Chronic kidney disease (CKD) indicates that the kidneys are not working as well as they should because some of the nephrons have become damaged. The kidneys are less able to filter off the waste products. Wastes can build to high levels in your blood and make you feel sick.

You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health, and nerve damage. Kidney disease may increase your risk of having heart and blood vessel disease.

These problems may occur slowly over a long period of time. In the early stages, you may not feel sick. Your family doctor may only find an abnormal lab or protein in your urine. Early detection and treatment are important to keep your kidneys as healthy as possible – for as long as possible. Although there are many causes of CKD, high blood pressure and diabetes are the two main causes in the United States.

Polycystic kidney is a very common genetic problem (1 in 400 to 1 in 1000 people) leading to the development of large kidneys, which are enlarged by the presence of cysts. These cysts can also develop in other organs, such as the liver and the pancreas. There is a variable expression of the problem within families, and not everybody with polycystic kidney disease will develop kidney failure – maybe 50-75% will progress. The genes responsible for this disease have been found. Often polycystic kidney disease will not cause anemia, as the kidneys still produce erythropoietin. Polycystic kidney disease can cause pain, urinary infections, and blood in the urine.

It is not unusual for people with chronic kidney failure to have low levels of Vitamin D. Your doctor may check your Vitamin D level and if it is low, order a supplement. The amount prescribed to rebuild Vitamin D levels may sound like an enormous amount — a typical dose is 50,000 IU ergocalciferol (Vitamin D2) once a week for 6 to 12 weeks. Very large doses such as this are needed to rebuild stores of Vitamin D when there is a deficiency. Healthy kidneys are rich with Vitamin D receptors and play a major role in turning Vitamin D into its active form, 1,25-dihydroxyvitamin D or calciferol. When Vitamin D is in its active form, it helps balance calcium and phosphorus in your body by controlling absorption of calcium and phosphorus from the food you eat and regulates parathyroid hormone (PTH). When kidneys fail, their ability to activate Vitamin D is lost. Without the activated Vitamin D to control calcium and phosphorus levels in the blood, parathyroid hormone (PTH) will try to over compensate and go out of range.

Glomerulonephritis can develop in an acute (sudden, rapid onset) or a chronic (slow) form, and is caused by a painless inflammation of the glomerulus (the kidney filter). It can occur by itself or as part of a more general problem such as systemic lupus erythematosus (SLE). Testing of the urine shows the presence of blood and protein. It is associated with high blood pressure and progressive decline of kidney function. It is diagnosed by blood tests and a kidney biopsy. High blood pressure and the presence of protein in the urine may predict the tendency towards progression. Many patients with glomerulonephritis will simply need to be followed-up each year in an outpatient setting. Others may need treatment with specific drugs to reduce inflammation, such as steroids, azathioprine, cyclosporin A, and cyclophosphamide.

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Edema is swelling caused by excess fluid trapped in the body’s tissues (fluid retention). Edema may be generalized or local. Swelling caused by edema commonly occurs in the hands, arms, ankles, legs and feet. It can appear suddenly, but usually develops subtly. You may first gain weight, or wake up with puffy eyes.

Damage to the kidneys can cause decreased levels of protein in your blood. This can contribute to capillary leaking and swelling. The edema associated with kidney disease usually occurs in your legs and around your eyes. Often, patients wait until symptoms are well advanced before seeking medical help.

A narrowing of the kidney blood vessels will lead to the kidney being starved of a good enough blood supply. This leads to the kidney becoming smaller. Often it presents with high blood pressure. If this problem exists in both kidneys, it can lead to kidney failure and pulmonary edema (fluid in the lungs causing breathlessness).

The problem may be suggested by a kidney ultrasonogram which shows one kidney is smaller than the other, but can only be diagnosed with certainty by an angiogram of the kidney blood vessels.

