Chronic kidney disease

Kidneys clean your blood by working as a filter to remove water and wastes from your body.

Chronic kidney disease damages these filters so they do not do their job properly. It usually affects both kidneys and also puts you at higher risk of heart attack and stroke.

There are often no symptoms of chronic kidney disease, particularly in the early stages. You can lose 70% of your kidney function before developing any symptoms.

The first signs may be general and can include:

• tiredness
• poor appetite and weight loss
• puffiness or swelling around your eyes and ankles
• blood in your wee (urine)
• changes in how often and how much you wee.

Kidney failure

When enough of the kidney filters are damaged, the body fills up with excess wastes and water. This is called kidney failure. It can happen when you have kidney disease for a long period of time (chronic kidney disease).

Kidney failure is fatal if not treated by either dialysis or a kidney transplant.

You are at greater risk of chronic kidney disease if you:

• have diabetes
• have high blood pressure
• have an unhealthy weight
• have a family history of kidney disease
• smoke
• are over 50
• are Māori or Pacific.

If you are in any of these groups, ask your healthcare provider for a kidney check-up.

Diabetes

When your blood sugar is raised, it causes damage to many blood vessels in your body, including the blood vessels in your kidneys.

About 1 in 3 people with diabetes will end up with some kidney damage.

High blood pressure

High blood pressure damages the small vessels that take blood to the kidney filters and can also damage the filters themselves.

Other causes

• Kidney inflammation called glomerulonephritis is a group of diseases that affects the filtering units in your kidneys.
• Polycystic kidney disease causes cysts to form in your kidneys. This is an inherited disease, passed down from your parents.
• Lupus and other diseases that affect your body’s immune system can also affect your kidneys.
• Obstructions or blockages in the flow of urine caused by kidney stones or an enlarged prostate gland can affect your kidneys.
• Urinary reflux where the urine flows back from your bladder to your kidneys can cause scarring in your kidneys.
• Repeated kidney infections can lead to long-term kidney problems.

Long term regular use of pain-relieving medicines called anti-inflammatories (NSAIDS) can harm your kidneys.

It is important to see your healthcare provider regularly. Early detection and treatment of chronic kidney disease is important as it can help slow down or stop your chronic kidney disease getting worse.

There are several tests that can be used to detect chronic kidney disease.

• Blood tests measure the levels of creatinine and urea in your blood. If your kidneys are not working properly, increased amounts will show up in your blood.
• Urine tests measure the amount of protein in your wee (urine), especially albumin. Damaged kidneys let some albumin pass through your blood to your wee.
• Ultrasounds measure the size, shape and structure of your kidneys.

Renal biopsys take a small sample of kidney tissue to look at how much damage there is. Not everyone needs this test.

There is no cure for chronic kidney disease . But there is treatment that can slow down the damage to your kidneys and treat your symptoms.

There are different stages of chronic kidney disease, ranging from mild loss of kidney function to complete kidney failure. Not all chronic kidney disease conditions progress to the most serious stage. Most people fall into the mild to moderate categories where hospital-based care is not necessary.

If your chronic kidney disease is in early stages

For most people, particularly those with the early stages of chronic kidney disease, your regular doctor or healthcare provider is likely to look after you.

If you find out about chronic kidney disease early, there are things you can do to help slow down or prevent further damage. Treatment includes medicines along with lifestyle changes.

To protect your kidneys:

• keep high blood pressure under control — usually with medicine
• keep your blood sugar under control if you have diabetes
• avoid dehydration
• avoid medicines that could damage your kidneys, such as those containing ibuprofen or diclofenac.

If your chronic kidney disease is more advanced

Some people may need to see a doctor who is a kidney specialist (called a nephrologist) if their chronic kidney disease is more advanced.

Over time, if the damage gets really bad, the body fills up with excess wastes and water. This is called kidney failure.

People with kidney failure have 3 treatment options:

• dialysis
• kidney transplant
• supportive treatment.

Healthcare providers will help you decide the best treatment option for you.

Dialysis

You cannot live without having your blood cleaned properly. If your kidneys have failed completely, a treatment called dialysis can take over the job of filtering and cleaning the blood.

You will need to stay on dialysis for the rest of your life, unless you can get a new kidney. Dialysis takes time and effort but helps you live a normal life.

Kidney transplant

Dialysis cannot make your kidneys work again. If you have complete kidney failure, a kidney transplant may be an option.

A kidney transplant is an operation to have someone else’s healthy kidney put inside your body. If the transplant works well, you no longer need dialysis.

For most people with kidney failure, having a kidney transplant is the best treatment.

People who are considering donating a kidney can find out more.

Organ donations and transplants — Ministry of Health (external link)

Supportive care

Not everyone can have dialysis or a transplant and some people choose not to.

Some people decide to have ‘conservative’ treatment (also called palliative or supportive care) rather than dialysis or a transplant — particularly if they have other serious health problems.

Conservative treatment includes medical, emotional, social, spiritual and practical care for both you and your whānau.

If you are at risk of chronic kidney disease, lifestyle changes can help such as:

• losing weight
• exercising
• stopping smoking
• eating less salt
• drinking less alcohol.

If you have high blood pressure

Talk to your healthcare provider about what your blood pressure should be and what you can do to keep it at a safe level.

• You may need to make some lifestyle changes to reduce your blood pressure.
• Your doctor may prescribe medication to control your blood pressure.

If you have diabetes

If you have diabetes, good blood pressure and blood sugar control are very important to reduce the risk of kidney damage.

• Have a kidney check at least once a year. This will include a blood test, urine test and a check of your blood pressure. Get your doctor to explain the results.
• Keep good control of your blood sugar levels, to help slow kidney damage.
• Make healthy food choices. It’s important to follow the eating plan given to you by your dietitian or health professional.
• Avoid becoming dehydrated, especially when you’re sick.
• Make sure you do some regular physical activity (like walking).
• Only drink small amounts of alcohol.
• Control blood cholesterol levels with diet and medication as needed.
• Do not take non-steroidal anti-inflammatories like ibuprofen or diclofenac.
• Treat urinary infections immediately.