Symptoms and Signs of CKD

In the early stages of CKD, there are no symptoms or signs of disease.  This is what makes CKD so difficult to manage.  By the time symptoms do appear, kidney function has likely dropped below 25%.  This is why it is so important to have your kidney function tested if you have high blood pressure or diabetes. 

Check out this fun video about CKD symptoms, made by the Renal Support Network:

By the end of stage 3, some patients will begin having symptoms associated with CKD.  One of the most common symptoms of declining kidney function is anemia.  Anemia is when there are not enough red blood cells in the body, resulting in not enough oxygen getting to the tissues of the body.  People who are anemic appear pale or ashen, bruise easily, and have low energy levels. 

Symptoms that people with declining kidney function will often notice include:

• Pale skin
• Edema (fluid build-up), especially in the legs 
• Muscle cramping, especially in the legs
• Low energy, fatigue
• Confusion, decreased mental function
• Loss of appetite
• Itchy skin
• Trouble sleeping
• Nocturia (needing to urinate at night)

Signs and Symptoms of CKD 

Image source: http://www.hostinger.co.uk/ 

By stages 4 and 5 patients can develop chronic metabolic acidosis, which means there is not enough bicarbonate in the body.  Bicarbonate is an important ingredient for the body to maintain balance; if the body is low on bicarbonate, it becomes too acidic.  The body will attempt maintain balance by taking bicarbonate out of the bones, red blood cells, and other areas.  This can result in brittle bones, nails, and anemia.

CKD can interfere with many of the body's hormones.  One may experience sexual dysfunction, infertility, loss of menstrual cycle in women, and erectile dysfunction in men. 

People with CKD are at increased risk for:

• Malnutrition
• Suppressed immune system
• Insulin resistance
• High Blood Pressure
• Osteoporosis
• Fractures
• Heart Disease

I hope that gives you a clear picture of what the signs and symptoms of CKD are.  Next week we will talk about the treatment options!

To learn more about the signs and symptoms of CKD, please visit DeVita.com and The National Kidney Foundation. 

References:

Cohen D, Goldberg M, Gulati A, Ferr F. Chronic Kidney Disease.  First Consult, Clinical Key Website.  Available at: https://www-clinicalkey-com.offcampus.lib.washington.edu/#!/content/medical_topic/21-s2.0-1014826.  Revised May 4 2010.  Accessed on January 29 2015. 

Kovesdy CP, Sterns RH, Forman JP.  Pathogenesis, consequences, and treatment of metabolic acidosis in chronic kidney disease.  In: UpToDate.  Available at: http://www.uptodate.com/contents/pathogenesis-consequences-and-treatment-of-metabolic-acidosis-in-chronic-kidney-disease.  Updated December 1 2014.  Accessed on January 29 2015. 

About Chronic Kidney Disease.  National Kidney Foundation website. https://www.kidney.org/kidneydisease/aboutckd.  2015.  Accessed on January 29 2015.

Diagnosis and Progression of CKD

In 2002 the National Kidney Foundation Kidney Disease Outcomes Initiative came up with a set of guidelines for diagnosis and treatment of CKD.  Those guidelines have since been revised, and an update set of guidelines was published in 2012.  This post reflects the information presented on the updated guidelines. 

The National Kidney Foundation defines CKD as the “…abnormalities of kidney structure or function, present for >3 months, with implications for health.” 

So, how does one know if they have CKD?  By measuring the glomerular filtration rate (GFR).  The GFR is a number that shows how well the kidneys are filtering out the bad stuff and holding onto the good stuff. 

How do we measure GFR?  By taking a sample of a person's blood and sending it the lab.  The lab has a special equation they use to calculate the estimated GFR.  This number will show how damaged the kidneys are. 

A picture of the GFR numbers that go along with kidney health 

Image source  http://www.safekidneycare.org/patient_family_gfr_calc.php    

The other number the healthcare team will look at is the presence of albuminuria.  Albuminuria means there is too much protein the urine.  It is measured by taking a urine sample in the morning.

Ms. Kidney getting her urine checked for albuminuria 

Image source  Albuminuria: http://thinkkimi.com/Research/index.html

Not everyone should be tested for CKD.  The US Preventive Services Task Force does not believe there is enough evidence to screen people who do not have risk factors. 

People who should be screened for CKD include people with diabetes, hypertension, autoimmune disease (i.e. Lupus), systemic infections, UTIs, urinary stones, lower urinary tract obstruction, neoplasia, family history of CKD, recovery from acute renal failure, exposure to certain drugs, and/or low birth weight. 

It is also recommended that African American, American Indian, Hispanic, Asian or Pacific Islander, adults over 65, and/or people who have been exposure to certain chemicals and environmental conditions be tested as well. 

If you have been diagnosed with CKD it is recommended that you have your GFR and albuminuria measured at least once a year, and more often if you have certain risk factors.  Your doctor will likely have you begin taking drugs to control your blood pressure, as well as ACE inhibitors, ARBs, or beta-blockers (more on this in a few weeks). 

CKD can lead to:

•         Heart disease
•         Bone disorders like osteoporosis, and scoliosis
•         Anemia
•         Malnutrition

Because of the wide range of problems that can arise with CKD, it is recommended that a multidisciplinary team care for CKD patients.

And now a short video featuring CKD patients talking about their diagnosis...

Reference:

Inker LA, Astor BC, et al. KDOQI US Commentary of the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD.  Am J Kidney Dis.  2014;63(5):713-735. http://dx.doi.org/10.1053/j.ajkd.2014.01.416.