods but is mainly present in cheese, milk and meat. Phosphorus is usually regulated by the kidneys. With renal failure, the kidneys are not able to remove excess amounts of phosphorus that may build up in your blood. If your blood tests reveal excess amounts of phosphorus, your doctor may adjust your diet to decrease phosphorus intake. As your kidney function decreases, you may also be prescribed a phosphate binder to help remove excess phosphorus so that it does not move into your blood. High phosphorus levels also cause an increase in the parathyroid hormone (PTH) levels. High PTH levels may cause bone damage.

Calcium (Ca) Should Be Monitored

As you may know, we all need calcium to build strong bones. When the kidneys fail, your body’s ability to absorb and use calcium properly is decreased. Your doctor may have you take a special form of vitamin D and/or a calcium supplement to help keep your bones healthy. If your calcium level is too high, your calcium intake may need to be reduced. The combination of too much calcium and too much phosphorus makes you itch and may be damaging to your arteries as well. Remember, you should never take over-the-counter calcium or vitamin supplements unless directed to do so by your nephrologist.

Fluids Should Be Monitored

Depending on how much function you have in your kidneys, you may or may not need to limit your fluid intake. Your kidneys help to control the amount of fluid that leaves your body. As your kidney disease progresses, your kidneys may be unable to remove the excess fluid from your body. Too much fluid may cause swelling, shortness of breath, or high blood pressure.

Nutrition Handouts

Common Tests to Help Diagnose Kidney Disease

Lab work, urine samples, and other tests may be completed as you undergo diagnosis and treatment for renal failure. The test results will be used to assist the healthcare team (your doctor, nurses, and others) in evaluating your kidney function and determining what your healthcare plan should include. Remember, you are in control and you are your own best healthcare provider, so it is essential for you to understand what these tests mean. Remember, there can be some differences in these values from one lab to another, so make sure you learn the normal values for your lab. Let’s get started.

Blood Urea Nitrogen (also called BUN)

Blood carries protein to cells throughout the body. After the cells use the protein, the remaining waste product is returned to the blood as urea nitrogen. Healthy kidneys take urea nitrogen out of the blood and remove it in the urine. If your kidneys are not working well, the urea nitrogen will stay in the blood. Normal blood contains 7-20 mg/dl of urea. If your BUN is more than 20 mg/dL, your kidneys may not be working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.

Serum Creatinine

Creatinine is a waste product in the blood created by the normal metabolism of muscle cells. Healthy kidneys take creatinine out of the blood and remove it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood. If the kidneys lose their ability to filter blood (GFR decreases) more creatinine will accumulate and serum creatinine will rise. As a result, creatinine is an indirect marker of glomerular filtration rate (GFR) or how well the kidneys work. A creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly.

Creatinine Clearance

Creatinine clearance is a measure of how much creatinine is in your urine. It gives an accurate measure of ability of the kidneys to remove the creatinine out of your body. To calculate a creatinine clearance you may be asked to save your urine for 24 hours and bring it to the lab. The lab measures the amount of creatinine in the urine. The normal creatinine clearance is greater than 90 ml/min.

GFR (Glomerular Filtration Rate)

GFR is a measurement of how well the kidneys are processing wastes. A sample of your blood is sent to the lab. The blood creatinine level is factored in with your age, gender, height, race, and weight to calculate your glomerular filtration rate (GFR). Normal GFR can vary according to age. As you get older it can decrease. The normal value for GFR is 90 ml/min or above. A GFR below 60ml/min is a sign that kidneys are not working properly. A GFR below 15 ml/min indicates that a treatment for kidney failure, such as dialysis or transplant will be needed.

Microalbumin Urine Test

Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only a small amount of protein that is too small to be measured with a standard dipstick may leak into the urine. This condition is known as microalbuminuria. This is how the test is read:

Less than 30 mg/L is normal
Greater than 30 mg/L but less than 300 mg/L is called microalbuminuria
Greater than 300 mg/L is called macroalbuminuria

Urine Protein Test

As kidney function worsens, the amount of albumin and other proteins in the urine often increases, and the condition is called proteinuria. Your doctor may test for protein using a dipstick in a small sample of your urine taken in the doctor’s office. The color of the dipstick indicates the presence or absence of proteinuria. This test should be negative.

Blood Tests to Check for Anemia

Hematocrit
Hematocrit (Hct) is a blood test that measures the number and the size of red blood cells. It gives a percentage of red blood cells found in whole blood. It is used to check for anemia. Anemia, a shortage of oxygen carrying red blood cells, often begins at the early stages of kidney disease. Anemia is treatable. A normal hematocrit (Hct) for a healthy adult is 38-45%. For a person with CKD, the desirable Hct is 33-36%.

