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Nephrology (Kidney Disease)
What are the different types of kidney diseases?
What do the kidneys do?
What is renal function?
Why do kidneys fail?
How do kidneys fail?
What are the signs of chronic kidney disease (CKD)?
What medical tests detect kidney disease?
What are the stages of CKD?
What can be done about CKD?
What happens if the kidneys fail completely?
How often should you have your kidney function tested?
Why Test Renal Function?
How can I stop kidney disease from progressing?
What are the kidneys?
What causes kidney failure?
What are the symptoms of kidney failure?
How is kidney failure diagnosed?
What is the treatment for kidney failure?
What are the symptoms of kidney disease?
What are the signs of kidney disease?
What are the early stages of Kidney Disease?
How do I know if I have kidney disease?
What are the treatments for kidney disease?
What are the different types of kidney diseases?
Acute kidney failure(Acute Renal Failure)
Acute nephritic syndrome
Analgesic nephropathy
Atheroembolic renal disease
Acute Glomerulonephritis (AGN)
Acute Interstitial Nephritis (AIN)
Acute Tubular Necrosis (ATN)
Acidosis (See Renal Tubular Acidosis)
Chronic kidney failure(Chronic Renal Failure)
Chronic nephritis
Congenital nephrotic syndrome
Diabetic Nephropathy
End-stage renal disease
Electrolyte Imbalance
Goodpasture syndrome
Hemolytic Uremic Syndrome (HUS)
Interstitial nephritis
Ischemic Nephropathy
Kidney cancer
Kidney damage
Kidney infection (Renal infection or pyelonephritis)
Kidney injury
Kidney Stones
Lupus nephritis
Membranoproliferative GN I
Membranoproliferative GN II
Membranous nephropathy
Minimal change disease
Necrotizing glomerulonephritis
Nephrogenic diabetes insipidus
Nephropathy - IgA
Nephrosis (nephrotic syndrome)
Nephrotic Syndrome (NS)
Polycystic kidney disease
Post-streptococcal GN
Proteinuria & Microalbuminuria
Renal Vascular Hypertension (RVH)
Reflux nephropathy
Renal artery embolism
Renal artery stenosis
Renal papillary necrosis
Renal tubular acidosis type I
Renal tubular acidosis type II
Renal underperfusion
Renal vein thrombosis
Urinary tract infection (UTI)
What do the kidneys do?

The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines. Every day, a person's kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.

The kidneys remove wastes and water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters.

Wastes in the blood come from the normal breakdown of active tissues, such as muscles, and from food. The body uses food for energy and self-repairs. After the body has taken what it needs from food, wastes are sent to the blood. If the kidneys did not remove them, these wastes would build up in the blood and damage the body.

The actual removal of wastes occurs in tiny units inside the kidneys called nephrons. Each kidney has about a 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. The glomerulus acts as a filtering unit, or sieve, and keeps normal proteins and cells in the bloodstream, allowing extra fluid and wastes to pass through. A complicated chemical exchange takes place, as waste materials and water leave the blood and enter the urinary system.

In the nephron (left), tiny blood vessels intertwine with urine-collecting tubes. Each kidney contains about 1 million nephrons.

At first, the tubules receive a combination of waste materials and chemicals the body can still use. The kidneys measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, the kidneys regulate the body's level of these substances. The right balance is necessary for life.

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

•erythropoietin, or EPO, which stimulates the bone marrow to make red blood cells
•renin, which regulates blood pressure
•calcitriol, the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

What is renal function?

The word "renal" refers to the kidneys. The terms "renal function" and "kidney function" mean the same thing. Health professionals use the term "renal function" to talk about how efficiently the kidneys filter blood. People with two healthy kidneys have 100 percent of their kidney function. Small or mild declines in kidney function-as much as 30 to 40 percent-would rarely be noticeable. Kidney function is now calculated using a blood sample and a formula to find the estimated glomerular filtration rate (eGFR). The eGFR corresponds to the percent of kidney function available. The section "What medical tests detect kidney disease?" contains more details about the eGFR.

Some people are born with only one kidney but can still lead normal, healthy lives. Every year, thousands of people donate one of their kidneys for transplantation to a family member or friend.

For many people with reduced kidney function, a kidney disease is also present and will get worse. Serious health problems occur when people have less than 25 percent of their kidney function. When kidney function drops below 10 to 15 percent, a person needs some form of renal replacement therapy—either blood-cleansing treatments called dialysis or a kidney transplant-to sustain life.

Why do kidneys fail?

Most kidney diseases attack the nephrons, causing them to lose their filtering capacity. Damage to the nephrons can happen quickly, often 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 simultaneously.

The two most common causes of kidney disease are diabetes and high blood pressure. People with a family history of any kind of kidney problem are also at risk for kidney disease.

Diabetic Kidney Disease

Diabetes is a disease that keeps the body from using glucose, a form of sugar, as it should. If glucose stays in the blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused glucose in the blood is called diabetic kidney disease. Keeping blood glucose levels down can delay or prevent diabetic kidney disease. Use of medications called angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to treat high blood pressure can also slow or delay the progression of diabetic kidney disease.

High Blood Pressure

High blood pressure can damage the small blood vessels in the kidneys. The damaged vessels cannot filter wastes from the blood as they are supposed to.

