CKD: Causes, symptoms and management of even the most severe cases - and more

The prospect of kidney failure from chronic kidney disease (CKD) can be scary, so it's good to know that chronic kidney disease is becoming more manageable - even in severe cases.

Top Doctors speaks to esteemed consultant nephrologist Dr James Pattinson about this common condition and its causes, symptoms and the treatment process, among other related topics, in this informative article. Read on to discover more.

What are the common causes of chronic kidney disease?

Chronic kidney disease is very common. As we get older, our kidney function decreases but the most common causes of kidney disease worldwide are diabetes and high blood pressure. Those is the most significant cause of kidney disease.

There are a number of other kidney diseases that we see; one type of kidney disease that affects the filters of the kidney, which are called glomerular diseases. A condition called IgA nephropathy is the most common disease to cause kidney failure. There are a number of systemic diseases that can affect multiple organs in the body and can include the kidneys.

Diseases such as systemic lupus erythematosus, vasculitis and myeloma can all affect the kidneys. Then, there are a number of genetic diseases that can affect the kidneys. Inherited diseases include polycystic kidney disease, reflux nephropathy and Alport syndrome. In elderly people we often see narrowing of the arteries to the kidneys so we see lack of blood flow to the kidneys. There are a number of other causes such as kidney stones but those are the major causes.

What are the symptoms of chronic kidney disease?

Most patients with kidney disease are unaware that they have any problems with their kidneys because kidney diseases are generally asymptomatic until kidney function drops below about 20 per cent of normal. Often they're picked up with kidney disease because they found to have an abnormality via a urine or blood test, or had problems picked up on kidney scan, which is done coincidentally.

When people pick up advanced kidney failure, they may develop symptoms of:

• Fatigue;
• Loss of appetite;
• Weight loss;
• Fluid retention;
• Itching;
• Cramps or;
• A metallic taste in the mouth.

How do you investigate a patient with kidney disease?

First of all, I take a history and I examine the patient. I take their blood pressure. Then, I do some very basic blood tests. Nephrologists like myself also organise some specific tests to exclude systemic diseases. We quantitate the protein in the urine; and we organise an ultrasound with a very highly-skilled, specialised renal radiologist. Those are the first screening tests we do and then depending on the results of those, we may need to do some second-line investigations. That may include further imaging of the kidneys, either with CT scans or even a renal angiogram. Or if it's maybe more appropriate, do a kidney biopsy. A kidney biopsy is a relatively invasive procedure so we reserve that for patients who really need to have that done.

How is kidney disease treated?

For all patients who have kidney disease, there's some generic lifestyle advice that we give. We advise patients to:

• Keep fit;  
• Lose weight; 
• Avoid salt in their diet if they have high blood pressure or diabetes, in order to try and optimise those conditions.

In terms of people with kidney disease, blood pressure control is very, very important. We believe that a type of medication called ACE inhibitors, or angiotensin septal blockers, are, for most kidney patients, the best at preserving kidney function. Now, in the early 2020s, there's a new medication coming along called the SGLT2 Inhibitors which also look like they're going to have a very important role in slowing down the progression of kidney disease.

For some kidney diseases there's specific treatments. There are some diseases which are caused by the immune system being overactive. You give some immunosuppression; steroids or other types of immunosuppressive medication. If you find that a kidney's obstructed, I would ask the urologist to relieve the obstruction. For certain other conditions such as polycystic kidney disease, there are some specific drugs that you can use. The key here, is to make an accurate diagnosis to be able to tailor the appropriate treatment to the patient.

How are patients with kidney disease followed up?

In the United Kingdom, we have guidelines which try and help us to assess which patients need to be followed in hospital and which can be followed in primary care. The follow up really depends on what treatment you're giving the patient and how severe the kidney disease is. If someone only has very mild kidney disease they can probably be followed by their primary care physician/GP, perhaps once a year. On the other hand if someone has got a disease that needs intensive monitoring then they need to be followed much more closely.

What happens if a patient has severe kidney failure? What are the treatment options?

Kidney failure can now be managed even if it's severe. There are options which include dialysis or kidney transplant. The optimal treatment for young patients would be a pre-emptive live donor transplant before the patient needs to have dialysis. That obviously depends on whether there's an appropriate live donor available. If there's no live donor, in the UK the patient will go on the list for a deceased donor transplant.

If the patient needs dialysis, there's a number of options. Patients can come to the hospital for dialysis three times a week or they can have home-dialysis therapy which could be home dialysis, haemodialysis or peritoneal dialysis.

If you'd like to receive leading medical assistance regarding chronic kidney disease or other nephrology conditions, arrange an appointment with Dr Pattinson via his Top Doctors profile.