Chronic kidney failure, also known as chronic renal insufficiency, is characterized in contrast to acute kidney failure by the fact that the kidney continuously reduces its function over a longer period of time (months to years) until it no longer performs its tasks properly. In the early stages, chronic kidney failure usually remains asymptomatic. The diagnosis should be made before symptoms occur.
Below you will find further information and selected specialists for chronic kidney failure.
The kidneys are one of the smallest organs in the body. At the same time, the kidneys are the organs with the highest blood flow (per gram of tissue) both at rest and during physical exertion. This is no coincidence, as the kidneys have a variety of tasks in the human organism. The importance of the kidneys is underestimated by doctors and usually patients.
As the kidneys perform a variety of tasks in the organism (diagram), increasing loss of kidney function not only leads to disorders of the kidneys, but also to a variety of other disorders in other organs.
Tasks of the kidneys in the human organism
There are many possible causes of chronic kidney failure. They can include disorders
The most common causes of chronic kidney disease are high blood pressure and long-term diabetes mellitus, which lead to the chronic destruction of the kidney through vascular calcification or disruption of the renal corpuscles. Chronic inflammation of the renal corpuscles by antibodies or of the renal tubules by bacteria also lead to chronic kidney destruction. In addition, congenital diseases such as cystic kidney disease, fungal poisoning and medication can also lead to kidney failure.
The kidneys can compensate for the increasing decline in kidney function over a long period of time. Therefore, in the vast majority of patients, chronic kidney disease remains completely asymptomatic in its early stages. Only when most functions have already failed and complications have arisen do symptoms appear. These are non-specific in nature and do not necessarily indicate chronic kidney failure. The following non-specific symptoms can occur in chronic kidney failure
It is therefore crucial to diagnose chronic kidney failure early, before symptoms occur. Chronic kidney failure is present when either:
Serum creatinine is determined in the blood and is only a very rough measure of kidney function. Due to its non-linear relationship, even small changes in serum creatinine close to the normal range are associated with an advanced loss of kidney function. Unfortunately, serum creatinine is not very sensitive for detecting chronic kidney dysfunction. However, serum creatinine, age and gender can be used to calculate kidney function measured as the glomerular filtration rate (GFR). The GFR is used to indicate the severity of kidney disease:
The treatment of chronic kidney failure consists of four pillars:
If diabetes or high blood pressure is the underlying disease, it is important to reduce blood sugar and blood pressure to normal levels. Antibiotics must be administered in the case of pyelonephritis. If autoimmune diseases are the cause of the kidney disease, cortisone and other drugs that suppress the immune response must be administered.
To prevent the progression of chronic renal insufficiency, kidney-damaging medication or X-ray contrast media must be avoided. Blood pressure must be adjusted close to normal. If possible, an ACE inhibitor should be administered. It is also advisable to eat a diet low in salt and avoid protein excesses. Only in the late phase of renal insufficiency is it important to eat a diet low in potassium and phosphate.
Complications such as arteriosclerosis, bone disease, anaemia or hyperacidity of the blood must be treated aggressively before they cause symptoms. These include blood pressure medication, lipid-lowering drugs, platelet inhibitors, phosphate-lowering drugs, vitamin D, the blood-forming hormone erythropoietin and bicarbonate.
If chronic kidney failure is so advanced that kidney function can no longer be maintained without dialysis, dialysis becomes necessary. There are two forms of dialysis: blood washing (hemodialysis) and abdominal washing (peritoneal dialysis). Both methods are equivalent, but have specific advantages for one patient or the other. In order to choose the optimal procedure, the doctor conducts several comprehensive explanatory discussions with the patient. The patient often receives two afternoons of training.
Kidney transplantation is an alternative to dialysis. Patients with kidney disease receive a functioning kidney from another person. This form of kidney replacement is the best solution. Unfortunately, due to a shortage of donor organs, patients often have to wait many years for a transplant.
Many medications are excreted via the kidneys. However, damaged kidneys can only perform this function to a limited extent. Medication therefore remains in the blood longer than desired, which can lead to side effects. For this reason, caution is required with any medication if you have kidney weakness. If medication cannot be avoided, the dose must be adjusted to the kidney function.
Chronic kidney disease can no longer be cured if kidney failure has already occurred. It often takes a progressive course with increasing loss of kidney function. The prognosis depends on how advanced the kidney impairment was at the start of treatment. Suitable therapy and lifestyle changes can reduce the further annual decline in kidney function.
Chronic kidney failure can be prevented or delayed by adopting a healthy lifestyle. High blood pressure and diabetes must be avoided or thoroughly treated. Nicotine consumption is not permitted, nor is passive smoking. Obesity should be avoided and bladder infections should be treated early and appropriately. Medication that damages the kidneys must be avoided.
The problems of patients with kidney disease are so multifaceted that they can often only be overlooked by specially trained doctors. The kidney specialist is not the urologist, as is often popularly believed, but the nephrologist. Early contact with a kidney specialist in the early stages of the disease often helps to avoid undetected complications affecting bones, blood vessels, hormones and nerves. It is also helpful to join a self-help group.
