Chronic Kidney Disease Symptoms
The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidneys disease may progress without symptoms for a long time until only very minimal kidneys function is left.
Because the kidneys perform so many functions for the body, kidneys disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.
Fatigue and weakness (from
anemia or accumulation of waste products in the body)
Loss of appetite, nausea and vomiting
Need to urinate frequently, especially at night
Swelling of the legs and puffiness around the eyes (fluid retention)
Itching, easy bruising, and pale skin (from
headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome
High blood pressure
chest pain due to pericarditis (inflammation around the heart)
Shortness of breath from fluid in lungs
Bleeding (poor blood clotting)
Bone pain and fractures
Decreased sexual interest and erectile dysfunction
Self-Care at Home
Chronic kidney disease is a
disease that must be managed in close consultation with your healthcare provider. Self-treatment is not appropriate.
There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications.
This is a complex process and must be individualized, generally with the help of your healthcare provider and a registered dietitian.
The following are general dietary guidelines:
Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high
Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake.
Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.
Other important measures that you can take include:
Carefully follow prescribed regimens to control your blood pressure and/or
Lose excess weight
In chronic kidney disease, several
medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:
Certain analgesics -
Aspirin nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
Fleets or phosphosoda enemas because of their high content of phosphorus
Laxatives and antacids containing magnesium and aluminum such as Milk of Magnesia and Mylanta
medications H2-receptor antagonists - cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease)
Decongestants like pseudoephedrine (Sudafed) especially if you have high
Alka Seltzer, since this contains a lot of salt
If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your healthcare provider as recommended for follow-up and monitoring.
In end-stage renal disease, kidney functions can be replaced only by
dialysis or by kidney transplantation. See the Transplant section for more information about transplants. There are two types of
dialysis 1) hemodialysis and 2) peritoneal dialysis.
Hemodialysis involves circulation of blood through a filter on a dialysis machine. Blood is cleansed of waste products and excess water. The acid levels and the concentration of various minerals such as sodium and potassium in the blood are normalized. The blood is then returned to the body.
dialysis requires access to a blood vessel so that the machine has a way to remove and return blood to the body. This may be in the form of a
dialysis catheter or an arteriovenous fistula or graft.
A catheter may be either temporary or permanent. These catheters are either placed in the neck or the groin into a large blood vessel. These catheters are prone to infection and may also cause blood vessels to clot or narrow.
The preferred access for hemodialysis is an arteriovenous fistula wherein an artery is directly joined to a vein. The vein takes two to four months to enlarge and mature before it can be used for
dialysis. Once matured, two needles are placed into the vein for
dialysis. One needle is used to draw blood and run through the dialysis machine. The second needle is to return the cleansed blood.
An arteriovenous graft is placed in patients who have small veins or in whom a fistula has failed to develop. The graft is made of artificial material and the dialysis needles are inserted into the graft directly.
These venous access devices usually can be placed with local anesthesia on an outpatient basis.
Hemodialysis typically takes three to five hours and is needed three times a week.
You will need to travel to a
dialysis center for hemodialysis.
Home hemodialysis is possible in some situations. A care partner is needed to assist you with the dialysis treatments. A family member or close friend are the usual options, though occasionally patients may hire a professional to assist with dialysis. Home hemodialysis may be performed as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer advantages in quality of life and better control of high
anemia, and bone disease.
dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid. A catheter is implanted into the abdomen by a minor surgical procedure. Peritoneal dialysis may be performed manually or by using a machine to perform the dialysis at night.
About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through this catheter. This fluid contains substances that pull wastes and excess water out of neighboring tissues.
The fluid is allowed to dwell for two to several hours before being drained, taking the unwanted wastes and water with it.
The fluid typically needs to be exchanged four to five times a day.
Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to a dialysis center for their treatment. You can carry out many of your usual activities while undergoing this treatment. This may be the preferable therapy for children.
Most patients are candidates for both hemodialysis and peritoneal dialysis. There are little differences in outcomes between the two procedures. Your physician may recommend one kind of dialysis over the other based on your medical and surgical history. It is best to choose your modality of dialysis after understanding both procedures and matching them to your life style, daily activities, schedule, distance from the
dialysis unit, support system, and personal preference.
If you have chronic kidney disease, your health care provider will recommend a schedule of regular follow-up visits.
At these visits, your underlying condition and your kidney status will be evaluated.
You will have regular blood and urine tests and possibly imaging studies as part of this ongoing evaluation.
Chronic kidney disease cannot be prevented in most situations. You may be able to protect your kidneys from damage, or slow the progression of the disease by controlling your underlying conditions.
Kidney disease is usually advanced by the time symptoms appear. If you are at high risk of developing chronic kidney disease, see your healthcare provider as recommended for screening tests.
If you have a chronic condition such as
blood pressure, or high cholesterol, follow the treatment recommendations of your healthcare provider. See your healthcare provider regularly for monitoring. Aggressive treatment of these diseases is essential.
Avoid exposure to drugs especially NSAIDs (nonsteroidal anti-inflammatory drugs), chemicals, and other toxic substances as much as possible.