Chronic kidney disease

Definition

Chronic kidney disease (CKD) means your kidneys are damaged and can’t filter blood the way they should.  

While Blacks make up about 13 percent of the population, they account for 35 percent of the people with kidney failure in the United States. 

Causes

Diabetes and high blood pressure are the leading causes of kidney failure among Black Americans:

Diabetes

Too much glucose, also called sugar, in your blood damages your kidneys’ filters. Over time, your kidneys can become damaged and no longer filter wastes and extra fluid from your blood.

Often, the first sign of kidney disease from diabetes is protein in your urine. When your kidneys’ filters are damaged, a protein called albumin, passes out of your blood and into your urine. Albumin is needed to stay healthy, therefore, healthy kidneys don’t let albumin pass from the blood into the urine.

Diabetic kidney disease is the medical term for kidney disease caused by diabetes.

High blood pressure

High blood pressure can damage blood vessels in the kidneys so they don’t work as well. If the blood vessels in your kidneys are damaged, your kidneys may not work as well to remove wastes and extra fluid from your body. Extra fluid in the blood vessels can also raise your blood pressure even more, which creates a dangerous cycle.

Other causes of kidney disease include:

• Family history of kidney failure
• Heart disease
• A genetic disorder that causes many cysts to grow in the kidneys, polycystic kidney disease (PKD)
• An infection
• A drug that is toxic to the kidneys
• A disease that affects the entire body, such as diabetes or lupus. Lupus nephritis is the medical name for kidney disease caused by lupus
• LgA glomerulonephritis
• Disorders in which the body’s immune system attacks its own cells and organs, such as Anti-GBM (Goodpasture’s) disease
• Heavy metal poisoning, such as lead poisoning 
• Rare genetic conditions, such as Alport syndrome 
• Hemolytic uremic syndrome in children
• LgA vasculitis
• Renal artery stenosis

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Symptoms

A number of symptoms can develop if kidney disease is not found early or it gets worse despite treatment.

Symptoms can include:

• weight loss and poor appetite
• swollen ankles, feet or hands – as a result of water retention (oedema) 
• shortness of breath
• tiredness
• blood in your pee (urine)
• an increased need to pee – particularly at night 
• difficulty sleeping (insomnia)
• itchy skin
• muscle cramps
• feeling sick
• headaches
• erectile dysfunction in men

Diagnosis

Early kidney disease doesn’t usually have any symptoms. Testing is the only way to know how well your kidneys are working. You should consider getting checked for kidney disease if you have:

• diabetes
• high blood pressure
• heart disease
• a family history of kidney failure

If you have diabetes, it is important that you get checked every year. If you have high blood pressure, heart disease, or a family history of kidney failure, talk with your health care provider about how often you should get tested. The sooner you get a kidney disease diagnosis, the sooner you can get treatment to help protect your kidneys.

To check for kidney disease, health care providers use:

• a blood test that checks how well your kidneys are filtering your blood, called GFR. GFR stands for glomerular filtration rate.
• a urine test to check for albumin. 

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Management

Your health care provider will work with you to manage your kidney disease.

If you have kidney disease, your health care provider will use the same two tests you took to get a diagnosis to help monitor your kidney disease and make sure your treatment plan is working.

You can tell that your treatments are working if your: 

• GFR stays the same
• urine albumin stays the same or goes down

You can also better manage your kidney disease through the following: 

• Controlling your blood pressure
• Meeting your blood glucose goal if you have diabetes
• Working with your health care team to monitor your kidney health
• Taking medicines as prescribed
• Working with a dietitian to develop a meal plan
• Making physical activity part of your routine
• Aiming for a healthy weight
• Getting enough sleep
• Stop smoking
• Finding healthy ways to cope with stress and depression
• Limit alcohol intake

You can also protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure.

Blacks are almost four times more likely to develop kidney failure than whites.

If you experience Kidney failure, that means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. If your kidney function drops to this level, you may have symptoms from the buildup of waste products and extra water in your body.

To replace your lost kidney function, you may have one of three treatment options:

• hemodialysis
• peritoneal dialysis
• kidney transplant

End-stage renal disease (ESRD) is kidney failure that is treated by dialysis or kidney transplant.

Some people with kidney failure choose not to have dialysis or a transplant but continue to receive care from their health care team, take medicines, and monitor their diet and lifestyle choices.

You can work with your health care team and family to consider your options and choose a treatment that is right for you.

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