Caring For The Kidneys When You Have Diabetes

A Guide for Diabetics on Caring for the Kidneys.

Background

More and more people are diagnosed each year with kidney failure. In the United States alone, there are more than 100,000 people diagnosed with kidney failure each year. This is according to the United States Renal Data System 2007 Annual Data Report. What’s alarming is that nearly 44 percent of new cases of kidney failure is caused by diabetes.

Diabetes is a disease in which blood glucose (or blood sugar) levels are above normal. People with diabetes have problems converting food to energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, and gum infections.

The kidney disease in diabetes patients is called diabetic kidney disease, or diabetic nephropathy. This commonly takes many years to develop. During the process, the tiny filtering units of the kidney are slowly being damaged. Without treatment, this could lead to chronic kidney disease (CKD) or even kidney failure. Kidney failure is a serious condition in which the kidneys fail to get rid of the body wastes. The harmful wastes build up in the body and causes serious health problems. You will need to have a dialysis or a kidney transplant.

High blood pressure, or hypertension, plays a major role in the development of kidney disease in people with diabetes. Chances of developing kidney disease appear to increase if a person has hypertension or a family history of hypertension. In addition, the progression of an existing kidney disease is accelerated by hypertension. Early detection and treatment of even mild hypertension are essential for people with diabetes.

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What can I do?

Truly, diabetes can cause serious complications and some of it cannot be reversed, such as kidney disease. But you can do your part to prevent or delay the onset of kidney disease if you have diabetes.

The following are steps that you can do if you have diabetes.

1. You should keep track of your blood sugar levels.

Keep it as close to normal as you can. Each time you check for your blood sugar, write the number in your record book. You can manage your diabetes by being physically active; following a healthy meal plan; and taking your prescribed medicines.

Another treatment approach for managing diabetes is Intensive Management of Blood Glucose. This is a treatment regimen for preventing and slowing down kidney disease in people with diabetes. It has shown great promise for diabetes patients, especially for those in the early stages of chronic kidney disease. This regimen aims to keep blood sugar levels close to normal. It include

 Frequent blood sugar testing

 Following a diet and activity plan

 Administering insulin throughout the day on the basis of food intake and physical activity

 Consulting a health care team regularly

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2. Keep your blood pressure under control.

The National Heart, Lung, and Blood Institute recommends that people with diabetes should aim for a blood pressure below 130/80 to help prevent kidney damage. Meal planning, medicines, and physical activity can help you reach your target blood pressure.

Keeping your blood pressure under control also slow down or prevent other diabetes complications.

If you already have kidney damage, ask your doctor if you should take pills to slow down further damage. Two medicines, called angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB), have been found to protect the kidneys while lowering the blood pressure.

3. You should follow a healthy eating plan.

You can work out with your doctor or dietitian a proper dietary plan. If you already have kidney problem, your health care provider may ask you to cut back on your protein intake, such as meat. Because a diet high in proteins can cause more damage to your kidneys. Experts recommends that people with diabetic kidney disease consume the recommended dietary allowance for protein.

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4. Be Physically Active. Exercise Regularly.

Research has shown many benefits from being physically active, especially if you have diabetes. In addition to following a healthy eating plan and taking your prescribed medicines, being physically active can reduce your risk for problems with your kidneys, eyes, nerves, feet and legs, and teeth. Risk for heart attack or stroke is also greatly reduced.

There are 4 kinds of activity that can help you manage diabetes. You can

 Be extra active everyday. Some things you can do include taking the stairs instead of the elevator, play with your kids, take the dog for a walk, and clean the house.

 Do aerobic exercise. Doing aerobic exercise for 30 minutes a day provide many benefits. Exercises include riding a bicycle, hiking, taking aerobics class, dancing, and swimming.

 Do strength training. Strength training can build more muscles that improve your balance and coordination, as well as your bone’s health. You can perform strength training with the use of hand weights, elastic bands, or weight machines.

 Stretch. Stretching increases your flexibility, lowers stress, and helps prevent muscle soreness after other types of exercise.

Before increasing your physical activity, especially if you have diabetes or kidney disease, you should work with your health care team in choosing what exercise or activity is best for your, how long you should perform, and the best time to perform exercise. Your daily schedule, meal plan, and your diabetes medications should be considered when deciding as to what physical activity you can perform.

