An untreated chronic kidney weakness often leads to complete failure of the kidneys (terminal renal failure) after years, especially in the case of hereditary diseases of the kidneys or if there is a lot of protein in the urine. The more a treatment can reduce the protein levels in the blood, the more likely it is to prevent complete kidney failure.
The aim of any treatment is to prevent or at least delay the progression of the disease. Although a complete cure is not possible in most cases, the earlier a kidney weakness is treated, the greater the chances of success. However, for some hereditary diseases, such as the familial cystic kidney, there is still no therapy available.
A distinction is made between the treatment of the disease underlying the kidney weakness, e.g. diabetes, high blood pressure or glomerulonephritis, and symptomatic treatment to alleviate the effects of the kidney weakness, e.g. anemia, edema, potassium increase. Early treatment of the underlying disease is a prerequisite for the successful treatment of kidney weakness.
If a kidney weakness is not yet too far advanced, it can be treated with medication. Later, an artificial blood purification (dialysis) or a kidney transplant is usually necessary.
In the case of diabetes mellitus, antihypertensive drugs are used to lower blood sugar levels, and anti-inflammatory drugs are used to reduce high blood pressure and inflammation of the kidney cells. Good control of blood sugar and blood pressure and permanent monitoring of these two values can prevent the occurrence of kidney disease from the outset or slow down the progression of existing kidney weakness.
Blood pressure medication
In patients with high blood pressure, antihypertensive drugs can slow the progression of the declining renal function. In this context, so-called ACE inhibitors and angiotensin II receptor antagonists are preferred, which, in addition to their antihypertensive effect, hardly burden the kidneys. It is important to note that the kidney-protective effect of ACE inhibitors is independent of blood pressure. Thus, ACE inhibitors are also prescribed when blood pressure values are normal. The target value is a blood pressure of 130/80. To achieve this, in many cases several drugs with different mechanisms of action have to be used. Patients can support the drug therapy through physical activity, no nicotine and a low-salt diet.
Inflammation of the renal corpuscles (glomerulonephritis) can be treated with drugs that reduce the activity of the immune system. These so-called immunosuppressants include drugs such as cortisone, cyclosporine or cyclophosphamide.
Since the formation of new red blood cells also decreases in the case of kidney weakness, the kidney hormone erythropoietin (Epo) is administered in the case of anemia (renal anemia), which promotes the formation of new blood cells and thus increases the number of red blood cells. Before Epo is used, the doctor will measure the amount of iron in the body, as iron is often also missing in chronic kidney weakness and anemia.
Blood lipid-lowering drugs such as statins are used to treat elevated cholesterol levels and to treat cardiovascular diseases such as arteriosclerosis.
Diuretics and phosphate binders
Diuretic drugs, so-called diuretics, increase the excretion of salt and water. Although these drugs can increase the amount of urine, they do not improve the detoxification function of the kidneys. If a low phosphate diet cannot keep phosphate levels stable as kidney function decreases, so-called phosphate binders are used, e.g. calcium carbonate, potassium acetate, calcium citrate. These bind a part of the phosphate in food already in the gastrointestinal tract. They should be taken in the correct dosage immediately before or at the beginning of the meal.
Treatment with vitamin D and/or vitamin D analogs also serves to normalize calcium and phosphate metabolism.
According to current guidelines, the initiation of renal replacement therapy (dialysis) is recommended at the latest when the creatinine clearance is less than 5-10 milliliters/minute, and earlier for diabetes patients. If a patient already suffers from damage to many organs (uremic syndrome) or if edema or high blood pressure cannot be controlled in any other way, renal replacement therapy should be started earlier.
It is important that the preparation and initiation of renal replacement therapy is carried out in good time. An adequate nutritional status, a well-adjusted blood pressure and a balanced blood count are important prerequisites.
If terminal renal failure occurs despite all therapeutic measures, only dialysis or a kidney transplant can help. This is the case when the consequences of the impaired kidney function can no longer be controlled by an appropriate diet and medication. Since an early start improves the prospects for treatment, preparations should be made in good time. Today, there are two different blood purification methods: hemodialysis as the most commonly used procedure on the one hand, and peritoneal dialysis on the other.
In a kidney transplant, a kidney patient receives a healthy kidney from a living or deceased donor. The surgeon transplants a kidney from either a deceased or a living relative or close relative. This is possible without any health restrictions for the donor, since of the two kidneys that each person usually possesses, a single one is sufficient for blood purification and urine production.