Chronic Kidney Failure - Specialists and Information

The kidneys are among the smallest organs in the body. At the same time, both at rest and during physical exertion, the kidneys have the highest blood flow (per gram of tissue) of any organ.

The kidneys perform a wide variety of functions in the human body. Doctors and patients often underestimate the importance of the kidneys.

Since the kidneys perform many functions in the body (see diagram), a failure of kidney function leads to further complications—including in other organs.

Functions of the Kidneys in the Human Body

There are many possible causes of chronic kidney disease.

The following functions are usually involved in a slowly progressive loss of kidney function:

• Renal blood flow
• Filtration function in the glomeruli
• Processes in the renal tubules or
• urine excretion

The most common causes of chronic kidney disease are high blood pressure and long-standing diabetes mellitus. In these cases, chronic kidney failure results from vascular calcification or dysfunction of the glomeruli.

Chronic inflammation of the glomeruli caused by antibodies or of the renal tubules caused by bacteria also leads to chronic kidney failure.

Congenital disorders can also lead to kidney failure, such as:

• polycystic kidney disease
• fungal poisoning, and
• medications

The kidneys can compensate for the gradual decline in kidney function over a long period of time. For this reason, in the vast majority of patients, chronic kidney disease remains completely asymptomatic in its early stages.

Symptoms do not appear until most kidney functions have already failed and complications have set in.

These symptoms are nonspecific in nature and do not necessarily indicate chronic kidney failure.

The following nonspecific symptoms may occur in chronic kidney failure:

• decreased physical performance
• Difficulty concentrating
• Feeling cold
• Nausea and vomiting
• Diarrhea
• Absence of menstruation
• Impotence
• Anemia
• Bone pain
• Broken bones
• Bruises
• Itching
• Calf cramps
• restless legs
• Sensory disturbances
• Water retention
• Nocturia
• Shortness of breath
• High blood pressure
• Arteriosclerosis
• Pericarditis
• Pleurisy
• Arrhythmia
• Premature aging

It is therefore crucial to diagnose chronic kidney disease early, before symptoms appear.

Chronic kidney failure is present if either:

• serum creatinine levels in the blood are elevated
• there is protein or blood in the urine
• or imaging studies show changes in the kidneys.

Serum creatinine can be measured in the blood and is only a rough indicator of kidney function.

Even small deviations from the normal range indicate advanced kidney dysfunction.

Unfortunately, however, serum creatinine is not very sensitive for detecting chronic kidney disease.

Kidney function can be calculated as the glomerular filtration rate (GFR).

It is important to note that:

• serum creatinine
• age, and 
• gender

The GFR is used to classify the severity of kidney disease:

1. Stage I: Kidney disease, GFR > 90 ml/min
2. Stage II: mild kidney impairment, GFR > 60 ml/min
3. Stage III: Moderate kidney impairment, GFR > 30 ml/min
4. Stage IV: severe kidney disease, GFR > 15 ml/min
5. Stage V: End-stage kidney disease, GFR < 15 ml/min

The treatment of chronic kidney disease is based on four pillars:

1. Treatment of the underlying disease
2. Preventing progression
3. Management of complications
4. Renal replacement therapy via dialysis or transplantation

If diabetes or high blood pressure is the underlying condition, it is important to lower blood sugar and blood pressure.

In cases of pyelonephritis, the patient is given antibiotics.

If autoimmune diseases are the cause of the kidney disease, the patient is given corticosteroids and other medications that suppress the immune system.

To prevent the progression of chronic kidney disease, the patient must avoid medications that damage the kidneys or X-ray contrast agents.

Blood pressure must be kept close to normal levels. Whenever possible, the doctor should prescribe ACE inhibitors.

In terms of diet, it is also advisable to follow a low-sodium diet and avoid excessive protein intake. Only in the late stages of kidney failure is it important to follow a diet low in potassium and phosphorus.

Complications such as atherosclerosis, bone diseases, anemia, or acidosis require aggressive treatment. Otherwise, they will cause symptoms.

These include:

• Blood pressure medications
• Lipid-lowering medications
• Antiplatelet agents
• Phosphate binders
• Vitamin D
• the blood-forming hormone erythropoietin and bicarbonate

If chronic kidney failure is advanced and the patient can no longer maintain kidney function, dialysis is necessary.

There are two forms of dialysis:

1. blood dialysis (hemodialysis) and
2. peritoneal dialysis

Both methods are equally effective but offer specific advantages for certain patients.

To help choose the best method, the doctor conducts several in-depth consultations with the patient. Often, the patient receives training over the course of two afternoons.

Approximately 100,000 people in Germany rely on dialysis @ Maria /AdobeStock

A kidney transplant is an alternative to dialysis. In this procedure, patients with kidney disease receive a functioning kidney from another person.

This form of renal replacement therapy is the best solution. Unfortunately, patients often have to wait many years for a transplant.

The body excretes many medications through the kidneys. However, damaged kidneys can only perform this function to a limited extent.

As a result, medications remain in the bloodstream longer than intended, which can lead to side effects.

Consequently, caution is advised with any medication in cases of kidney impairment. If medication cannot be avoided, the doctor must adjust the dose to account for kidney function.

Chronic kidney disease is defined as a condition in which kidney impairment has already set in and is no longer curable.

It often follows a progressive course with a gradual decline in kidney function. The prognosis depends on the extent of kidney impairment at the start of treatment.

With appropriate treatment and lifestyle changes, the annual decline in kidney function can be slowed.

Chronic kidney failure can be prevented or delayed by leading a healthy lifestyle.

High blood pressure and diabetes require thorough treatment. Smoking is not permitted, nor is secondhand smoke.

Excess weight should be avoided. Urinary tract infections must be treated early and appropriately. Patients must avoid medications that damage the kidneys.

The problems faced by patients with kidney disease are so complex that often only specially trained doctors can fully assess them.

The specialist for the kidneys is the nephrologist. Consulting with kidney specialists in the early stages of the disease helps prevent complications affecting the bones, blood vessels, hormones, and nerves. It is also helpful to join a support group.