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5. Have your blood and urine tested at least once a year.

Urine testing is used to check for proteins in your urine and blood test to check for creatinine. The result of these tests will tell how well your kidneys are working.

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6. You should avoid taking painkillers regularly.

Long term, regular use of painkillers, such as aspirin or acetaminophen, can damage the kidneys. Talk to your doctor if you regularly take pills to relieve chronic pain. He or she can provide you with alternative medications to relieve your pain without putting your kidneys at risk.

If you have diabetes or hypertension, you should have them checked regularly and remember to keep them as close to normal as possible. By doing this, you are doing a great favor for your kidneys.

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Reference: National Institute of Diabetes and Digestive and Kidney Diseases. NIH Publication No. 08–3925, January 2008

Ways to Protect Your Kidneys

Protecting the Kidneys from Further or Future Damage

The kidneys play an important role in keeping the right amount of water in the body. In addition, they also help filter out harmful wastes and maintain balance of chemicals in the body. Further more, the kidneys play a role in maintaining normal blood pressure and the normal number of red blood cells in the blood.

In kidney disease, parts of the kidneys that filter out wastes are damaged. Harmful wastes and substances can build up in the body that can lead to a variety of symptoms. When the kidneys totally fail to work, a person has to have his blood filtered through a machine (a procedure called dialysis) for several times a week or has to get a kidney transplant.

There are several things that you can do to prevent or delay the onset of kidney disease. Some of the things you can do include:

 Have your blood and urine checked regularly.

If you think that you are at risk of having kidney problems, make sure to let your doctor about it. Risk factors for kidney disease include diabetes, hypertension, heart disease, and family history of kidney problems. Early stages of kidney disease might not present with any signs or symptoms. So talk to your health care provider about having it checked.

 Keep Your Blood Sugar Levels Under Control.

Diabetes can cause diabetic kidney disease, also called diabetic neuropathy, which can lead to kidney failure if left untreated. According to the Centers for Disease Control and Prevention, controlling your blood sugar levels can prevent or delay the onset of kidney disease.

 Keep Your Blood Pressure Under Control. Over time, high blood pressure (or hypertension) can damage your kidneys. The National Heart, Lung, and Blood Institute recommends that people with diabetes and reduced kidney function should keep their blood pressure below 130/80 mm Hg. You may want to check your blood pressure at home to be sure it stays lower than 130/80. Have your health care provider check your blood pressure at least 4 times a year.

Not all medicines that lower blood pressure help protect your kidneys. Your doctor may have you take blood pressure pills, called angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARBs). These types of medications have been found to protect the kidneys more than other medicines that lower blood pressure to similar levels.

 Choose Healthy Foods.

Your doctor may ask you to cut back on foods high in proteins (such as meat, milk, and cheese). A high-protein diet can cause more damage to your kidneys over time. Eating less sodium and fats is also a good idea. A renal dietitian can help develop a good dietary plan for you, especially if you already have kidney disease.

 Exercise.

Physical activity can help you control your blood sugar, weight, and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol. Talk to your health care provider about safe exercise plan, especially if you already have kidney problems.

References:

National Center for Chronic Disease Prevention and Health Promotion (June 2006). Frequently Asked Questions: Exercise and Diabetes. Centers for Disease Control and Prevention, Atlanta Georgia. June 27, 2006.

National Center for Chronic Disease Prevention and Health Promotion (December 2005). Take Charge of Your Diabetes. Centers for Disease Control and Prevention, Atlanta Georgia. December 20, 2005.

National Kidney and Urologic Diseases Information Clearinghouse (July 2006). Kidney Failure: What to Expect. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 06-6059, July 2006.

National Kindey and Urologic Diseases Information Clearinghouse (July 2006). Kidney Disease of Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 08-3925, January 2008.

National Kidney and Urologic Diseases Information Clearinghouse (July 2006). Kidney Failure: What to Expect. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 07-3195, August 2007.

Kidney Failure Related Conditions and Their Treatments

Introduction

The kidneys, the most important excretory organ of the body, help to clean the blood by removing extra water, minerals, and wastes. In addition, they also make hormones that keep your bones strong and blood clean.

