Nephrologist Andrew Bentall, M.D., answers the most frequently asked questions about kidney disease.
As a first step toward diagnosis of kidney disease, your doctor discusses your personal and family history with you. Among other things, your doctor might ask questions about whether you’ve been diagnosed with high blood pressure, if you’ve taken a medication that might affect kidney function, if you’ve noticed changes in your urinary habits and whether you have family members who have kidney disease.
Next, your doctor performs a physical exam, checking for signs of problems with your heart or blood vessels, and conducts a neurological exam.
For kidney disease diagnosis, you might also need certain tests and procedures to determine how severe your kidney disease is (stage). Tests might include:
- Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
- Urine tests. Analyzing a sample of your urine can reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.
- Imaging tests. Your doctor might use ultrasound to assess your kidneys’ structure and size. Other imaging tests might be used in some cases.
- Removing a sample of kidney tissue for testing. Your doctor might recommend a kidney biopsy, which involves removing a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that’s inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what’s causing your kidney problem.
Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.
Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease.
Treating the cause
Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as diabetes mellitus or high blood pressure, has been controlled.
Kidney disease complications can be controlled to make you more comfortable. Treatments might include:
- High blood pressure medications. People with kidney disease can have worsening high blood pressure. Your doctor might recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function.High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you might need frequent blood tests to monitor your condition. Your doctor may also recommend a water pill (diuretic) and a low-salt diet.
- Medications to relieve swelling. People with chronic kidney disease often retain fluids. This can lead to swelling in the legs as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.
- Medications to treat anemia. Supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron, help produce more red blood cells. This might relieve fatigue and weakness associated with anemia.
- Medications to lower cholesterol levels. Your doctor might recommend medications called statins to lower your cholesterol. People with chronic kidney disease often have high levels of bad cholesterol, which can increase the risk of heart disease.
- Medications to protect your bones. Calcium and vitamin D supplements can help prevent weak bones and lower your risk of fracture. You might also take medication known as a phosphate binder to lower the amount of phosphate in your blood and protect your blood vessels from damage by calcium deposits (calcification).
- A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor might recommend eating less protein. A registered dietitian can suggest ways to lower your protein intake while still eating a healthy diet.
Your doctor might recommend regular follow-up testing to see whether your kidney disease remains stable or progresses.
Treatment for end-stage kidney disease
If your kidneys can’t keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.
- Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood.In peritoneal dialysis, a thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from your body, carrying the waste with it.
- Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors.After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant.
For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).