Chronic Kidney Disease

Symptoms usually develop very slowly. As kidney failure progresses and metabolic waste products build up in the blood, symptoms progress.

Mild to moderate loss of kidney function may cause only mild symptoms, such as the need to urinate several times during the night (nocturia). Nocturia occurs because the kidneys cannot absorb water from the urine to reduce the volume and concentrate it as normally occurs during the night.

As kidney function worsens and more metabolic waste products build up in the blood, people may feel fatigued and generally weak and may become less mentally alert. Some have a loss of appetite and shortness of breath. Anemia also contributes to fatigue and generalized weakness.

The buildup of metabolic waste also causes loss of appetite, nausea, vomiting, and an unpleasant taste in the mouth, which may lead to undernutrition and weight loss. People with chronic kidney disease tend to bruise easily or bleed for an unusually long time after cuts or other injuries. Chronic kidney disease also diminishes the body’s ability to fight infections. Gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more may cause acute arthritis with joint pain and swelling.

Severe loss of kidney function causes metabolic wastes to build up to higher levels in the blood. Damage to muscles and nerves can cause muscle twitches, muscle weakness, cramps, and pain. People may also feel a pins-and-needles sensation in the arms and legs and may lose sensation in certain areas of the body. They may develop restless legs syndrome. Encephalopathy, a condition in which the brain malfunctions, may ensue and lead to confusion, lethargy, and seizures.

Heart failure may cause shortness of breath. Body swelling may develop, particularly in the legs. Pericarditis may cause chest pain and low blood pressure. People who have advanced chronic kidney disease commonly develop gastrointestinal ulcers and bleeding. The skin may turn yellow-brown and/or dry, and occasionally, the concentration of urea is so high that it crystallizes from sweat, forming a white powder on the skin. Some people with chronic kidney disease itch all over their body. Their breath may also be foul.

Blood and urine tests are essential. They confirm the decline in kidney function.

When loss of kidney function reaches a certain level in chronic kidney disease, the levels of chemicals in the blood typically become abnormal.

Doctors measure kidney function by using the level of creatinine in the blood, sex, and body weight in a formula called the estimated glomerular filtration rate (eGFR). Doctors previously used race to assess whether kidney function was abnormal. However, doing so increased health care disparities between races in diagnosis and treatment of kidney disease. Thus, including race in such assessments is no longer recommended.

Measuring the blood level of potassium is important, because it can become dangerously high when kidney failure reaches an advanced stage or if people ingest large amounts of potassium or take a medication that prevents the kidneys from excreting the potassium.

Analysis of the urine may detect many abnormalities, including protein and abnormal cells.

Ultrasonography is often done to rule out obstruction and check the size of the kidneys. Small, scarred kidneys often indicate that loss of kidney function is chronic. Determining a precise cause becomes increasingly difficult as chronic kidney disease reaches an advanced stage.

Removing a sample of tissue from a kidney for examination (kidney biopsy) may be the most accurate test, but it is not recommended if results of an ultrasound examination show that the kidneys are small and scarred.

The goal of treatment is to slow the decline of kidney function and delay the need for dialysis.

Conditions that can cause or worsen chronic kidney disease and adversely affect overall health should be promptly addressed, such as

Controlling the level of sugar (glucose) in the blood as well as high blood pressure in people with diabetes substantially slows deterioration in kidney function. Drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which help lower blood pressure, may decrease the rate of decline in kidney function in some people with chronic kidney disease. Drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors can also slow deterioration in kidney function, but they should be avoided in people with type 1 diabetes mellitus.

Doctors avoid prescribing drugs that are excreted by the kidneys, or they prescribe lower doses of such drugs. Many other drugs may need to be avoided. For example, ACE inhibitors, ARBs, and certain diuretics (such as spironolactone, amiloride, and triamterene) may need to be stopped in people with severe chronic kidney disease and high potassium levels because these drugs can increase potassium levels.

Obstructions in the urinary tract are removed or relieved. Bacterial infections are treated with antibiotics.

Dietary measures should be taken and drugs can be prescribed to slow the progression of chronic kidney disease.

If chronic kidney disease is caused by a disorder that can be corrected (for example, urinary tract blockage) and if that disorder has not been present for too long, then kidney function may improve when the causative disorder is successfully treated. Otherwise, kidney function tends to worsen over time. The rate of decline in kidney function depends somewhat on the underlying disorder causing chronic kidney disease and on how well the disorder is controlled. For example, diabetes and high blood pressure, particularly if poorly controlled, cause kidney function to decline more rapidly. Chronic kidney disease is fatal if not treated.

When the decline in kidney function is severe (sometimes called end-stage kidney failure or end-stage renal disease), survival is usually limited to several months in people who are not treated, but people who are treated with dialysis Dialysis Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. There are a number of reasons... read more can live much longer. However, even with dialysis, people with end-stage kidney failure die sooner than people their age who do not have end-stage kidney disease. Most die from heart or blood vessel disorders or infections.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.