When the kidneys stop working, problems can arise. Such problems include anemia and disorders that affect the skin, bones, and nerves.

Conditions that are commonly caused by kidney failure include:

 Extreme tiredness

 Bone problems

 Itching (pruritus)

 Joint problems

 Sleep disorders

In addition, totally damaged kidneys result in build up of harmful wastes in the body, rise in blood pressure, causes the body to retain excess fluid and not make enough red blood cells. Treatment is necessary to replace the work of the failed kidneys.



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Anemia in Kidney Disease and Dialysis

Having a low count of red blood cells (RBCs) in your blood is called anemia. RBCs are the primary cells that carry oxygen to the different tissues and organs of the body. Without oxygen, cells cannot use the energy from food. Because of this, someone with anemia may tire easily and look pale. Having a low RBC count may also contribute to heart problems.

Anemia is commonly experienced by people with kidney disease. Normally, healthy kidneys produce a hormone called erythropoietin, or EPO. This hormone stimulates the bone marrow to produce red blood cells. People with damaged kidneys, however, do not make enough EPO. This results in less production of red blood cells.

Anemia may begin to develop during the early stages of kidney disease. It tends to worsen as the disease progresses. Nearly all people with kidneys that totally stop working have anemia. Complete failure of the kidneys is sometimes known as end-stage renal disease.

Treatment of anemia in people with kidney disease may include injection with a man-made EPO.



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Renal Osteodystrophy and Kidney Disease

Renal osteodystrophy was the term used in the past to describe the mineral and hormone disturbances caused by kidney disease. Now, the term renal osteodystrophy is used only to describe the bone problems that result from a condition called chronic kidney disease-mineral and bone disorder (CKD-MBD).

To learn more about the condition, please visit our CKD-MBD page.

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Page Last Updated: October 2, 2009

Itching and Kidney Disease

What to do when you feel the itch.







Itchy skin, medically termed as pruritus, is a common complaint among people treated with dialysis. However, itching is also common even in people who do not have kidney disease. In people with kidney failure, wastes in the bloodstream that are not completely removed through dialysis make the itching worse.

Kidney disease related itching might also be related to high levels of parathyroid hormone. Some people have experienced dramatic relief after having their parathyroid glands removed. However, a cure for itching that works for everyone has not been found. In some people, taking phosphate binders that bind phosphorus while in the stomach seem to help. Others find relief after exposure to ultraviolet light. Still others feel improvement with EPO shots. Certain antihistamines have also been found to help. In any case, taking care of dry skin is important. Applying creams with lanolin or camphor may help.

Your health care provider can provide you with informations about medications or creams that you can use to manage the itching.


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Sleep Disorders and Kidney Disease

Patients on dialysis often have insomnia, and some people have a specific problem called the sleep apnea syndrome, which is often signaled by snoring and breaks in snoring. Episodes of apnea are actually breaks in breathing during sleep. Over time, these sleep disturbances can lead to “day-night reversal” (insomnia at night, sleepiness during the day), headache, depression, and decreased alertness. The apnea may be related to the effects of advanced kidney failure on the control of breathing. Treatments that work with people who have sleep apnea, whether they have kidney failure or not, include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose (nasal continuous positive airway pressure, or CPAP).

Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or “restless” legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. The causes of restless legs may include nerve damage or chemical imbalances.

Moderate exercise during the day may help, but exercising a few hours before bedtime can make it worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco; some people also find relief with massages or warm baths. Some prescription medications may also help as well.

Sleep disorders may seem unimportant, but they can impair your quality of life. Don’t hesitate to raise these problems with your nurse, doctor, or social worker.


This information is provided by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).



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Amyloidosis and Kidney Disease

Dialysis-related amyloidosis (DRA) is common in patients, especially older adults, who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit in bones, joints, and tendons. This can cause pain, stiffness, and fluid build-up in joints. Amyloid is the term used for abnormal depositions of proteins in tissues, and the disease process is called amyloidosis. Amyloid deposits may cause abnormal tears in ligaments and tendons.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about half of people with DRA also develop a condition called carpal tunnel syndrome. It results from the unusual build-up of proteins in the wrists. Symptoms may include numbness or tingling sensation in the fingers and hands.

