What are the signs and symptoms of CKD?

I see a lot of patients in consultation in my clinic who are, well, not quite sure why they are in my clinic! Usually, they would have been referred from their primary physician because they were deemed to have "chronic kidney disease, or CKD". A frequent refrain is, "Doc, I feel fine. I don't know why they asked me to see you?!" 

The reality is that CKD belongs to that dreaded class of diseases called, "the silent killers". In other words, you may or may not have any symptoms! In the early stages especially, the only abnormality might be elevated creatinine or reduced GFR when your physician checks your kidney function. Some common misconceptions regarding kidney disease are that the kidneys "should hurt", or you "stop making urine". These are nothing more than medical myths.
There certainly are kidney disease conditions that can cause pain, like kidney infections (pyelonephritis), or kidney stones. However, medical kidney disease due to something like hypertension or diabetes may not cause you to feel any pain. Similarly, you could continue to produce urine even in advanced stage 5 CKD. I see dialysis patients who make a liter of urine daily. This is not surprising if you realize that the kidneys filter almost 1440 liters, or 380 gallons, of blood everyday. Even if your GFR is 1, it could mean that your kidneys are still filtering about 10-14 liters of blood daily. It is not hard to imagine that the kidneys can still produce a liter of urine from this 10 liter of daily blood flow. 

As kidney disease worsens from stage 1 thru 5, other not-so-subtle abnormalities can begin to develop. These include:


  • Your blood pressure may begin to increase. This is because you tend to build up fluid and salt in your body (which normal kidneys do a better job of getting rid of). The kidneys could also produce excess amount of certain hormones called renin and angiotensin that increase blood pressure. The built up fluid/salt may manifest as swelling, or edema; or fluid accumulation in the belly (ascites) or around the lungs (effusion). 
  • Acid level in the blood can increase. This is because it is the kidneys that get rid of excess acid that you eat, or the acid that the body creates from breakdown of other metabolites. This excess acid can then have deleterious consequences for your heart muscle or nerve function, and cause calcium to leach out of the bones (thus increasing your risk for fractures).
  • Potassium level in the blood can build up as well. High potassium can in turn cause symptoms ranging from muscle weakness to abnormal heart rhythm. 
  • Normally, the kidneys also produce a hormone called erythropoietin (yes, the same hormone that a certain professional cyclist was accused of doping with!). This hormone is crucial in the production of red blood cells. Patients with CKD could hence have anemia, or low red blood cell counts, leading to fatigue, failure to thrive, and in severe cases, heart failure. 
  • Elevated phosphorus levels in the blood can be seen. This could then lead to elevated production of another hormone called PTH (parathyroid hormone) by the parathyroid glands. High PTH levels, along with low vitamin D levels that can also be seen in CKD, can increase the risk of bone disease and fractures. This is referred to in medical terms as "CKD related mineral and bone disorder (CKD-MBD)". 
  • Urea level in the blood can be extremely high in advanced CKD. Patients at this stage can have a constellation of symptoms that include fatigue, lethargy, nausea, chest pain, shortness of breath, difficulty falling asleep, decreased appetite or a metallic taste in the mouth, etc. This is referred to as "uremia". 

Needless to say, patients may have some, or none of the above signs and symptoms. Which is why you need to consult with your nephrologist to determine an appropriate treatment plan regardless of how you feel!

Comments

Post a Comment

Popular posts from this blog

I do not want dialysis: how long can I expect to live, and how would I feel?

Image
I often see patients in my office who refuse dialysis (should it become necessary) for their advancing kidney disease. I divide these patients in to two categories. The more common category is patients who refuse it because of the "fear of dialysis". They could have trouble understanding dialysis and what potential benefits they could derive from it. They would often make good dialysis candidates who have more to lose than gain by refusing dialysis therapies. The other category is the patient who rightfully refuses dialysis because she or he would not make a good candidate for such treatment. There could be multiple reasons for that. It could be advanced age and frailty, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the "big picture". So the questions that come up in
Read more

Is a vegan or vegetarian diet better for patients with kidney disease?

Image
Over the last few decades, we have seen the accumulation of evidence that supports the health benefits of plant-based diets. Vegetarian diets have been shown to be associated with a lower incidence of obesity, hypertension ,  diabetes , and coronary artery disease . Since all these entities are risk factors for chronic kidney disease (CKD), it might be reasonable to assume that these diets might actively reduce the risk of CKD development and progression. However, at the very outset, let me emphasize that any diet, vegetarian or not, comes with the same restrictions that are advised for patients with CKD . For instance, potassium intake might need to be restricted in advanced CKD. Fruits, a significant portion of the vegetarian diet, are an important source of potassium, and will need to be appropriately restricted. So you have to watch what you eat regardless. More importantly, you owe it to yourself to know what exactly is there in the food that you eat.
Read more