Kidney Disease

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One in nine Americans has chronic kidney disease. Early diagnosis and treatment of kidney disease can delay its progression and significantly improve patient outcomes and quality of life. Diabetes is the most common cause of chronic kidney disease in the United States, followed by hypertension. Optimal management of these diseases can limit kidney damage. The goal blood pressure for an individual with kidney disease and/or diabetes is less than 130/80 mmHg, lower if there is significant protein in the urine. 

There are many other causes of kidney disease, including IgA nephropathy, lupus, various glomerulonephritis, and polycystic kidney disease.  A simple blood test and urinalysis is all that is needed to screen for the presence of abnormal kidney function. A formula using the results of the blood test (to calculate estimated GFR) is used to stage the severity of kidney disease and establish a treatment plan. Kidneys can be imaged using ultrasound, CT scan, MRI or nuclear scan to look for structural abnormalities. Kidney disease specific genetic testing is available to help with diagnosis. A kidney biopsy may be necessary to determine the exact cause of an individual’s kidney disease.

Over the past decade, several new classes of medications have been developed to delay the progression of kidney disease. These include medications that are indicated for almost all patients with kidney disease, as well as medications for specific types of kidney disease including IgA nephropathy, lupus nephritis and polycystic kidney disease.

There are five stages of chronic kidney disease, with stage one being the mildest form and stage five being the most severe. As kidney function worsens, complications can develop which include worsening high blood pressure, swelling, low blood count (anemia), electrolyte imbalance, bone disease and acidosis. Diet and medication can treat many of these complications. Patients with stage four kidney disease should develop an individualized treatment plan to be prepared if their kidney function continues to deteriorate. Options include pre-emptive kidney transplant, peritoneal dialysis, home or incenter hemodialysis, or conservative care. Obtaining a living donor kidney transplant before initiating dialysis results in the best outcomes. If hemodialysis is planned, timely placement of a fistula is very important.