Hemoglobin
Hemoglobin (Hb. Hgb) is the part of the red blood cell that carries oxygen to the cells of the body. Both hemoglobin and hematocrit are measured to check for anemia. Three times the hemoglobin level equals the hematocrit. A normal hemoglobin level for a healthy adult is 12-15 g/dl. For a person with CKD the desirable hemoglobin is 11-12 g/dl.

Blood Tests that Measure Diabetes Control

Glucose (Blood Sugar)
A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose is your blood sugar. It is measured to make sure your body is able to digest and utilize sugar and carbohydrates correctly. If your blood sugar is too high, it may mean you have diabetes.

Normal Fasting (before eating) Glucose levels:

No known diabetes: less than 100 mg/dl.
Above 125 mg/dl can indicate diabetes.
Diabetics: 70-130 mg/dl is within target range

Normal Non-fasting (2 hours after you have eaten a meal)

No known diabetes: less than 140 mg/dl.
Diabetics: less than 180 mg/dl

Hemoglobin A1C (HbA1c)
A glycosylated hemoglobin A1C (also called HbA1c, Hemoglobin A1C, and A1C) reading reveals your average blood glucose level over the past three months and can be used to monitor your diabetic control and to predict your risk for diabetic complications. How does it do that? Your body actually memorizes the trail that sugar leaves in your body. When blood glucose is high, the sugar molecules attach themselves to red blood cells. The red blood cells store the sugar information for about four months. A blood test can then retrieve your average blood glucose results in the format of a percentage. The greater your A1C value, the higher your risk for diabetic complications. For the diabetic with CKD, good control of your blood sugar can slow the worsening of kidney function. Ask your doctor what your result should be. For most people, the result should be less than 7%.

Nutritional Blood Tests

Serum Albumin
Albumin is the protein level in the blood. It is produced in the liver and released into the blood. It helps prevent blood from leaking out of blood vessels. It carries medications and other substances through the blood, and is important for tissue growth and healing. A normal serum albumin is a measure of good nutrition. Research shows that people with kidney disease who become malnourished, have low serum albumin levels, and do not get enough protein may suffer from complications. The normal serum albumin in a healthy adult is 3.5 g/dl. The target for adults with CKD is 4 g/dl.

Lipid Panel
Lipids are found in your blood and are stored in your tissues. They are an important part of cells, and they help keep your body working normally. Lipid disorders such as high cholesterol, may lead to life-threatening illnesses, such as coronary artery disease, heart attack and stroke. There is also growing evidence that hyperlipidemia contributes not only to cardiovascular disease but also to renal disease progression.

Total Cholesterol
People with high levels of cholesterol may feel well, but they are at a higher risk for heart attacks and hardening of the arteries than those with normal levels. Normal range for cholesterol in healthy adults and adults with CKD is less than 200 mg/dl.

HDL-(High-Density Lipoprotein)
This is known as the “good” cholesterol. Higher levels are associated with a lower risk of heart disease. The normal range for HDL for healthy adults and adults with CKD is 40-79 mg/dl.

LDL-(Low Density Lipoprotein)
This is known as the “bad” cholesterol. High levels of LDL are bad and associated with a higher risk of heart disease and stroke. The normal range for healthy adults and adults with CKD is less than 100 mg/dl.

Triglycerides
Triglycerides are the main form of fat in foods and in the human body. The normal range for healthy adults and adults with CKD is less than 150 mg/dl.

Additional Tests for Kidney Disease

If blood and urine tests indicate reduced kidney function, your doctor may recommend additional tests to help identify the cause of the problem.

Renal Imaging
Methods of renal imaging (taking pictures of the kidneys) include ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI). These tools are most helpful in finding unusual growths or blockages to the flow of urine.

Renal Biopsy
Your doctor may want to see a tiny piece of your kidney tissue under a microscope. To obtain this tissue sample, the doctor will perform a renal biopsy—a hospital procedure in which the doctor inserts a needle through your skin and into the kidney. The needle retrieves a strand of tissue about 1/2 to 3/4 of an inch long. For the procedure, you will lie on your stomach on a table and receive local anesthetic to numb the skin. The sample tissue will help the doctor identify the cause and severity of your kidney disease.

What Can I Do About Kidney Disease?

Unfortunately, chronic kidney disease often progresses to stage 5 despite early diagnosis and aggressive treatment. If you are still in stage 3 or 4 of kidney disease, you are still able to live without dialysis. Even though the kidneys are damaged, they are still able to filter some wastes and excess fluid from the blood. The primary focus at stages 3 and 4 is keeping your body well nourished, reducing protein waste build-up in the blood, and managing other conditions you may have by taking your prescribed medications and keeping your regularly scheduled doctor appointments. You will need to visit your doctor about every three months. It is important that your blood is checked at regular intervals by your nephrologist so that he or she can monitor your kidney function and make adjustments in your diet and medications as needed. You may still be able to make your kidneys last longer by taking steps to slow further kidney damage. You should be seeing a nephrologist at this stage. If you are not, you should be referred to one as soon as possible so that you can be assessed regularly for renal changes.

