Written by Mr. Mousiadis Dimitrios, Nephrologist, Scientific Head of Nephrology Department and Artificial Kidney Unit of ‘ANASSA General Clinic
The human body has two kidneys of approximately 115 grams each. which are located in the posterior part of the peritoneal cavity and which are its vital organs.
The main function of the kidneys is to regulate the balance of salt, water and other ions and trace elements in the human body, such as calcium, phosphorus, magnesium, potassium , chlorine and various acids.
At the same time, the kidneys secrete hormones such as erythropoietin, vitamin D and renin. More specifically, erythropoietin stimulates the production and maturation of red blood cells in the bone marrow, while vitamin D regulates the body’s calcium and phosphorus, bone structure and a host of other actions. The kidneys are also the site of action of hormones responsible for regulating blood pressure, fluid balance or bone metabolism and vascular calcification.
Finally, the kidneys remove all waste products of metabolism as well as drugs and other toxins that enter the body.
Decreasing kidney function is called achronic kidney disease (CKD). By this definition we mean the reduction of kidney function to varying degrees for a period longer than three months.
Also, there may not be such a reduction in renal function but there may be a functional disorder, such as protein excretion (albuminuria) or microscopic hematuria, or on the other hand there may be a structural disorder such as this detected in an imaging test (kidney ultrasound).
How is the existence of kidney disease documented?
The diagnosis of kidney disease is made, in addition to the measurement of albumin excreted in the urine, the detection of microscopic hematuria or the imaging test mentioned above, with the assessment of kidney function through the calculation of the Glomerular Filtration Rate (GFR). This calculation takes into account the patient’s body mass index, age, sex, race and laboratory values of serum creatinine. Based on the RSD, CKD is classified into five stages.</p >
In some cases a percutaneous kidney biopsy is done to determine the specific type of kidney disease, the extent of kidney involvement and the design of special treatment.
Symptoms of kidney disease
A peculiarity of chronic kidney disease is the fact that it often develops without symptoms, or if there are soe they are subtle.
Symptoms occur when kidney function is reduced to 15-20% of normal values and may manifest as weakness, easy fatigue, sensitivity to cold, edema (swelling) in the lower limbs, itching, foamy urine due to increased albumin excretion, hematuria.
Even patients with CKD may experience life-threatening conditions due to hyperkalemia, metabolic acidosis, or pulmonary edema. Complications of kidney failure include anemia, skin pigmentation, nausea, vomiting, anorexia, bone disease, libido disorders, impotence, asthenia, convulsions, peripheral neuropathy, myopathy, uremic coma, arterial hypertension, pericardial effusion, sleep disturbances, restless limb, muscle cramps and susceptibility to infections.
The sooner kidney disease is diagnosed, the greater the chance of avoiding serious and life-threatening complications.
What are the causes of chronic kidney disease?
The most common causes of CKD, which account for two-thirds of cases, are diabetesand hypertension .
Also, chronic kidney disease itself can cause high blood pressure.
Other conditions that can cause kidney damage are: Glomerinonephritis, Hereditary diseases, Congenital malformations strong> of the fetus, Lupus and other autoimmune diseases, obstructive nephropathy caused by problems such as kidney stones, benign and malignant tumors, or enlarged prostate gland in men, urinary tract infections, drug toxicity. If for some reason the kidneys underperform, many drugs are not eliminated from the body normally, so they accumulate in the blood creating toxic effects. Also, many drugs affect the functioning of the kidneys as such.
The most common nephrotoxic drugs are nonsteroidal anti-inflammatory drugs, which are used for musculoskeletal pain.
Other nephrotoxic drugs are various antibiotics, such asaminoglycosides.
The drugs used in imaging tests(CT scans, pyelograms, coronary angiograms, etc.) are called iodinated contrast agents and it is possible to have a nephrotoxic effect.
Immunosuppressant drugs such as cyclosporine and methotrexate damage the kidneys with chronic use, as well as antineoplastic drugs (such as cis-platinum ).
Finally, various other substances (snake venoms, mushrooms, herbicides, some herbs and heavy metals, such as lead and mercury) show nephrotoxic damage.
How is Chronic Kidney Disease treated?
The first step in treating CKD is preventing kidney disease. This includes the identification of predisposing factors (age, family history, race, kidney size) and factors that initiate kidney disease (diabetes, hypertension, infections, autoimmune diseases, lithiasis, medications).
Next comes the treatment of CKD, which includes slowing the progression of kidney disease by controlling albuminuria, arterial hypertension, smoking cessation, improving lipid profile and diabetes control. At the same time, specific causes that may be reversible are identified and corrected.
Finally, it is essential to treat the complications of progressively worsening kidney disease. Important among others is the management of nephrogenic anemia, the treatment of bone disease and metabolic acidosis, in combination with appropriate dietary guidelines, the evaluation of medication and preparation in advanced stages for renal replacement therapy.</p >
In spite of all the above, the patient is likely to end up in the final stage of chronic kidney failure, which means that he has lost more than 85% of normal kidney function. Contrary to what happens with the failure of other organs, the patient has options for replacing the kidney function, while maintaining a satisfactory quality of life.
What are the ways to replace kidney function?
– Hemodialysis:
The patient undergoes a treatment to cleanse his blood of useless metabolic substances through a special dialysis machine, usually three times a week. Depending on the patient and his comorbidities, it is possible to modify the method and duration of hemodialysis.
–Peritoneal Dialysis:
The patient undergoes a purification treatment of the useless metabolic substances through special solutions that enter the peritoneal cavity every day.
– Kidney transplant:
This is the replacement method ideally recommended for each patient, instead of hemodialysis or peritoneal dialysis. The kidney transplant can come from a living or cadaveric donor. The advantage is that the patient can have an excellent quality of life. At the same time, however, the continuous administration of immunosuppressive drugs is necessary, in order to prevent rejection of the kidney transplant by the body that recognizes it as a foreign body. For this reason and to avoid infections or other complications from the treatment, regular nephrological monitoring is required.