The kidneys are vital organs for waste excretion and maintaining water balance in the body. When suffering from kidney disease, the concern is that there are often no clear symptoms initially. By the time one realizes, the kidneys may be damaged or severely affected to the point of chronic kidney disease in its final stage. Therefore, being aware of kidney disease, observing warning signs and keeping the kidneys healthy is essential.
How are kidney dysfunction, acute kidney failure, and chronic kidney failure different?
Kidney failure and kidney dysfunction can be both acute and chronic. Acute kidney failure (Acute Kidney Injury – AKI) is a temporary kidney dysfunction occurring in a matter of days or weeks, often due to dehydration, infection, certain medications, or low blood pressure. Reduced urine output may be observed, but symptoms are often absent and only detected through blood tests. The importance of this condition lies in early detection, identifying the cause, and prompt treatment, allowing the kidneys to return to normal or nearly normal function.
On the other hand, chronic kidney disease (Chronic Kidney – CKD) gradually worsens over several months or years. The main causes include diabetes, hypertension, and chronic kidney disease. The danger is that chronic kidney failure in the early stages often shows no symptoms, but the kidneys gradually deteriorate over time. By the time one realizes, dialysis may be imminent. The importance of this stage is that early detection and appropriate treatment, combined with lifestyle changes, can slow the progression to end-stage chronic kidney disease requiring dialysis.
How to tell if you are starting to have chronic kidney failure?
Diagnosing chronic kidney failure from clinical symptoms is very difficult without continuous health checks because chronic kidney failure has many stages. In the early stages, there are often no symptoms or very few, and they are often non-specific, causing many to discover their kidney disease only in the late stages, almost requiring dialysis. Warning signs include:
- Frequent urination at night
- Reduced urine output or excessive frothy urine
- Swelling of body, face, legs, feet
- Easily fatigued, weak, and tired
- Loss of appetite, chronic nausea
- Unexplained itching all over the body
As mentioned earlier, symptoms of chronic kidney disease are non-specific and often absent in the early stages. If you have underlying health conditions or are at risk for diabetes, high blood pressure, obesity, or a family history of kidney disease, kidney function tests can help detect chronic kidney disease in the early stages, even when there are no symptoms.
What causes chronic kidney disease?
Chronic kidney disease can occur from multiple causes. Data from the Kidney Foundation indicates common causes of chronic kidney disease as follows:
- Diabetes
- Hypertension
- Kidney cyst
- Kidney inflammation diseases, such as lupus nephritis
- Kidney disease from urinary tract obstruction
- Kidney disease from certain drugs or toxins such as NSAIDs, herbal medicines, etc.
How to test kidney function?
There are several methods to test kidney function, including:
- Urinalysis (Urinalysis) In the early stages of chronic kidney disease, albumin protein leakage in the urine may be detected even when kidney function is still normal.
- Blood tests for kidney function by measuring Serum Creatinine and using it to estimate eGFR (Estimated Glomerular Filtration Rate), the amount of blood filtered by the kidneys.
Chronic kidney disease has a total of 5 stages classified by eGFR as per the table
|
Stages of Chronic Kidney Disease |
eGFR Level (ml/min/1.73m2) |
|
1 |
>90 |
|
2 |
60 – 89 |
|
3a |
45 – 59 |
|
3b |
30 – 44 |
|
4 |
15 – 29 |
|
5 |
<15 |
- eGFR below 15 indicates end-stage kidney failure, requiring planning for dialysis such as hemodialysis or peritoneal dialysis.
- Mostly if eGFR is less than 6 or below 10 with symptoms of fluid overload or accumulation of toxins, dialysis is required.
Early detection allows for early treatment planning, behavior adjustments, and medication adjustments to identify the cause, provide treatment, and slow the kidney deterioration to prevent reaching the kidney dialysis stage.
When should kidney disease screening be done?
