Kidney Disease Overview

Introduction

The kidneys are located just under the rib cage, on either side of the human spine. Their main role is to filter out water and dissolved substances or toxins from the blood to produce urine. Any damage to the kidney which interferes with its filtering system is considered kidney disease, and such problems could include injuries, cysts, stones, or infections.

What is kidney disease?

Types: Chronic kidney disease, glomerulonephritis, lupus nephritis

Kidney disease can be acute or chronic depending on the underlying cause and duration. For acute kidney injuries, the main causes are related to an injury, drug, or other illness showing sudden extreme symptoms during a period of seven days, which can be reversible when treating the root cause. The main evidence of acute kidney injury includes the increase of creatinine within the bloodstream. In chronic kidney disease, the dysfunction is progressive over a long period slowly deteriorating the kidney function. They are generally associated with other chronic diseases and the symptoms do not appear clearly until significant damage has been done. 

The location of a dysfunction in the kidney filtration process characterizes what type of acute kidney injury has manifested. If the amount of blood flow to the kidneys is compromised, then the disease is considered a pre-renal obstruction, with the main causes usually being: renal artery thrombosis, liver failure, cardiac failure, or local infection. If the actual kidney structure is damaged then the injury is intrinsic, which is mediated by pressure force injuries, toxic substances, and extreme kidney infection. Finally, any obstruction faced downstream is characterized as a post-renal injury which includes kidney stones, bladder or prostate cancer, and blocked catheter.² 

On the other hand, chronic kidney disease is much more widespread as it affects up to 15% of adults in western countries. The diagnosis is characterized by having kidney damage for longer than 3 months, with the display of structural dysfunctions which may lead to a decreased glomerular filtration rate of under 60mL/min/1.73m.^1,2 Often, the main causes of the disease involve damage to the internal structure of the kidney, mainly due to high blood pressure, diabetes, glomerulonephritis, or chronic inflammation.

Other types of kidney disease that are also common worldwide are:

• Polycystic kidney disease – an autosomal genetic disorder that forms abnormal fluid cysts in the kidneys.
• Nephrotic syndrome – the leakage of plasma protein from blood into the urine, causing water to build up.
• Fabry disease – a genetic disorder in which the chemical GL-3 is not broken down and induces damage to the kidney, heart, and brain.
• Systemic lupus erythematosus – is a progressive autoimmune disease that damages the kidney mostly common in young women of Asian, Hispanic, or African backgrounds.

Symptoms

Signs of kidney disease are very broad and can develop over a short or long period of time. Therefore, any symptoms depend on the severity and type of the disease, but they generally are linked to the build-up of fluid or body waste, or electrolyte problems.

Main symptoms of kidney disease:

• Change in urination habits
• Protein/Blood in urine
• Nausea & Vomiting
• Fatigue
• Decreased cognitive focus
• Muscle cramps
• Swelling of feet and ankles
• Dry, itchy skin
• Hypertension
• Shortness of breath
• Fluid build-up around heart/lungs
• Seizures
• Insomnia

Causes

Blood flow in the kidneys is much greater than in other areas of the body, therefore it is very likely for them to experience damage associated with high pressure or have high exposure to any harmful agents within the blood. Furthermore, the filtration process in the glomerulus relies on further pressure into the capillaries which makes them more susceptible to hemodynamic injury. In addition to that, the filtration membrane has negatively charged molecules attached which function in the process, and any disruption to those barriers will allow unwanted plasma proteins to enter the nephrons, causing injury. Any nephrotic damage triggers inflammatory mediators which can contribute to a long-term interstitial inflammatory reaction. Also, damage in one part of the kidney will affect other functioning parts as they all collectively work together to filter out blood.¹

Risk factors

• Genetics & Family History – depending on your genes, some individuals are more susceptible to developing certain kidney diseases like Autosomal dominant polycystic kidney disease, Alport syndrome, Cystinosis, and Fabry disease.³
• Ethnicity – many studies show a higher risk of kidney disease in specific ethnicities such as end-stage renal failure in African Americans, diabetes in Hispanic populations, and lupus in the majority of all ethnicities except Caucasians.
• Age – renal function declines with age so people are more prone to advance to various kidney diseases as they grow older.
• Obesity – one of the strongest risk factors for end-stage renal failure, as it advances kidney injuries through inflammation, oxidative stress, and endothelial dysfunction.³
• Smoking – has proinflammatory implications that increase the risk of developing chronic kidney disease.
• Diabetes mellitus – a leading cause of kidney disease globally as it interferes with hyperfiltration and the glycosylation of end products.
• Hypertension – systemic hypertension can be spread to intraglomerular capillaries which can destroy the vessel walls causing loss of kidney function.

