What Is Kidney Disease?
Kidney disease can affect your body’s ability to clean your blood, filter extra water out of your blood, and help control your blood pressure. It can also affect red blood cell production and vitamin D metabolism needed for bone health.
When your kidneys are damaged, waste products and fluid can build up in your body. That can cause swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath. Without treatment, the damage can get worse and your kidneys may eventually stop working. That’s serious, and it can be life-threatening.
- Keep a balance of water and minerals (such as sodium, potassium, and phosphorus) in your blood
- Remove waste from your blood after digestion, muscle activity, and exposure to chemicals or medications
- Make renin, which your body uses to help manage your blood pressure
- Make a chemical called erythropoietin, which prompts your body to make red blood cells
- Make an active form of vitamin D, needed for bone health and other bodily functions
- Filter all the blood in your body every 30 minutes.
Types of Kidney Disease
Chronic kidney disease (CKD)
CKD is a condition where your kidneys can't filter toxins or extra fluid from your blood as well as they should. While the condition can vary in how serious it is, CKD usually gets worse over time. Treatment can slow the progression of the disease.
If left untreated, CKD may lead to kidney failure. At this stage, called end-stage renal disease (ESRD), the condition must be treated by dialysis or kidney transplant. Diabetes and high blood pressure are the leading causes of CKD.
It's estimated that 1 in 7 adult Americans have the condition. But 40% of those with serious chronic kidney disease aren't aware they have the condition.
Other common forms of kidney disease include:
- Polycystic kidney disease. This genetic disorder causes cysts (fluid-filled sacs) to grow on your kidneys, limiting their ability to filter waste from your blood.
- Lupus nephritis. Lupus is an autoimmune disease, meaning your immune system attacks healthy cells. Lupus nephritis is when your immune system attacks your kidneys.
- Interstitial nephritis. This condition happens when you have a bad reaction to a medicine that limits your kidneys' ability to filter toxins. If you stop the medicine, your kidney health should improve.
- Glomerulonephritis (glomerular disease). Glomeruli are the thousands of tiny filters that remove waste from your blood in your kidneys. This condition damages them, and your kidneys can't function as well. Inflammation in the glomeruli can happen after a strep infection, as well.
- APOL1-mediated kidney disease. Normally, the APOL1 gene helps make an immune system protein, but if you inherit a mutated version of the gene from both parents, you may be more at risk for kidney disease. You may be more likely to have this gene mutation if you identify as Black, African American, Afro-Caribbean, or Latina/Latino.
- Long-lasting viral illnesses. HIV and AIDS, hepatitis B, and hepatitis C may cause kidney disease.
- Pyelonephritis . This is a urinary tract infection within the kidneys, which can result in scarring as the infection heals. It can lead to kidney damage if it happens several times.
Kidney Disease Causes
Acute kidney disease causes: If your kidneys suddenly stop working, doctors call it acute kidney injury or acute renal failure. The main causes are:
- Not enough blood flow to the kidneys
- Direct damage to the kidneys
- Urine backed up in the kidneys
Those things can happen when you:
- Have a traumatic injury with blood loss, such as being in a car wreck
- Are dehydrated or your muscle tissue breaks down, sending too much kidney-toxic protein into your bloodstream
- Go into shock because you have a severe infection called sepsis
- Have an enlarged prostate or kidney stones that block your urine flow
- Take certain drugs or are around certain toxins that directly damage the kidney
- Have complications during a pregnancy, such as eclampsia and preeclampsia
People with severe heart or liver failure commonly go into acute kidney injury as well.
Chronic kidney disease causes: When your kidneys don't work well for longer than 3 months, doctors call it chronic kidney disease. You may not have any symptoms in the early stages, but that's when it’s simpler to treat.
Diabetes (types 1 and 2) and high blood pressure are the most common culprits. High blood sugar levels over time can harm your kidneys. And high blood pressure creates wear and tear on your blood vessels, including those that go to your kidneys.
Defects present at birth can block the urinary tract or affect the kidneys. One of the most common ones involves a kind of valve between the bladder and urethra. A urologist can often do surgery to repair these problems, which may be found while the baby is still in the womb.