A doctor may prescribe blood pressure medication. ACE inhibitors and ARBs have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels.

Glomerular Diseases

Several types of kidney disease are grouped together under this category, including autoimmune diseases, infection-related diseases, and sclerotic diseases. As the name indicates, glomerular diseases attack the tiny blood vessels, or glomeruli, within the kidney. The most common primary glomerular diseases include membranous nephropathy, IgA nephropathy, and focal segmental glomerulosclerosis. The first sign of a glomerular disease is often proteinuria, which is too much protein in the urine. Another common sign is hematuria, which is blood in the urine. Some people may have both proteinuria and hematuria. Glomerular diseases can slowly destroy kidney function. Blood pressure control is important with any kidney disease. Glomerular diseases are usually diagnosed with a biopsy—a procedure that involves taking a piece of kidney tissue for examination with a microscope. Treatments for glomerular diseases may include immunosuppressive drugs or steroids to reduce inflammation and proteinuria, depending on the specific disease.

Inherited and Congenital Kidney Diseases

Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure.

Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons. The signs of kidney disease in children vary. A child may grow unusually slowly, vomit often, or have back or side pain. Some kidney diseases may be silent-causing no signs or symptoms-for months or even years.

If a child has a kidney disease, the child’s doctor should find it during a regular checkup. The first sign of a kidney problem may be high blood pressure; a low number of red blood cells, called anemia; proteinuria; or hematuria. If the doctor finds any of these problems, further tests may be necessary, including additional blood and urine tests or radiology studies. In some cases, the doctor may need to perform a biopsy.

Some hereditary kidney diseases may not be detected until adulthood. The most common form of PKD was once called "adult PKD" because the symptoms of high blood pressure and renal failure usually do not occur until patients are in their twenties or thirties. But with advances in diagnostic imaging technology, doctors have found cysts in children and adolescents before any symptoms appear.

Other Causes of Kidney Disease

Poisons and trauma, such as a direct and forceful blow to the kidneys, can lead to kidney disease.

Some over-the-counter medicines can be poisonous to the kidneys if taken regularly over a long period of time. Anyone who takes painkillers regularly should check with a doctor to make sure the kidneys are not at risk.

How do kidneys fail?

Many factors that influence the speed of kidney failure are not completely understood. Researchers are still studying how protein in the diet and cholesterol levels in the blood affect kidney function.

Acute Kidney Injury

Some kidney problems happen quickly, such as when an accident injures the kidneys. Losing a lot of blood can cause sudden kidney failure. Some drugs or poisons can make the kidneys stop working. These sudden drops in kidney function are called acute kidney injury (AKI). Some doctors may also refer to this condition as acute renal failure (ARF).

AKI may lead to permanent loss of kidney function. But if the kidneys are not seriously damaged, acute kidney disease may be reversed.

Chronic Kidney Disease

Most kidney problems, however, happen slowly. A person may have "silent" kidney disease for years. Gradual loss of kidney function is called chronic kidney disease (CKD) or chronic renal insufficiency. People with CKD may go on to develop permanent kidney failure. They also have a high risk of death from a stroke or heart attack.

End-stage Renal Disease

Total or nearly total and permanent kidney failure is called end-stage renal disease (ESRD). People with ESRD must undergo dialysis or transplantation to stay alive.

What are the signs of chronic kidney disease (CKD)?

People in the early stages of CKD usually do not feel sick at all.

People whose kidney disease has gotten worse may

•need to urinate more often or less often
•feel tired
•lose their appetite or experience nausea and vomiting
•have swelling in their hands or feet
•feel itchy or numb
•get drowsy or have trouble concentrating
•have darkened skin
•have muscle cramps

What medical tests detect kidney disease?

Because a person can have kidney disease without any symptoms, a doctor may first detect the condition through routine blood and urine tests. The ________ Kidney Foundation recommends three simple tests to screen for kidney disease: a blood pressure measurement, a spot check for protein or albumin in the urine, and a calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Measuring urea nitrogen in the blood provides additional information.

Blood Pressure Measurement

High blood pressure can lead to kidney disease. It can also be a sign that the kidneys are already impaired. The only way to know whether a person's 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 in the blood vessels when the heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when the heart is resting between beats. A person's blood pressure is considered normal if it stays below 120/80, stated as "120 over 80." The NHLBI recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.

Microalbuminuria and Proteinuria

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 small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of deteriorating kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. A doctor may test for protein using a dipstick in a small sample of a person's urine taken in the doctor's office. The color of the dipstick indicates the presence or absence of proteinuria.

A more sensitive test for protein or albumin in the urine involves laboratory measurement and calculation of the protein-to-creatinine or albumin-to-creatinine ratio. Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.

The albumin-to-creatinine measurement should be used to detect kidney disease in people at high risk, especially those with diabetes or high blood pressure. If a person's first laboratory test shows high levels of protein, another test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria and should have additional tests to evaluate kidney function.

Glomerular Filtration Rate (GFR) Based on Creatinine Measurement

GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation-the eGFR-requires only a measurement of the creatinine in a blood sample.

In a laboratory, a person's blood is tested to see how many milligrams of creatinine are in one deciliter of blood (mg/dL). Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. A person whose creatinine level is only slightly above this range will probably not feel sick, but the elevation is a sign that the kidneys are not working at full strength. One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.

