Chronic Kidney Disease

Chronic kidney disease is a gradual, permanent loss of kidney function, most often caused here by diabetes and long-standing high blood pressure. It is silent until a large share of function is already gone, which is why screening the at-risk matters more than waiting for symptoms.

Symptoms

Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.

No symptoms in the early stages
Swelling of the face in the morning and of the feet by evening
Frothy urine, or a change in the volume passed
Tiredness, poor appetite and a metallic taste
Nausea, vomiting and hiccups in advanced disease
Itching, muscle cramps and difficulty sleeping
Breathlessness from fluid overload or anaemia

When to see a doctor

Do not wait these out

If any of the following applies, arrange to be seen the same day. For anything sudden or severe, call 9281862028 or come straight to the emergency department at SIMS — it is open 24 hours and does not need an appointment.

Marked reduction in urine output
Swelling of the face and legs with breathlessness — attend the emergency department
Persistent vomiting or drowsiness in a known kidney patient
Everyone with diabetes, high blood pressure or a family history of kidney failure should have creatinine and urine protein checked at least annually

Tests that may be advised

Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.

Serum creatinine with estimated GFR
Urine routine examination and urine albumin-creatinine ratio
Ultrasound of the kidneys to assess size and structure
Haemoglobin, calcium, phosphate and parathyroid hormone
Blood sugar, HbA1c and lipid profile
Kidney biopsy in selected patients where the cause is unclear

How it is treated

Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.

Strict blood pressure and blood sugar control, which slows progression more than anything else
Kidney-protective medication and control of urine protein
Avoiding painkillers of the NSAID class, unsupervised herbal remedies and repeated contrast scans
Dietary advice on salt, potassium, phosphate and protein, planned individually
Treatment of anaemia and bone disease
Timely planning for dialysis access or transplant assessment when function declines

This page is general information, not a diagnosis

Chronic Kidney Disease can look like several other conditions, and the reverse is equally true. Nothing here can replace an examination, your test results and the judgement of the doctor treating you — and no medicine mentioned by name to a friend or relative should be started on the strength of this page. If you recognise yourself in it, book a consultation with the Nephrology department. If a symptom is sudden or severe, call 9281862028.

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