Approximately 26 million American adults have chronic kidney disease and millions of others are at risk but may not know it. Kidney disease is often called the “silent killer,” because it has no symptoms until the advanced stage of the disease. In fact, one in nine Americans has chronic kidney disease and are unaware that they have it, because they do not feel ill.
Function of the Kidneys

The kidneys help our bodies remove wastes, fluids, and toxins; regulate the body’s supply of water and certain chemicals in the blood (such as calcium, sodium, and potassium); and release hormones into the bloodstream that help to regulate blood pressure, create red blood cells, and produce vitamin D – helping maintain strong bones. According to the National Kidney Foundation, the kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours.
Understanding Chronic Kidney Disease

Chronic kidney disease (CKD) occurs when the kidneys are damaged and unable to perform their cleansing and restorative functions. Over time, this can lead to a build-up of waste matter in the bloodstream, which makes us sick. Complications of CKD include high blood pressure, anemia, weak bones, nutritional deficits, and nerve damage.

Many health conditions can contribute to CKD, but the primary causes are two very common conditions: diabetes and high blood pressure. Diabetes and the accompanying high levels of blood sugar can damage the organs in the body, including the kidneys and heart. High blood pressure, or hypertension, can damage blood vessels throughout the body, including those in the kidneys. When these blood vessels are damaged, the kidneys are less effective at removing waste and extra fluid from the body. The excess fluid, in turn, raises blood pressure even more, which then increases the risk of chronic kidney disease – a vicious cycle. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation.

What’s so challenging about this disease is that many people will have no symptoms in early in the disease progression. However, some people may start to experience the following symptoms as the disease advances:

• Excessive fatigue and lack of energy
• Difficulty concentrating
• Poor appetite
• Difficulty sleeping
• Swollen feet and ankles
• Puffiness around the eyes, especially in the morning
• Dry, itchy skin
Risks and Treatment

Chronic kidney disease can develop in anyone, at any age, but certain individuals have greater risk. In addition to having diabetes and high blood pressure, other risk factors include advanced age and a family history of the disease.

Early detection of CKD can be done through simple tests such as a blood test for creatinine levels, which tells how effectively your kidneys are removing waste from the blood; and a urine test to measure protein levels in the urine. High levels of protein in the urine may indicate kidney disease.

The first step in treatment is to determine the cause of CKD. Although many causes remain unknown, there are other reasons for kidney problems, many of which are treatable. These include kidney problems caused by medications that impair kidney function, a kidney stone, obstruction in the urinary tract, urinary tract infection, or decreased blood flow to the kidneys. Treatment of these causes may stop or slow the progression of CKD.

Managing diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) often helps to slow the progression of chronic kidney disease.

If you or a loved one is experiencing symptoms or may be at risk for chronic kidney disease, talk to your primary care provider. They can help you determine if a test is appropriate and whether or not your condition can be managed through lifestyle and behavior modifications, or if medicine or other treatments would be needed.

By Sam Stea, MD
Nephrologist, UPMC

Sam Stea, MD, is a nephrologist with SH Nephrology located at 1201 Grampian Blvd., Suite 1A, Williamsport. He also sees patients at UPMC Outpatient Center, One Outlet Lane, Lock Haven, and UPMC Specialty Care, 260 Reitz Blvd., Suite C, Lewisburg. For more information, call 570-326-8080 or visit UPMCSusquehanna.org.