Chronic kidney disease (CKD) slowly gets worse over months or years. you may not notice any symptoms for some time. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.
The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.
Most people will have high blood pressure at all stages of chronic kidney disease. During an exam, your health care provider may also hear abnormal heart or lung sounds in your chest. You may have signs of nerve damage during a nervous system exam.
A urinalysis may show protein or other changes in your urine. These changes may appear 6 months to 10 or more years before symptoms appear.
Tests that check how well the kidneys are working include:
Controlling blood pressure will slow further kidney damage.
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
The goal is to keep blood pressure at or below 130/80 mmHg.
Making lifestyle changes can help protect the kidneys, and prevent heart disease and stroke, such as:
Do not smoke.
Eat meals that are low in fat and cholesterol.
Get regular exercise (talk to your doctor or nurse before starting to exercise).
Take drugs to lower your cholesterol, if needed.
Keep your blood sugar under control.
Avoid eating too much salt or potassium.
Always talk to your kidney doctor before taking any over-the-counter medicine. This includes vitamins, herbs and supplements. Make sure all of the doctors you visit know you have chronic kidney disease.
Other treatments may include:
Medicines called phosphate binders, to help prevent high phosphorous levels
Extra iron in the diet, iron pills, iron given through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions to treat anemia
Extra calcium and vitamin D (always talk to your doctor before taking)
Weakening of the bones and increased risk of fractures
Treating the condition that is causing the problem may help prevent or delay chronic kidney disease. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke.
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KDOQI; National Kidney Foundation II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis. 2006;47(5 Suppl 3):S16-S85.
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Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.