If You Have Been Diagnosed with Diabetes

The most common cause of end stage renal disease is diabetes mellitus. If you have diabetes, watch your blood glucose (sugar) closely to keep it under control. Make sure you are taking your oral anti-diabetic agent or insulin as directed by your doctor.

Follow your diet. Consult your doctor for the latest in treatment.

If You Have Been Diagnosed with High Blood Pressure

High blood pressure is the second leading cause of chronic renal failure. High blood pressure damages the small vessels in the kidneys. Blood pressure should be checked regularly. People with reduced kidney function should have their blood pressure controlled. Work with your doctor to find the anti-hypertension medicine that works best for you. Many people will require two or more types of medication to keep their blood pressure normal. Along with prescribing medication, your doctor may recommend lifestyle changes such as exercising regularly and reducing your salt intake in order to keep your blood pressure under control.

Treating Anemia

Anemia is a shortage of red blood cells. These cells are important because they carry oxygen throughout the body. If you are anemic, you will feel tired and will look pale. Anemia may also stress your heart. Heart disease is the leading cause of death in people with kidney disease. Healthy kidneys make the hormone erythropoietin (EPO), which stimulates the bone marrow to make red blood cells. Diseased kidneys may not make enough EPO. Ask your doctor about medications such as epoetin (EPO) to treat anemia.

Iron Management

Adequate iron must be available in your body in order for epoetin (EPO) therapy to work. Your doctor will check your lab work to evaluate your iron status. If you suffer from iron deficiency, he or she may prescribe an iron supplement for you to take to build your iron stores. Correction of anemia has been shown to lower the chances of heart failure in people with CKD.

Keeping Your Bones Healthy

Your doctor will check your lab work periodically to evaluate you for bone disease.

Phosphorus: If you suffer from high phosphorus levels, your doctor may prescribe a phosphorus binder. It will be important for you to take your phosphorus binder as your doctor prescribes. (Usually it is taken with your meals and snacks.)
Calcium: Your lab work will tell the doctor if your calcium levels are within normal range. If your calcium levels are low, your doctor may prescribe a calcium supplement, or, if your calcium levels are high, you may need to limit your calcium.
Vitamin D: Your doctor may check your vitamin D level. If it is low he or she may prescribe a vitamin D supplement. Remember, only take vitamins and minerals prescribed by your doctor.

Medications to Avoid

If you have been prescribed medications such as ibuprofen (Advil), naproxen sodium (Aleve), and celecoxib (Celebrex), take only your prescribed dose. If your doctor has NOT prescribed these medications, it is important to ask him or her before you take them. Be sure your doctor knows about all prescription medicines, over-the-counter medicines, and herbs that you are taking.

Procedures that Use Dyes

If you need to have an x-ray or a procedure that uses dye, be sure the doctor performing the procedure knows you have kidney disease so that either no dye or a special dye is used.

Immunizations

In order to start as healthy as possible, you should talk to your doctor about getting immunized against influenza, pneumococcus, and hepatitis B.

Lifestyle Changes May Need to Occur

It is important to keep yourself as healthy as possible to help slow down the progression of your kidney disease. You can succeed in this by making the necessary lifestyle changes.

Maintain a healthy weight by following the prescribed diet.
Limit alcohol consumption.
Maintain good control of your blood sugar if you have diabetes. Diabetes is the number one leading cause of kidney disease.
It is important to manage your blood pressure if you have hypertension. It is the second leading cause of kidney disease.
Strive to include some form of physical activity in your day. Regular exercise can improve your mood, lower bad cholesterol and triglycerides and keep your muscles and bones healthy.
You should try your best to stop smoking. Smoking not only increases the rate of kidney disease progression, but it also contributes to deaths from strokes and heart attacks in people with CKD.
Reduce stress in your life. It may take time to adjust to CKD. Be patient and set realistic goals. Continue to perform your normal activities and responsibilities of daily life, and share your feelings with your close friends and family. Consider joining a support group.
Visit your doctor regularly to monitor your health and adjust your diet and medications as needed. Remember to tell your doctor if you are having any problems with your medications.
Make sure to keep your appointments with your nephrologist. Discuss any problems you have had since your last visit.
You should have routine lab tests completed. Each test has a specific range, or “normal,” indicating a healthy or unhealthy level. You should review your lab results and see what range you are in. You can use the various “Laboratory Tests” charts located on the following pages as a guide to some common lab tests that will be completed.

Notice what the normals (or recommended range) should be. Keep in mind that laboratories may use different equipment that will result in different normals. Consult with your doctor on what your lab results should be and what the normal range is for your lab. If you are not in the normal range, work with your doctor to develop a plan that will help you to achieve that range.