Unfortunately, there is no cure for DRA. Treating the complications, however, is beneficial, such as correcting the torn ligament or tendon and treating carpal tunnel syndrome. Successful kidney transplant may also stop dialysis-related amyloidosis from progressing.

References:

National Kidney and Urologic Diseases Informations Clearinghouse. Amyloidosis and Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 06–4694, May 2006

National Kidney and Urologic Diseases Informations Clearinghouse. Anemia in Kidney Disease and Dialysis. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 05–4619, January 2005

National Kidney and Urologic Diseases Informations Clearinghouse. Renal Osteodystrophy. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 06–4630, January 2005


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Kidney Disease

Description

What is kidney disease?

Kidney disease results from damage to nephrons, the tiny structures inside your kidneys. The nephrons function to filter blood, and remove waste products and excess water from your system.

Usually, the damage occurs in both kidneys and happens very gradually over years. Unfortunately, there are no obvious symptoms during the early stages of the disease, so you don’t know it’s happening. As the disease progresses, levels of fluid and wastes dangerously accumulate in your body.

When the kidneys totally fail or do not work well enough to maintain life, you will need to undergo dialysis or kidney transplantation.


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Kidney Disease Signs and Symptoms

What are the signs and symptoms of kidney disease?

You may not know that you have a kidney disease during its early stages because, usually, you do not feel sick at all.

When kidney disease progresses, signs and symptoms may appear. Each individual with the disease may experience the symptoms differently. Symptoms may include:

 Feeling tired

 Loss of appetite

 Nausea and vomiting

 Tissue swelling

 Itching

 Numbness on hands and feet

 Difficulty in urinating

 Drowsiness

 High blood pressure

 Anemia

 Trouble concentrating

 Sleep problems

 Muscle cramping

 Darkening of the skin

Because the symptoms of kidney disease may resemble other health problems, you should talk to your doctor about your symptoms.

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Kidney Disease Risk Factors

Who is at risk of for kidney disease?

You may be at risk of having kidney disease if:

 You have diabetes

 You have high blood pressure or hypertension

 You have a heart disease

 Someone in your family has kidney disease. Some forms of kidney disease results from hereditary factors, and can run in families.

 You take certain pain relievers for a long time. Long-term use of certain over-the-counter medicines can damage the kidneys.

If you are at risk of having the disease, talk to your doctor or health care professional about getting tested. The only way to know if you have it is to get checked.

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Causes of Kidney Disease

What are the common causes of kidney disease?

Diabetes and high blood pressure are the leading causes of kidney disease. According to the U.S. Renal Data System of the National Institutes of Health (2006), diabetes and high blood pressure account for about 69 percent of new cases of kidney disease.

Other causes of kidney disease include:

 Glomerular diseases. As the name indicates, glomerular diseases attack the tiny blood vessels within the kidney, called glomeruli. They can slowly destroy kidney function.

 Inherited and congenital kidney diseases. Some kidney diseases result from genetic (hereditary) factors. Example of a genetic disorder that can lead to kidney failure is polycystic kidney disease (PKD).


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Kidney Disease Tests and Diagnosis

Since early stages of kidney disease do not have any symptoms, your doctor may first detect the condition through routine blood and urine tests.

Your doctor may perform very simple tests that include:

 Blood pressure measurement

 Measurement of the level of protein in the urine. Increased levels of protein in your urine—called proteinuria—show your kidneys are not working properly.

 Measurement of the level of serum creatinine in the blood to estimate to estimate your glomerular filtration rate (GFR). GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood.

Additional tests and procedures:

 Blood urea nitrogen (BUN). Urea, a compound that contains nitrogen, is a waste product that results from breakdown of proteins. If the kidneys are not working well, the urea will stay in the blood.

 Renal imaging (taking pictures of the kidneys) such as ultrasound, computerized tomography (CT) scan, and magnetic resonance imaging (MRI) are used to detect unusual growth or blockage to urine flow.

 Renal biopsy. A kidney tissue sample from your kidney is obtained. The sample is viewed under a microscope to help identify problems in the cellular level.

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Kidney Disease Treatment Options

How is kidney disease treated?