Drugs and toxins -- such as lead poisoning, long-term use of some medications including NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen, and IV street drugs -- can permanently damage your kidneys. So can being around some types of chemicals over time.
Alcohol and Kidney Disease
Your kidneys are responsible for filtering harmful substances from your blood, including alcohol. When you drink, your kidneys have to work harder to perform their function.
Binge drinking -- which for women is defined as having about four drinks in 2 hours, and for men five drinks in 2 hours -- can cause serious harm your kidneys. One risk of binge drinking is acute kidney failure, which is a sudden drop in kidney function that can damage the organs.
Regular heavy drinking can increase your chances of developing chronic kidney disease. Even drinking two alcoholic drinks a day can increase your risk of high blood pressure, a common cause of kidney disease. Drinking alcohol can also disrupt hormones that help your kidneys function.
Kidney Disease Symptoms
Your kidneys are very adaptable. They can compensate for some of the problems that can happen when you have kidney disease. So if your kidney damage gets worse slowly, your symptoms will reveal themselves slowly over time. In fact, you may not feel symptoms until your disease is advanced.
You might have:
- High blood pressure
- Nausea and vomiting
- Loss of appetite
- A metallic taste in your mouth
- Trouble thinking
- Sleep issues
- Muscle twitches and cramps
- Swelling in your feet and ankles
- Itching that won't go away
- Chest pain if fluid builds up around the lining of the heart
- Shortness of breath if fluid builds up in the lungs
How to Diagnose Kidney Disease
Your doctor will start by asking questions about your family medical history, which medications you're taking, and if you notice that you're peeing more or less than normal. After that, they'll do a physical exam.
You also may have:
Kidney Disease Treatment
Some forms of kidney disease are treatable. The goals of these treatments are to ease symptoms, help keep the disease from getting worse, and lessen complications. In some cases, your treatment may help restore some of your kidney function. But there is no cure for chronic kidney disease.
If a condition is “chronic,” that means it’s a long-term condition. If you have chronic kidney disease, you and your doctor will manage it together. The goal is to slow it down so that your kidneys can still do their job.
First, your doctor will work to find out what caused the kidney disease. For instance, kidney disease can happen if you have diabetes or high blood pressure. You may work with a nephrologist, a doctor who specializes in kidney disease.
You’ll take medicines and may need to change your diet. If you have diabetes, it needs to be managed. If your kidneys don’t work anymore, you might need dialysis (in which a machine filters your blood) and you could talk with your doctor about whether a kidney transplant would help.
Medications for kidney disease
High blood pressure makes chronic kidney disease more likely -- and kidney disease can affect your blood pressure. So your doctor may prescribe one of these types of blood-pressure medicines:
ACE inhibitors, such as:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Ramipril (Altace)
ARBs, such as:
- Azilsartan (Edarbi)
- Eprosartan (Teveten)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Olmesartan (Benicar)
- Valsartan (Diovan)
Along with controlling blood pressure, these medicines may lower the amount of protein in your urine. That could help your kidneys over time.
The diabetes medicines dapagliflozin (Farxiga) and empagliflozin (Jardiance) have been shown to slow kidney disease even in people without diabetes.
You might also need to take a medicine to help your body make erythropoietin, a chemical that tells your body to make red blood cells. So you might get a prescription for daprodustat (Jesduvroq), darbepoetin alfa (Aranesp), or epoetin alfa (Procrit, Epogen) to curb anemia.
Medicines to avoid
If your kidneys don’t work well, check with your doctor before you take any medications, including over-the-counter drugs (medicines you can get without a prescription).
Your doctor may tell you to avoid certain pain relievers such as aspirin, ibuprofen, naproxen (Aleve), and celecoxib (Celebrex). These drugs, which doctors call “NSAIDs” (nonsteroidal anti-inflammatory drugs), could play a role in kidney disease. If you take a type of heartburn drug called a “proton pump inhibitor (PPI),” you may also want to know that some studies show a link between those medicines and chronic kidney disease. Your doctor may want to check on whether you need these medicines, or if a different dosage or something else might work better for you.
Tell your doctor if you take any herbal products or other supplements. It’s best to have that talk before you start to take them.
Diet for kidney disease
Your doctor may put you on a special diet that’s lower in sodium, protein, potassium, and phosphate.
