The kidneys are vital organs that cleanse the blood and influence many bodily functions. Various diseases can cause the kidneys to work worse for a short period of time – for example, in the case of circulatory failure or when urine accumulates in the kidneys due to an enlarged prostate or kidney stones.
If, however, the kidneys only work to a limited extent for more than three months or are permanently damaged, this is referred to as chronic kidney disease. The most common causes in adults are diabetes mellitus and high blood pressure.
Elderly people, in particular, develop chronic kidney disease. Since the loss of kidney function does not initially cause any symptoms, it often goes unnoticed for a long time.
The main aim of the treatment is to stop or delay any further weakening of the kidneys. However, it is also important to treat consequences such as anemia, hyperacidity or changes in bone metabolism. In the event of complete kidney failure, dialysis or transplantation of a donor kidney will allow the patient to live on.
A chronic kidney disease is often only noticed when secondary diseases cause discomfort or when the kidneys fail. The body then excretes too little water and waste products from the metabolism slowly accumulate. Symptoms can affect almost the entire body, for example:
-swelling (edema), for example on the legs or face
-nausea, vomiting, diarrhea
-loss of appetite, weight loss
-Paleness and itching
-tiredness, listlessness, weakness
-shortness of breath
-concentration disturbances, confusion, disturbances of consciousness up to unconsciousness
-signs of paralysis, muscle cramps
The most common causes of chronic kidney disease in adults are diabetes mellitus and high blood pressure.
However, permanent kidney damage can also occur:
Inflammation of kidney tissue
medication taken permanently, especially painkillers
kidney stones, tumors, or scarring that interfere with urinary flow
congenital kidney diseases (e.g. cystic kidneys)
In Germany for example, the function of the kidneys is permanently restricted in an estimated two million people. Most of those affected are older than 60 years.
Every year, around 90,000 people have to undergo dialysis because their kidneys no longer function properly. In addition, more than 2000 donor kidneys are transplanted every year. Kidney transplants account for more than half of all organ transplants in Germany.
Every year, about 10,000 people die in Germany as a result of chronic kidney disease.
On the other hand, it is important to note that more than 37 million Americans have chronic kidney disease and approximately 5,000 die each year while on the kidney waiting list from chronic disease. That’s about 12 people each day, making kidney disease the ninth leading cause of death in the United States.
So we can see that in several important countries of the world, this is one of the main causes of death, which is why there are articles dedicated to this.
At the beginning of the disease, the kidneys can still sufficiently clean the blood despite limited function. This condition can last for years, and sometimes the kidneys even recover.
However, kidney function can also continue to deteriorate, leading to kidney weakness (renal insufficiency). Some people experience complete renal failure over time. This so-called “terminal kidney failure” is life-threatening.
People with chronic kidney weakness have an increased risk of cardiovascular diseases such as stroke or heart attack.
The kidneys play an important role in blood formation and bone metabolism. Damaged kidneys can therefore also lead to anemia, blood coagulation disorders and bone damage (renal osteopathy).
If the kidneys fail completely, waste products accumulate to such an extent that “poisoning from the inside” occurs. Experts call this uremia. Among other things, it causes skin changes, gastrointestinal problems as well as brain and nerve damage. In addition, the water and electrolyte balance gets out of balance and the body can overacidify. Unconsciousness, pulmonary edema, and cardiac arrhythmia can be life-threatening consequences of uremia.
To determine the causes and severity of chronic kidney disease are necessary:
-a detailed examination (anamnesis)
-a physical examination including blood pressure measurement
an ultrasound examination of the abdomen and kidneys
-Blood tests; important clues are, for example, the creatinine, blood sugar and hemoglobin values as well as a blood gas analysis to determine the acid content in the blood.
-Urine tests, including the determination of protein content
The kidney function can be assessed with the help of the above and other laboratory values from the blood. Other values indicate, for example, whether diabetes mellitus is the cause or whether the kidney disease has already led to secondary diseases.
If questions remain unanswered, further imaging methods such as computer tomography (CT) or, for example, a tissue sample of the kidneys (biopsy) can be helpful.
Diseases such as diabetes mellitus or high blood pressure increase the risk of chronic kidney disease. Then it makes sense to have your kidneys regularly checked by your family doctor. In this way, kidney weakness can be detected at an early stage.
From the age of 35, people with statutory health insurance can take advantage of a free early diagnosis examination every two years (so-called Check-up 35). This examination is intended to detect signs of cardiovascular diseases, diabetes and kidney diseases.
If you reduce your risk of diabetes mellitus and high blood pressure, you can also prevent chronic kidney disease. To this end, it is particularly important to avoid being overweight and to exercise sufficiently.
If diabetes or high blood pressure is already present, additional medication is often required to adjust blood sugar and blood pressure well in order to prevent late effects such as chronic kidney disease.
Which therapy is appropriate for a chronic kidney disease depends on its cause, its stage and personal circumstances and wishes.
If the kidneys are still largely normal, the treatment should stop or slow down the progression of the disease. In this case, drugs are mainly used to lower blood pressure and prevent cardiovascular diseases. If diabetes mellitus is present, it is important to control blood sugar.
If consequences such as anemia or disorders of the bone metabolism have already occurred, other drugs are added – such as iron-containing drugs, drugs that stimulate blood formation or so-called phosphate binders. If acidosis occurs, bicarbonate is used. In addition, however, a diet adapted to the stage of kidney disease, the right amount to drink and physical activity also play a role.
If the kidneys fail completely, dialysis or kidney transplantation is possible.
Dialysis or kidney transplantation is rarely possible in cases of complete kidney failure. Some people also consciously decide against it and accept that they will soon die. For them, palliative treatment makes sense in order to ensure that the last phase of their lives is as pain-free as possible.
Life and everyday life
Chronic kidney disease changes everyday life. For example, those affected should follow certain advice when eating and drinking. For this reason, kidney specialists usually offer nutritional advice especially for kidney patients and their relatives.
Especially during dialysis treatment, it is usually important not to drink too much. Because the non-functioning kidneys often hardly excrete any water, water retention occurs. A sour candy, a piece of lemon or sugar-free chewing gum can help against thirst. It is also helpful,
to use small glasses and cups,
to drink slowly,
to avoid dry room air and
If possible, take the medication with a meal instead of an extra glass of water.
People with chronic kidney disease often have to cope with taking several medications permanently. A medication plan that clearly lists what needs to be taken and when can help. The weakened kidneys also make it necessary to do without some drugs: Instead of resorting to NSAIDs such as ibuprofen or tablets to treat diabetes mellitus as usual in the case of pain, you have to talk to your doctor about alternatives and possibly get used to completely new treatments such as insulin injections.
Not only diet, restricted drinking and medication can be stressful. Dialysis requires a lot of time and changes in everyday life, which has an impact on professional and private life.
A toll-free telephone hotline of the Association of German Kidney Centres e.V. and the Federal Association of Kidneys e.V. is available to answer these and other questions.
The feeling of lifelong dependence on therapy or of restricting one’s family can become a burden and can also make one depressed. Many then benefit from exchanges with other sick people – for example in a self-help group or during dialysis. In the case of stronger or longer-lasting psychological stress, one can also turn to a psychotherapeutic practice.
Further information on the
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