You can reduce your risk of kidney disease by making a few changes to your lifestyle

The following lifestyle factors have the greatest impact on your risk of kidney disease. We will also look at what you can do to reduce your risk from today.

Nutrition

Maintaining a healthy diet can vastly reduce the risks of developing kidney and other dietary problems. Lowering the amount of sugar and salt consumed can reduce the chances of developing diabetes and hypertension respectively, which are major pathways that lead to damage to the kidney filtration process. So, an equal balance of healthy nutrients should be included in the diet, ranging from vitamins to proteins and fibres.

Physical activity

Frequent exercise supports improving the general health of an individual. Patients with kidney disease should be able to exercise safely. In fact, aerobic training can enhance the control of abnormal blood pressure, lipid metabolism, and mental health in adults, all of which contribute to a healthy lifestyle that makes a person less at risk for chronic diseases.

Obesity

Considering that obesity is one of the largest contributing risk factors for kidney disease, preventing or treating obesity may help to avoid developing dysfunction in kidney filtration. Daily methods to target weight loss include changing your lifestyle by having a healthy eating plan as well as exercising regularly. However, if the condition of one’s weight is very severe, then bariatric surgery or gastric bypass may be considered. 

Alcohol

Excessive alcohol abuse is a global problem, and it has been correlated with the development of chronic kidney disease. Many patients with kidney disease often hold other diseases, such as diabetes or cardiac diseases. Therefore, especially for these vulnerable patients, drinking alcohol may further increase their risk of death. A Taiwanese retrospective cohort study concluded that patients who heavily abuse alcohol in their daily lives have a higher risk of developing chronic kidney disease.⁴

Hydration

Water assists the kidneys to filter out toxins from the blood in the form of urine. Dehydration leads to the production of highly concentrated urine, which may form crystals that affect kidney function and contribute to certain kidney diseases, such as kidney stones.

Sleep

Abnormal sleeping habits have a deep impact on general health and quality of life, and patients living with chronic illnesses are more likely to have sleep disorders. Considering kidney function is moderated by the sleep-wake cycle, ensuring getting enough rest and sleep is crucial to allow your kidneys to function at their optimum state.

Mental health

Neuropsychiatric disorders such as anxiety disorders, cognitive impairment, and depression are all very common in patients with chronic kidney disease. These circumstances usually worsen their quality of life and may directly cause them to have higher hospitalisation rates and higher mortality. Also, extra stress, anxiety, or depression could change a person's sleeping and eating habits, and with a rise in blood glucose and blood pressure levels, the state of kidney function may become compromised easily.

Wellness

Keeping your emotional health balanced is necessary for your physical health. Self-care is important for overall good health.

All of the modifiable lifestyle changes collectively contribute to the goal of improving a person's general wellness, both psychological and physiological. This way, not only can kidney disease be avoided, but also other associated chronic conditions that may lessen the quality of life across the populations.

Summary

Chronic kidney disease impacts many different populations worldwide and it is a leading cause of death in this modern age. The best method to manage the disease includes reducing the main lifestyle risk factors associated with kidney dysfunction such as avoiding smoking, drinking, and unhealthy diets to prevent obesity and diabetes. Patients should monitor related complications of the disease as some symptoms are very extreme. Ensuring an early diagnosis and staging are done as fast as possible is crucial for physicians to help administer the required treatments before the condition worsens.

Diagnostic testing

At Klarity we use the latest technology when it comes to diagnostic testing. Our home blood tests give you health insights and personalised recommendations. Find out which test you should take.