This diet helps because if your kidneys are damaged, it’s harder for them to get those nutrients out of your blood. The special diet means that your kidneys don’t have to work as hard.
You may also have limits on how much water can be in the foods you eat and how much you drink. A kidney diet specialist, called a renal dietitian, can help. Your doctor can refer you to one. They may also advise you to take specific amounts of vitamins and minerals, such as calcium and vitamin D.
If you have diabetes or high blood pressure, you’ll need to follow your doctor’s diet advice if you have either or both of these conditions in addition to kidney disease. With diabetes, it’s important to make the right food choices so that your blood sugar levels stay under control throughout the day. And if you have high blood pressure, you may need a low-salt diet to help manage it.
If your kidneys don’t work well anymore, you’ll need dialysis to do their job.
Hemodialysis uses a machine with a mechanical filter to cleanse your blood. You can get this done at a dialysis center or at home (after you or a caregiver learn how).
With the at-home version, you may have to do it up to 6 days a week, about 2 1/2 hours per day, instead of three times a week at a clinic. There is also the option of hemodialysis treatment at night.
Before you start hemodialysis, you’ll need surgery to make a place of access for the machine. Your surgeon may connect an artery and vein in your arm through a “fistula.” This is the most common type of access. It needs at least 6 weeks to heal before you can start hemodialysis.
If you need to start dialysis sooner than that, the surgeon might be able to make a synthetic graft instead of a fistula.
If neither of those options will work -- for instance, if you need to start dialysis right away -- you may get a dialysis catheter that goes into the jugular vein in your neck.
When you get hemodialysis, another tube connects the machine to your access point so that your blood goes through the dialysis machine to be cleaned and pumped back into your body. This will take several hours.
Peritoneal dialysis is a different form of dialysis. It uses the lining of the abdomen, or peritoneal membrane, to help clean the blood.
First, a surgeon implants a tube into your abdominal cavity. Then, during each treatment, a dialysis fluid called dialysate goes through the tube and into your abdomen. The dialysis fluid picks up waste products and drains out after several hours.
You’ll need several cycles of treatment -- sending in the fluid (or “instilling” it), time for the fluid to work in your abdomen, and drainage -- every day. Automated devices can now do this overnight, which may give you more independence and time during the day for usual activities. If you do it during the day, you may need to do the whole cycle several times.
Both types of dialysis have possible problems and risks, including infection. You’ll want to talk with your doctor about the pros and cons of each option.
If your kidney disease is advanced, a kidney transplant could be a treatment option.
A "matching" kidney may come from a living family member, from someone who’s alive and isn’t a relative, or from an organ donor who has recently died. It’s a major surgery, and you may go on a waitlist until a donated kidney becomes available.
A successful transplant would mean that you don’t have to get dialysis. After your transplant, you will need to take medicines so that your body accepts the donated kidney.
A kidney transplant might not be right for you if you have other medical conditions. Your age might also be an issue. And you may need to go on a waitlist until a kidney is available. You’d get dialysis until your transplant can happen.
A kidney from a living donor will generally last 12 to 20 years. One that’s donated from someone who recently died may last 8 to 12 years. If you have “end stage” renal (kidney) disease, doctors consider a transplant to be the best option if you’re a good candidate.
The plan you and your doctor will decide on will depend on what’s causing your kidney disease. In some cases, even when the cause of your condition is controlled, your kidney disease will worsen.
Kidney disease is often caused by high blood pressure and diabetes. There are no early warning signs for chronic kidney disease, so if you're at risk for CKD, do your best to regularly see your doctor, who can give you the blood and urine tests that screen for it. If kidney disease advances, you may require dialysis or a kidney transplant.
Kidney Disease FAQs
What are the three early warning signs of kidney disease?
There are no early warning signs of CKD. Your doctor will check for the condition with regular blood and urine tests.
Can kidney disease be cured?
While you can take steps to slow the progression of chronic kidney disease, there's no cure for it. Advanced kidney disease must be treated with dialysis or a kidney transplant.
Is kidney disease hereditary?
Yes, kidney disease can caused by gene mutations passed from parent to child. If parents have a gene mutation -- or they're carriers of one -- there's a chance they could pass on the genes that could cause kidney disease in their child.