Most kidney disease patients have no symptoms or only non-specific symptoms. Therefore, in the early stages of kidney disease, chronic kidney failure is diagnosed only through kidney function tests. Screening for kidney disease in asymptomatic patients is recommended for two groups:
- At risk of chronic kidney disease, such as diabetes, hypertension, cardiovascular disease, obesity, or a family history of kidney disease.
- General individuals over 35 years should include kidney function tests as part of the annual health check-up.
How to slow kidney deterioration?
Since chronic kidney disease, in many cases, cannot significantly improve in kidney values from the time of detection, the primary goal of kidney disease treatment is to prevent chronic kidney failure from developing into end-stage kidney disease or requiring dialysis. Slowing kidney deterioration involves two areas requiring cooperation between doctor and patient:
1) Medication and treatment of the cause of chronic kidney failure
- Specialized doctors will identify the causes of chronic kidney failure and provide root cause treatment, along with handling underlying conditions or other factors that may worsen chronic kidney failure, while prescribing medications with evidence of slowing the progression to chronic dialysis.
- Currently, no supplements or herbs have evidence-based information supporting their ability to slow kidneys , so consuming doctor-recommended foods along with taking prescribed medicines is sufficient for chronic kidney disease patients.
- Some patients believe that taking multiple medications will further deteriorate the kidneys, but this notion is incorrect. Not all drugs are excreted through the kidneys, and not all drugs that are excreted by kidneys worsen kidney function. Once doctors know that patients have kidney disease, they will always avoid prescribing such medications. It’s crucial to follow the doctor’s prescriptions strictly because not taking certain medications may lead to uncontrolled conditions that worsen kidney function. Therefore, taking prescribed medications rigorously and informing the doctor of the chronic kidney condition is the right approach.
2) Behavioral changes
- Patients must collaborate with doctors to change behaviors and dietary habits to minimize kidney strain, thereby slowing the deterioration, including quitting smoking, avoiding decoction medicines, pots, herbal balls, certain painkillers.
- Diet to prevent kidney deterioration can be achieved through the following principles
- Eat moderately, choose quality protein like fish, tofu, egg whites, complete amino acids, easy to digest, low fat
- Select lean meats like chicken breast, non-fat pork, etc.
- Focus on light green vegetables to ease kidney workload such as cabbage, Chinese cabbage, broccoli, etc.
- Choose light fruits with high fiber and low sugar like apples, guavas, pears, etc.
- Drink clean water, avoid sugary drinks or sodas
- Avoid extremely salty foods like snacks, instant noodles, pickled foods as they strain the kidneys
- Kidney patients should be cautious with foods high in phosphorus, including ready-to-eat foods, processed foods, and sodas containing preservatives
What is kidney replacement therapy?
For end-stage kidney failure patients, essential treatment involves kidney replacement therapy to remove waste on behalf of the non-functional kidneys, with three therapy methods :
- Hemodialysis
- Benefits: Travel to the kidney center, where dialysis nurses perform dialysis treatment
- Limitations: Requires 2-3 times weekly dialysis, limiting travel and work for some patients, necessitating strict dietary restrictions
- Peritoneal dialysis
- Benefits: Self-administered dialysis at home, with fewer travel and work restrictions and lifestyle adaptability, requiring less strict dietary constraints than hemodialysis
- Limitations: Requires self-attachment of treatment equipment
- Kidney transplant is the best solution and has evidence-based information indicating lower mortality rates and improved quality of life compared to other methods
- Benefits: No more dialysis is needed, nearly normal diet, no need to restrict fluid intake
- Limitations: Lifetime immunosuppressant medication is required
Effective kidney disease management requires adherence to specialized medical advice, with patients strictly following guidelines and attending all scheduled appointments.
Which hospital specializes in kidney disease treatment?
Bangkok Hospital Kidney Center offers kidney disease diagnosis and treatment by specialized doctors, nurses, and multidisciplinary teams with advanced equipment and technology to help return to a good quality of life each day.
Doctors specializing in kidney disease treatment
Dr..Irin Jariyayothin Nephrologist and Kidney Transplant Specialist Kidney Center and Dialysis Center Bangkok Hospital
You can click here to make an appointment yourself.