The eGFR calculation uses the patient's creatinine measurement along with age and values assigned for sex and race. Some medical laboratories may make the eGFR calculation when a creatinine value is measured and include it on the lab report. The ________ Kidney _________ has determined different stages of CKD based on the value of the eGFR. Dialysis or transplantation is needed when the eGFR is less than 15 milliliters per minute (mL/min).

Blood Urea Nitrogen (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, a compound that contains nitrogen. Healthy kidneys take urea out of the blood and put it in the urine. If a person's kidneys are not working well, the urea will stay in the blood.

A deciliter of normal blood contains 7 to 20 milligrams of urea. If a person's BUN is more than 20 mg/dL, the kidneys may not be working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.

Additional Tests for Kidney Disease

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

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

Kidney biopsy. A doctor may want to examine a tiny piece of kidney tissue with a microscope. To obtain this tissue sample, the doctor will perform a kidney biopsy-a hospital procedure in which the doctor inserts a needle through the patient's skin into the back of the kidney. The needle retrieves a strand of tissue less than an inch long. For the procedure, the patient lies facedown on a table and receives a local anesthetic to numb the skin. The sample tissue will help the doctor identify problems at the cellular level.

What are the stages of CKD?

A person's eGFR is the best indicator of how well the kidneys are working. An eGFR of 90 or above is considered normal. A person whose eGFR stays below 60 for 3 months or longer has CKD. As kidney function declines, the risk of complications rises.

Moderate decrease in eGFR (30 to 59). At this stage of CKD, hormones and minerals can be thrown out of balance, leading to anemia and weak bones. A health care provider can help prevent or treat these complications with medicines and advice about food choices.

Severe reduction in eGFR (15 to 29). The patient should continue following the treatment for complications of CKD and learn as much as possible about the treatments for kidney failure. Each treatment requires preparation. Those who choose hemodialysis will need to have a procedure to make veins in their arms larger and stronger for repeated needle insertions. For peritoneal dialysis, one will need to have a catheter placed in the abdomen. A catheter is a thin, flexible tube used to fill the abdominal cavity with fluid. A person may want to ask family or friends to consider donating a kidney for transplantation.

Kidney failure (eGFR less than 15). When the kidneys do not work well enough to maintain life, dialysis or a kidney transplant will be needed.

In addition to tracking eGFR, blood tests can show when substances in the blood are out of balance. If phosphorus or potassium levels start to climb, a blood test will prompt the health care provider to address these issues before they permanently affect the person's health.

What can be done about CKD?

Unfortunately, CKD often cannot be cured. But people in the early stages of CKD may be able to make their kidneys last longer by taking certain steps. They will also want to minimize the risks for heart attack and stroke because CKD patients are susceptible to these problems.

People with reduced kidney function should see their doctor regularly. The primary doctor may refer the patient to a nephrologist, a doctor who specializes in kidney disease.

People who have diabetes should watch their blood glucose levels closely to keep them under control. They should ask their health care provider about the latest in treatment.

People with reduced renal function should avoid pain pills that may make their kidney disease worse. They should check with their health care provider before taking any medicine.

Controlling Blood Pressure

People with reduced kidney function and high blood pressure should control their blood pressure with an ACE inhibitor or an ARB. Many people will require two or more types of medication to keep their blood pressure below 130/80. A diuretic is an important addition when the ACE inhibitor or ARB does not meet the blood pressure goal.

Changing the Diet

People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure.

Protein. Protein is important to the body. It helps the body repair muscles and fight disease. Protein comes mostly from meat but can also be found in eggs, milk, nuts, beans, and other foods. Healthy kidneys take wastes out of the blood but leave in the protein. Impaired kidneys may fail to separate the protein from the wastes.

Some doctors tell their kidney patients to limit the amount of protein they eat so the kidneys have less work to do. But a person cannot avoid protein entirely. People with CKD can work with a dietitian to create the right food plan.

Cholesterol. Another problem that may be associated with kidney failure is high cholesterol. High levels of cholesterol in the blood may result from a high-fat diet.

Cholesterol can build up on the inside walls of blood vessels. The buildup makes pumping blood through the vessels harder for the heart and can cause heart attacks and strokes.

Sodium. Sodium is a chemical found in salt and other foods. Sodium in the diet may raise a person's blood pressure, so people with CKD should limit foods that contain high levels of sodium. High-sodium foods include canned or processed foods like frozen dinners and hot dogs.

Potassium. Potassium is a mineral found naturally in many fruits and vegetables, such as oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in the blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium. With very poor kidney function, high potassium levels can affect the heart rhythm.

Not Smoking

Smoking not only increases the risk of kidney disease, but it also contributes to deaths from strokes and heart attacks in people with CKD.

Treating Anemia

Anemia is a condition in which the blood does not contain enough red blood cells. These cells are important because they carry oxygen throughout the body. A person who is anemic will feel tired and look pale. Healthy kidneys make the hormone EPO, which stimulates the bones to make red blood cells. Diseased kidneys may not make enough EPO. A person with CKD may need to take injections of a form of EPO.