Sometimes it may be felt that the narrowing should be stretched open using a fine, narrow balloon (angioplasty) and then kept open with a tube inserted into the blood vessel (a stent). All of this can be done from the “inside,” during a procedure similar to an angiogram. For anyone with this disorder, the blood pressure will be controlled, the cholesterol level checked and normalized, and aspirin may be given.

Glomerulosclerosis is a general term to describe scarring of the kidneys’ tiny blood vessels, the glomeruli, which are the functional units in the kidney that filter urine from the blood. This disease may result in proteinuria (abnormal amounts of protein in urine). A kidney biopsy (removal of tiny part of kidney with a needle) may be necessary to determine whether a patient has glomerulosclerosis, or another kidney problem. Scarred glomeruli cannot be repaired, and many patients with glomerulosclerosis get worse over time until their kidneys fail. This condition is called end-stage renal disease (ESRD), and patients must undergo dialysis treatment or a kidney transplant.

The #1 cause of kidney failure is diabetes. Kidney damage develops in about 20% of patients with both type 1 and type 2 diabetes. Problems start after 10 to 15 years of diabetes, and the kidney problems are associated with diabetic eye disease. Poor control of blood glucose and high blood pressure are factors which lead to this problem, and make it worse once it starts. Recent work has shown that lowering blood pressure, particularly using ACE inhibitors at the earliest stages, can have a major impact on reducing the progression of kidney disease.

Kidney stones are one of the most common disorders of the urinary tract.

High concentrations of natural chemicals in the urine can lead to crystal formation. Under special circumstances, these small crystals may “clump” together to form a kidney stone. The majority of kidney stones create no symptoms. Kidney stones vary in size, and a stone may stay in the kidney or travel down the urinary tract. A small stone may pass on its own, causing little or no pain. A larger stone may get stuck along the urinary tract and block the flow of urine – causing symptoms that include back pain, lower abdominal pain, urinary tract infection or blood in the urine.

It is estimated that 60-80% of people with a kidney stone will form another stone within 10 years of the first episode. Removal of an existing stone does not prevent further stone formation. Medication, changes in diet and lifestyle modification may prevent kidney stone formation. A Nephrologist can help you determine the treatment to prevent new stone formation, while a Urologist can remove existing stones if needed.

Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either “gross” (visible to the naked eye) or “microscopic” (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra.

Lupus, or systemic lupus erythematosus (SLE), is an inflammatory disease resulting from an abnormality in the body’s immune system regulation. It is an unpredictable disease, varying a great deal from one case to another. A potentially serious disorder, systemic lupus erythematosus affects women much more often than men. In about eighty percent of SLE cases, joint inflammation occurs. The inflammation may affect connective tissues throughout the body and cause problems in one or more of the body’s organs, including the eyes, muscles, heart, lungs, and kidneys. In some people, systemic lupus erythematosus can produce potentially life-threatening complications, including kidney failure.

Nephrotic syndrome is not a single underlying disease, but develops alongside other processes such as glomerulonephritis or diabetes. The kidneys pass large amounts of protein (the urine may be “frothy”) into the urine and this means the water in the blood stream passes into the tissues, particularly the feet and around the eyes. Usually, it is caused by glomerulonephritis such as minimal change nephropathy (the most common in children) or membranous glomerulonephritis.

The kidney function may be absolutely normal and the only problem is the protein leak. Treatment includes restricting the fluid intake, using diuretics and perhaps aspirin and cholesterol-lowering drugs. A kidney biopsy will be done to determine the exact nature of the problem and to decide if treatment with steroids or other drugs is needed.

Renal bone disease (also known as renal osteodystrophy) is due to changes in mineral metabolism and bone structure, and occurs to some degree in everyone with progressive renal disease. Renal bone disease can be slowed or perhaps even prevented with early intervention using dietary measures and medications such as phosphate binders and calcitriol. Recently, new phosphate binders and a new class of drugs, the calcimimetics, have been introduced. Sometimes surgery (parathyroidectomy) is needed.