What is chronic kidney disease?

Chronic kidney disease is defined one of two ways:

  1. Kidney damage evidenced by structural abnormalities (eg found on radiographic studies of the kidneys) or functional abnormalities (eg abnormal blood or urine tests) that persist for at least 3 months with or without a decrease in glomerular filtration rate (GFR) less than 60 mL/min.
  2. Glomerular filtration rate (GFR) less than 60 ml/min with or without evidence of kidney damage (eg on radiographic, blood, or urine testing).
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What are the complications of chronic kidney disease?

  • High blood pressure (hypertension)
  • Salt and water retention (swelling)
  • Fluid and electrolyte abnormalities
  • Anemia due to underproduction of red blood cells
  • Bone disease
  • Kidney failure resulting in the need for dialysis and or transplantation
  • Increased risk of cardiovascular disease (stroke, heart attack, or peripheral vascular disease)

Measuring your kidney function

Your kidney function is measured by the level of creatinine in your blood, by a 24 hour urine collection (Creatinine Clearance), or by calculating your Glomerular Filtration Rate (GFR).

Calculating your GFR

The national kidney foundation provides a GFR calculator. You will need to know your creatinine level to calculate this.

Stages of kidney disease

There are 5 stages of kidney disease based on glomerular filtration rate (GFR), with increasing stage and worsening GFR representing a decline in kidney function and an increased risk of suffering a further loss of kidney function.

Stage

Glomerular Filtration Rate

Description

1

>90 ml/min

Kidney Damage with Normal GFR

2

60-89 ml/min

Kidney Damage with Mildly Decreased GFR

3

30-59 ml/min

Kidney Damage with Moderately Decreased GFR

4

15-29 ml/min

Kidney Damage with Severely Decreased GFR

5

<15ml/min

Kidney Damage with Kidney Failure

What are the symptoms of kidney disease?

For most patients chronic kidney disease has no symptoms to warn a patient of a loss of kidney function prior to the onset of kidney failure. Therefore monitoring by your healthcare provider is important.

Blood Pressure control

  • Our goal is to keep your blood pressure less than or equal to130/80 mm/Hg
  • Multiple medications may be needed to achieve this level of control
  • Additional factors that will help to control you blood pressure are maintaining a low sodium (salt) diet, frequent exercise, and weight loss if you are overweight

What dietary modifications are necessary for patients with chronic kidney disease?

Patients with chronic kidney disease may require a number of modifications in their diet including reductions in sodium, potassium, phosphorous, and protein. Please ask your physician to see what restrictions if any are needed.

National Kidney Foundation

Precautions for patients with kidney disease

  • Avoid over the counter pain medicines other than tylenol (or acetaminophen). Nonsteroidal antiinflammatory medications (NSAIDs) such as ibuprofen (Advil or Motrin), naproxen (Naprosyn or Aleve) or greater than one aspirin daily should be avoided as these may worsen blood pressure, contribute to swelling, and may cause acute kidney failure
  • Intravenous contrast is an injection given with some radiographic (x-ray procedures). Intravenous contrast may potentially be harmful to your kidneys. Please notifiy the ordering physician and the radiologist performing the procedure that you have chronic kidney disease. This will help to assure that the procedure willbe done safely and/or that appropriate precautions are taken
  • If you have advanced kidney disease (Stage 4, GFR < 30ml/min) please avoid blood draws and IVs in your non dominant arm (If you are right handed your non dominant arm is the left) to prevent damaging veins that may be needed for dialysis access (arteriovenous fistula)

Minimizing your risk of cardiovascular disease

  • Blood pressure control (See above)
  • Know your cholesterol. Your LDL (“bad cholesterol”) should be less than 100
  • If you are diabetic work on tight blood sugar control
  • If you smoke tobacco you must quit