Preparing for End-stage Renal Disease (ESRD) As kidney disease progresses, a person needs to make several decisions. People in the later stages of CKD need to learn about their options for treating the last stages of kidney failure so they can make an informed choice between hemodialysis, peritoneal dialysis, and transplantation.

What happens if the kidneys fail completely?

Total or nearly total and permanent kidney failure is called ESRD. If a person's kidneys stop working completely, the body fills with extra water and waste products. This condition is called uremia. Hands or feet may swell. A person will feel tired and weak because the body needs clean blood to function properly.

Untreated uremia may lead to seizures or coma and will ultimately result in death. A person whose kidneys stop working completely will need to undergo dialysis or kidney transplantation.


The two major forms of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis uses a special filter called a dialyzer that functions as an artificial kidney to clean a person's blood. The dialyzer is a canister connected to the hemodialysis machine. During treatment, the blood travels through tubes into the dialyzer, which filters out wastes, extra salt, and extra water. Then the cleaned blood flows through another set of tubes back into the body. The hemodialysis machine monitors blood flow and removes wastes from the dialyzer. Hemodialysis is usually performed at a dialysis center three times per week for 3 to 4 hours. A small but growing number of clinics offer home hemodialysis in addition to standard in-clinic treatments. The patient first learns to do treatments at the clinic, working with a dialysis nurse. Daily home hemodialysis is done 5 to 7 days per week for 2 to 3 hours at a time. Nocturnal dialysis can be performed for 8 hours at night while a person sleeps. Research as to which is the best method for dialysis is under way, but preliminary data indicate that daily dialysis schedules such as short daily dialysis or nocturnal dialysis may be the best form of dialysis therapy.


In peritoneal dialysis, a fluid called dialysis solution is put into the abdomen. This fluid captures the waste products from a person's blood. After a few hours when the fluid is nearly saturated with wastes, the fluid is drained through a catheter. Then, a fresh bag of fluid is dripped into the abdomen to continue the cleansing process. Patients can perform peritoneal dialysis themselves. Patients using continuous ambulatory peritoneal dialysis (CAPD) change fluid four times a day. Another form of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), can be performed at night with a machine that drains and refills the abdomen automatically.

Peritoneal dialysis


A donated kidney may come from an anonymous donor who has recently died or from a living person, usually a relative. The kidney must be a good match for the patient's body. The more the new kidney is like the person receiving the kidney, the less likely the immune system is to reject it. The immune system protects a person from disease by attacking anything that is not recognized as a normal part of the body. So the immune system will attack a kidney that appears too "foreign." The patient will take special drugs to help trick the immune system so it does not reject the transplanted kidney. Unless they are causing infection or high blood pressure, the diseased kidneys are left in place. Kidneys from living, related donors appear to be the best match for success, but kidneys from unrelated people also have a long survival rate. Patients approaching kidney failure should ask their doctor early about starting the process to receive a kidney transplant.

How often should you have your kidney function tested?

How often you need to have your kidney function tested depends in part on what other conditions you have. You are more likely to develop chronic kidney disease if you have diabetes, high blood pressure, cardiovascular disease (such as heart attack or stroke), or a family history of kidney disease. If you have any of these conditions but do not yet have kidney disease, your doctor may want to test you every year.
If you have been diagnosed with chronic kidney disease, your doctor will schedule regular visits to check your kidney function.

Why Test Renal Function?

Patients with kidney disease have few signs and symptoms early in disease course; laboratory evaluation may be only way of detecting disease
Tests should detect abnormalities early enough to allow corrective therapy
Important for measuring renal disease progression and efficacy of therapies
Help predict when renal replacement therapy may be necessary
Aid in appropriate dosing of medications
Tests that best detect abnormalities of renal function measure

How can I stop kidney disease from progressing?

Stopping the progression of chronic kidney disease (CKD) can be as simple as changing daily habits. The most common way kidney disease accelerates is high blood pressure. Exercise and a healthy diet can greatly improve blood pressure, as well as, prescription medicines called ACE inhibitors and angiotensin-II receptor blockers. The ideal blood pressure for kidney disease patients is 130/80 or lower. Being under a doctor’s care can help determine if medication is necessary.

Smoking also advances kidney disease and interferes with high blood pressure medicine. According to the American Lung Association, as few as 1 to 4 cigarettes per day nearly triple the risk of death from heart disease. Cigarette smoke contains about 4,000 chemicals, 60 of which are known to cause cancer. The detrimental effects of smoking can multiply the complications for CKD patients.

It’s crucial to take all medication as prescribed by your doctor and keep scheduled doctor’s appointments. Skipping appointments or not taking medication (or taking too much) can reduce the effects of the drug or can be toxic. Half of the people who have chronic kidney disease don’t have symptoms. Unlike other conditions, feeling healthy doesn’t mean kidney disease is cured. CKD needs to be monitored regularly. It’s also very important to tell a doctor about over- the- counter medications and vitamins. Anti-inflammatory drugs including ibuprofen can be harmful to kidneys and multivitamins can cause spiked potassium levels.

How kidneys age

Kidneys are similar to skin. They both show signs of age. Even the healthiest person will most likely lose a bit of kidney function due to the natural process of growing old. How fast a person ages can be up to them. If the skin is exposed to too much sun, cigarettes, alcohol, abusive behavior or an unhealthy diet, it wrinkles quicker. Similarly, kidneys can be treated well to help maintain function. Unfortunately, chronic kidney disease can never get better, but you can help maintain and even prolong kidney function.

Exercise and diet are important tools to maintain health Exercise is an excellent way to maintain a healthy body weight. Being over weight can lead to high blood pressure. By lowering blood pressure, it helps reduce the progression of kidney disease. Other benefits to exercise are building body strength and according to USA Today, can improve memory. Exercise increases the supply of oxygen to the brain, which helps expand memory. Walking 30 minutes a day can help provide better physical and mental health.

A proper diet is crucial to help lower blood pressure and aid kidney function. Here are some dietary considerations that should be discussed with your doctor:

Protein – A protein heavy diet can strain kidney function. Protein includes: meat, fish, cheese, eggs, milk and nuts. Ask your doctor or a dietitian how much protein you should have each day to help prolong kidney function and maintain good health. •Alcohol – Too much alcohol can increase blood pressure, interfere with medicines, prevent kidneys from maintaining proper fluid and mineral balance, and lead to dehydration. While alcohol in moderation can be okay, ask your doctor if it is okay for you to drink alcohol.

Fluids – Fluid can build-up in CKD patients when kidney function declines. People on dialysis are generally given a fluid restriction, which includes foods such as: jelly, ice cream, milk on cereal, porridge, pudding, soup, gravy and sauces. Your doctor or dietitian will let you know if you need to restrict your fluid intake.

Sodium – A salty diet can increase blood pressure and lead to thirstiness. A high-sodium diet can make a fluid restriction difficult. Talk to your doctor about how much sodium you can have each day and ask your dietitian for tips on eating a low-sodium diet.

Potassium – When kidneys aren’t functioning properly, they cannot get rid of potassium in the blood. High levels of potassium can be dangerous to the heart. You may be instructed to limit high-potassium foods. Some foods high in potassium are: bananas, potatoes, tomatoes, kidney beans and milk products. •Phosphorus (phosphate) – It’s a mineral found in the bones. Kidneys normally get rid of excess phosphorus, which can cause thinning of the bones, joint pain and can damage blood vessels. As kidney function declines, you may be instructed to limit phosphorus intake. Some foods containing high levels of phosphate are: colas, chocolate, citrus candy, processed meats, mayonnaise and hot dogs. People on dialysis are usually prescribed phosphorus binders, or phosphate binders, to absorb the phosphorus in the gastrointestinal system so it doesn’t get into the bloodstream.

Cholesterol – Foods high in cholesterol, including red meat and dairy, may need to be reduced to protect your heart.

Triglycerides – Triglycerides are a type of fat. People who have kidney disease often have higher triglyceride levels. Foods that contain high triglyceride are: alcohol, fried foods, fast foods, prepackaged snack foods, sugary foods, fruit juices and energy bars. Follow your doctor’s advice and take prescribed medicines Several conditions may accompany kidney disease and can be helped with prescription medication. The following conditions can be treated by your doctor:

Fluid overload - It can cause swelling throughout the body and shortness of breath •High blood pressure - Causes blood vessel, kidney and heart damage, which can lead to stroke, heart disease and circulation problems.

Anemia - A deficiency of a hormone produced by the kidneys to stimulate red blood cell production from the bone marrow.

Bone disease - A serious problem for CKD patients that causes joint pain and bone fractures.

Acidaemia - An excess of acid waste in the blood.

High cholesterol - It can lead to increased risk of heart disease.

High triglycerides - May lead to high blood pressure and increase risk of heart disease. Learning about chronic kidney disease, being aware of resources available for people with CKD and making healthy lifestyle choices can help you get the support you need to help slow the progression of chronic kidney disease.

Normal and Abnormal Kidney Function

The kidneys are essential organs in the body which function to remove water and waste products. They also produce important hormones such as erythropoietin, Vitamin D, and renin.

The kidneys are located in the back of the abdomen, one on each side of the spinal column, at about the level of the lower ribs. The average weight of an adult human kidney is approximately one-quarter pound. Each kidney is approximately 4 inches long, 2.5 inches wide, and 1.5 inches thick.

The kidney receives about 20 percent of the blood coming from the heart each time it beats. The rate of blood flow through both kidneys is approximately 1.2 liters per minute.

The basic functioning unit of the kidney is called the nephron. The kidneys together comprise greater than 2 million nephrons, and each is capable of forming urine. The nephron’s function is to clean the blood of unwanted substances as it flows past. The nephron is composed of the glomeruli, through which the blood is filtered, and then the tubules, which receive and process the filtered fluid. Kidney function is estimated using the glomerular filtration rate or GFR. This is the amount of filtrate formed in all nephrons.

The normally functioning kidney controls the concentration of body fluids. It accomplishes this by excreting excessive amounts of water in the urine if body fluids are too dilute or by excreting excessive solutes when body fluids are too concentrated. Despite large intakes of salt and water, almost no change in blood volume or concentration occurs. Another important function is acid-base balance. The body maintains a constant pH via several buffering mechanisms. The kidney plays a major role in this by the net excretion of hydrogen ions when the blood is too acidic and the net excretion of bicarbonate ions when the blood is too alkaline.

The kidneys also have a hormonal role. They are in part responsible for the conversion of Vitamin D to its active metabolite, which is important in the absorption of calcium from the intestine. Erythropoietin is manufactured by the kidney and stimulates the bone marrow to produce red blood cells. With renal failure there is decreased production of this hormone and anemia results. With a decreased number of red blood cells and therefore fewer cells to carry oxygen to the tissues, patients may tire easily and become short of breath after only minimal activity. Often patients benefit by taking injections of synthetic erythropoietin to achieve and improved blood count (see Chapter 19). Renin is another kidney-produced hormone that is important in sodium and blood pressure control.

Renal failure occurs from a variety of causes, and the time course and clinical symptoms vary from individual to individual. A person’s kidney failure may occur suddenly or progress slowly over a period of many years. As failure progresses the kidney is less able to maintain a steady volume and concentration of body fluids. For many, as fluid and salt become increasingly difficult to remove, high blood pressure occurs as well as edema or fluid in the tissues. Patients may have problems with swelling of their legs and shortness of breath from accumulation of fluid in the lungs (pulmonary edema). Medications may be necessary to control blood pressure and assist in fluid removal (diuretics). The kidneys also are no longer able to excrete the waste products of metabolism, and substances such as potassium and phosphorus can accumulate in the body. Elevated phosphorus levels cause calcium levels in the blood to fall and result in the stimulation of a hormone from the parathyroid glands. This hormone increases the release of calcium from bones and if not suppressed can result in bone pain and progress to weakened and demineralized bones.

As failure progresses patients are required to modify their diets—usually decreasing sodium, potassium, and phosphorus intake and ultimately restricting fluids. Patients will generally need to take phosphate binders as well as Vitamin D supplements.

As waste products accumulate, patients may have problems with fatigue, headaches, nausea, vomiting, and decreased appetite resulting in weight loss. Itching may also be prominent if the body’s phosphorus levels are high. Patients may note a decreased ability to concentrate. Finally, there may be an increased tendency to bleed.

The decision to start hemodialysis is based on a combination of symptoms and laboratory data. Emergent indications to start are encephalopathy (change in mental status), seizures, and coma due to uremia, as well as severe hyperkalemia (elevated potassium), acidosis, pericarditis (or inflammation of the heart lining) from accumulated toxins, and pulmonary edema which no longer responds to medications. Most patients reach the need to initiate on hemodialysis gradually. The goal is to begin when a patient’s symptoms are no longer responsive to conservative management and before there are serious complications. Practically speaking, most patients will start dialysis when the creatinine clearance (CRCI) is very low, 3–5 cc per minute (normal 100 cc per minute) and the serum creatinine is greater than 12–14 mg/dl (normal 1.0 mg/dl). These are not absolute numbers, however, and must be carefully interpreted for the individual patient. In a small person, a creatinine of 5 mg/dl may represent a level of function which requires dialysis.

What are the symptoms of kidney disease?

Early detection is the first step in treating chronic kidney disease. The early symptoms of kidney disease may include:

Increased urination at night.
Passing only small amounts of urine.
Swelling, particularly of the hands and feet, and puffiness around the eyes.
Unpleasant taste in the mouth and urine-like odour to the breath.
Persistent fatigue or shortness of breath. Loss of appetite.
Increasingly higher blood pressure. Pale skin.
Excessively dry, itchy skin.
In children: increased fatigue and sleepiness, decrease in appetite, and poor growth.

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
•Drowsiness or confusion
•Darker color to skin
•Muscle cramps
•Trouble Sleeping
•Inability to concentrate

What are the early stages of Kidney Disease?

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.

How do I know if I have kidney disease?

Blood and urine tests can help uncover signs of early kidney disease and monitor kidney disease. Common tests include:

Blood pressure monitoring. Detection and early treatment of high blood pressure is key to slowing or preventing kidney damage. Your doctor will advise a plan, which may include diet changes and medication, to keep your blood pressure as close to normal as possible. Normal blood pressure is generally considered to be less than 120/80.

Protein in the urine. Excess protein in the urine may be a sign of damage in the kidneys' filters (the glomeruli).

GFR (glomerular filtration rate). This is a measure of how well your kidneys are filtering your blood. An estimate of your "filtering rate" is determined by a blood test called a blood creatinine test, which measures the amount of a waste product -- creatinine -- in your blood. This test, along with your age, body size, and gender, gives your doctor an estimate of your GFR. Your GFR, or "filtering rate," helps confirm normal or low kidney function.

Your doctor may also refer you to a kidney specialist, called a nephrologist, for more specialised testing. A kidney biopsy may be advised, which removes a small amount of kidney tissue for microscopic examination to pinpoint the cause of kidney damage and plan treatment.

What are the treatments for kidney disease?

Medication, especially those that control diabetes and high blood pressure, can sometimes help slow the progress of chronic kidney disease.

But with long-term kidney disease, if the kidneys deteriorate and can no longer function at all, there are only two treatment options: dialysis, which uses an artificial device to clean the blood of waste products, or a kidney transplant. With some underlying medical conditions, acute kidney failure complicates treatment, as well as being life-threatening in itself.

Renal Replacement Therapy
    What is Dialysis?
    What is Hemodialysis?
    How are you attached to the dialysis machine?
    Does hemodialysis hurt?
    How long does hemodialysis take?
    What type of dialysis treatment is best?
    What about proper nutrition?
    What other changes are needed with hemodialysis?
    How should you do a quick assessment, diagnosis, and treatment of a person reported as a renal medical emergency?
    What are the criteria for diagnosis of acute renal failure?
    When is dialysis required in acute renal failure?
    When should patient with chronic renal failure be admitted to hospital and treated with emergency dialysis?
    What are various renal medical disabilities?
    When does chronic renal failure need intensive care?
    How do you calculate chronic renal failure?
    When does acute renal failure need intensive care?
    How do you calculate acute renal failure?
    How is creatinine clearance calculated?
    How is the number of hours a chronic renal failure needs dialysis calculated?

    What to look for when you visit a dialysis center.
    Is the dialysis center clean?
    Yes __________ No __________
    Cleanliness helps prevent infections.

    Are there patient education materials in the dialysis center's waiting room?
    Yes __________ No __________
    The center should help you understand your care through education.

    Does the dialysis center's staff seem friendly, caring, and respectful of patients?
    Yes __________ No __________
    Every staff member should help patients feel welcome and well-treated.

    Is the center disability accessible?
    Yes __________ No __________
    People who use wheelchairs or walkers should be able to get into and around the center easily.

    Hallways and treatment areas should be kept clear.
    How easy is parking at the dialysis center? How much does it cost?
    Yes __________ No __________
    Some dialysis centers have free parking nearby, some don't.

    Are you offered a tour of the dialysis center?
    Yes __________ No __________
    Staff should be willing to show you around to help you learn about the center.

    How is the temperature in the dialysis treatment room? Is it warm or cold?
    Yes __________ No __________
    Ask the staff what they do to keep patients comfortable.

    General information to ask about a dialysis center.
    What hours are you open? Does that change during the holidays?

    Knowing when the dialysis center is open can help you plan ahead.
    Who could be the member of my dialysis care team?

    Each care team member has a different role and you need to learn what each one does.
    How can you help me get involved in my care? How will you involve my family?

    Patients and families who are active partners with staff in their care usually do better.
    How will you involve me in planning my care?

    You are a member of your care team and should take an active role.
    If I have a concern about my care, who do I talk to?

    The staff should be able to tell you who can help you with your concerns.
    Who audits or reviews this dialysis center?

    All dialysis centers should be reviewed by a surveyor from your state to help protect patient safety and quality of care.
    What happens if a patient has medical emergency?

    You should know what to do in the event of bad weather.
    If I need help when the clinic is closed, who do I call?

    The center may have staff that speaks your language.
    If I am deaf or speak a different language and need an interpreter, how do I get one?

    You have a right to an interpreter if you need one.
    What kind of security do you have at this center?

    You should feel safe at the dialysis center.
    Can you help me if I have transportation problems?

    The staff should be able to help you with your transportation issues.
    What to ask about patient support
    How will you help me adjust to dialysis when I'm first getting started?

    Staff should help you adjust to dialysis.
    What is your visitors' schedule?

    Some centers allow visitors in the treatment rooms and some don't.
    Can I talk to a patient who gets treated at this dialysis center?

    Talking to another patient can help you learn about the center.
    Do you do patient satisfaction surveys? If so, can I see the results?

    Patient satisfaction surveys can tell you how other patients feel about the dialysis center.
    Do you have a list of patient and family support groups in this area or on the Internet?

    Many patients find that they can learn a lot from talking to other patients.
    Do you have a patient newsletter?

    Some dialysis centers use newsletters to help patients learn more about their care.
    What type of education do you have for new dialysis patients? For long-term dialysis patients?

    Knowing more about kidney disease and its treatment can help you take better care of yourself and live longer.
    Do you offer an education program for people who haven't started on dialysis yet?

    Patients who learn about their disease before they need dialysis are usually better prepared when it starts.
    Do you have an exercise program?

    Many facilities offer advice to help you stay active.
    What to ask about Hemodialysis(HD)
    What is hemodialysis (HD)? How does it work?

    Understanding HD will help you be a more active partner in your care.
    What types of activities can I do during HD?

    Some centers allow patients to use them during HD and some donÂ’t.
    Do you provide blankets and pillows for use during HD treatment?

    ItÂ’s important to feel comfortable during your treatment.
    What should I bring with me to my HD treatments?

    Many patients like to bring things from home so that they are more comfortable.
    What clothes should I wear during HD?

    You should dress to feel comfortable.
    What are dialyzers? What are the risks and benefits of re-using dialyzers? Do you re-use dialyzers?

    Dialyzers are the filters that clean the blood in hemodialysis. They lose some filter action each time they are re-used.
    What HD shifts do you offer?

    The staff should work with you to find the best shift for you.

    How many HD patients are treated at this center?

    Some patients prefer smaller dialysis centers; others like larger ones.
    What are the ages of the HD patients treated at this center?

    What is your schedule on eating or drinking during HD treatments?

    What is Peritoneal Dialysis?

    Questions to Ask Your Doctor

    Q) What are my options for treating my kidney disease?
    Q) What should I think about when choosing the best treatment option for me?
    Q) What are the pros and the cons of hemodialysis(HD)?
    Q) What are the pros and the cons of peritoneal dialysis(PD)?
    Q) What options do I have to do my dialysis at home?
    Q) What are the pros and the cons of kidney transplant?
    Q) How do I get on a kidney transplant waiting list? How many lists can I get on at once?
    Q) What would I need to do to get a living donor for a kidney transplant?
    Q) Which dialysis center do you refer patients to? Which centers do you prefer?
    Q) What other dialysis centers are in this area?
    Q) Which dialysis center gives the best care?
    Q) Why are you suggesting this dialysis center for me?
    Q) How often will I see you if I get my dialysis treatments here?
    Q) What are the pros and cons of three kinds of vascular access possible for HD(fistulas, grafts and catheters)?
    Q) What percent of your HD patients have a fistula? A graft? A catheter?
    Q) How can I get my veins and arteries mapped to see if a fistula will work for me?
    Q) What are some common problems with dialysis and how can I help prevent them?
    Q) What happens if I miss an HD session?
    Q) Can you suggest good books, websites, patient support groups, or other ways to learn more about kidney disease and its treatment?
    Q) How can my family learn more about kidney disease and its treatment?
    Q) What will my future be like with my kidney disease?

    What to ask a NURSE at a dialysis center

    Q) What are my treatment options?
    Q) How many nurses work on each shift at this dialysis center? How many patients does each nurse take care of?
    Q) How many dialysis technicians work with each nurse in this dialysis center? What do they do?
    Q) How many patients does each dialysis technician care for?
    Q) Will I have a choice about which staff put my needles in for HD?
    Q) Can I learn to put my needles in myself for HD?
    Q) If I don't feel well when I am getting HD at the dialysis center, what should I do?
    Q) What type of education do you offer for patients and their families?
    Q) Can you suggest good books, websites, patient support groups, or other ways to learn more?
    Q) What will my future be like with kidney disease?

    What to ask a DIALYSIS TECHNICIAN at a dialysis center

    How does a dialysis machine work?
    What does my dialysis machine do?
    What are those plastic jugs sitting in front of my machine?
    How does my blood get in and out of my body?
    WhatÂ’s in the syringe thatÂ’s attached to my machine?
    How does the machine keep me safe?
    Why are there so many alarms?

    What to ask a SOCIAL WORKER at a dialysis center

    Q) When is a social worker at this center? How do I contact you?
    Q) How many other patients do you see? Do you also see patients in other clinics?
    Q) How common is anxiety and depression with kidney disease? How can you help me with this?
    Q) How can you help me and my family adjust to dialysis?
    Q) Do you have a list of patient and family support groups in this area or on the World wide web?
    Q) Can you help me get dialysis when I am traveling?
    Q) Can you help me if I have transportation problems?

    What to ask a DIETICIAN at a dialysis center

    Q) When is a dietician at this center? How do I contact you?
    Q) How many other patients do you see? Do you also see patients in other centers?
    Q) What will you do to help me understand kidney disease?
    Q) Will you go over my lab test results with me each month?
    Q) How can you help me learn more about diets, recipes, and menus that are good for kidney patients like me?
    Q) What do the dietitians do?
    Q) Do I need to be on a special diet?
    Q) Do I need to watch how much fluid I drink?
    Q) Will dialysis cause me to lose weight?
    Q) Can I still go out to eat?
    Q) Can I still take my vitamin, mineral, and/or herbal supplements?
    Q) I am vegetarian. Will this be ok for me when I start dialysis?
    Q) I am diabetic. Will my blood sugar be difficult to control when on dialysis?
    Q) Why do I have a bad taste in my mouth?
    Q) Why is my hair falling out?
Blood tests
Kidney biopsy
Renal ultrasound
Computerized tomography
Hemodialysis and Peritoneal dialysis
Kidney function monitoring and treatment
Pediatric Nephrology
Kidney Transplant

Genitourinary emergencies.
Renal medical emergencies

What are renal medical emergencies?

Genitourinary emergencies.

Acute kidney failure (Acute Renal Failure)
Renal Failure, Chronic and Dialysis Complications
Acute Tubular Necrosis
Artificial Urinary Sphincter
Bartholin Gland Diseases
Bedside Ultrasonography, Obstructive Uropathy
Fournier Gangrene
Glomerulonephritis, Acute
Glomerulonephritis, Acute
Glomerulonephritis, Chronic
Glomerulonephritis, Crescentic
Glomerulonephritis, Diffuse Proliferative
Glomerulonephritis, Membranoproliferative
Glomerulonephritis, Membranous
Glomerulonephritis, Nonstreptococcal Associated With Infection
Glomerulonephritis, Rapidly Progressive
Glomerulosclerosis, Focal Segmental
Goodpasture Syndrome
Hypersensitivity Nephropathy
Hyperuricosuria and Gouty Diathesis
IgA Nephropathy
Injectable Bulking Agents for Incontinence
Lead Nephropathy
Lithium Nephropathy
Minimal-Change Disease
Nephritis, Radiation
Phimosis and Paraphimosis
Renal Calculi
Testicular Torsion
Torsion of the Appendices and Epididymis
Transplants, Renal
Urethritis, Male
Urinary Incontinence
Urinary Obstruction
Urinary Tract Infection, Female
Urinary Tract Infection, Male
Here are further guidelines.
Laboratory Tests