Unfortunately, long-term (chronic) kidney disease often has no cure because of the irreversible damage to the kidneys. During its early stages,however, you may be able to make your kidneys last longer by taking certain steps. That is why detection of kidney disease in its early stages is important.

In most cases, treatment of kidney disease is focused on treating the underlying cause. This may minimize or delay the progression of kidney damage.

 If you have diabetes, it is essential to monitor your blood sugar closely to keep it under control. Your doctor can provide you with the latest in treatment.

 Blood pressure management. It is also important to monitor your blood pressure often. High blood pressure can damage small blood vessels in your kidneys.

To control high blood pressure, medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blocker (ARBs) may be prescribed by your doctor. These types of blood pressure medicines have been found to protect the kidneys even more than other medications that lower blood pressure to similar levels. The National Heart, Lung, and Blood Institute (NHLBI) recommends that people with diabetes or reduced kidney function should keep their blood pressure below 130/80 mm Hg.

 Dietary and lifestyle changes.

In addition to taking your medications, following a proper diet is also important in the treatment of kidney disease. Your doctor may advise you to cut back on your protein, sodium, potassium, and fat intake. A registered dietitian may also help you make the necessary changes in your diet.

Stop smoking. Smoking increases your risk of kidney disease. It also contributes to deaths from stroke and heart attacks in people with chronic kidney disease. You should try your best to quit smoking.

 Anemia. The kidneys normally produce a hormone called EPO. It helps to stimulate production of red blood cells (RBCs)—the oxygen carrying cells. A diseased kidney, however, may not be able to make enough EPO leading to reduced number of RBCs—called anemia. If you’re anemic, you feel tired and look pale. To treat anemia, your doctor may inject you with a man-made EPO.

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Kidney Disease: When Kidneys Fail Completely.

When kidneys fail completely.

If your kidneys stop working completely, sometimes called end-stage renal disease (ESRD), wastes can build up in your system. Your body needs clean blood to function properly. When this happens, the only option is to undergo dialysis or kidney transplantation to support life.

Dialysis

The two major forms of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis is usually performed at a dialysis center three times per week for 3 to 4 hours. In this form of dialysis, your blood is sent through a filter that removes waste products. The clean blood is then returned to your body.

In peritoneal dialysis, a fluid is put into your abdomen. This fluid captures the waste products from your blood. After a few hours, the fluid containing your body’s wastes is drained away. Then, a fresh bag of fluid is dripped into the abdomen. Patients can perform peritoneal dialysis themselves. Patients using continuous ambulatory peritoneal dialysis (CAPD) change fluid four times a day. Another form of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), can be performed at night with a machine that drains and refills the abdomen automatically.

Kidney transplant

Another treatment for ESRD is to undergo kidney transplantation. In kidney transplant operation, a kidney from a donor is transplanted to the recipient. A donated kidney may come from an anonymous donor who has recently died or from a living person, usually a relative. The kidney that you receive must be a good match for your body. The more the new kidney is like you, the less likely your immune system is to reject it. Your immune system protects you from disease by attacking anything that is not recognized as a normal part of your body. So your immune system will attack a kidney that appears too “foreign.” You will take special drugs to help trick your immune system so it does not reject the transplanted kidney.

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See Also: Total Kidney Failure: Treatment Options

Kidney Disease: What You Can Do.

What you can do.

If you are in the early stages of renal or kidney disease, you may be able to save your remaining kidney function for many years by

 controlling your blood glucose

 controlling your blood pressure

 following a low-protein diet

 maintaining healthy levels of cholesterol in your blood

 taking an ACE inhibitor or an ARB

 quitting smoking

References:

National Kidney and Urologic Diseases Information Clearinghouse (2007). Your Kidneys and How They Work. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. Publication No. 07–3195, August 2007

U.S. Renal Data System (2006). National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.

National Kidney Disease Education Program (2005). Kidney Disease Information. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.


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Polycystic Kidney Disease (PKD)

Description

Polycystic Kidney Disease (PKD) is an inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. Cysts are abnormal sacs containing gas, fluid, or a semisolid material. It may form in the kidneys or in other parts of the body. When these cysts form in the kidneys, they are filled with fluid. Eventually, they take over and destroy working kidney tissues, resulting in reduced kidney function and can lead to kidney failure or end-stage renal disease.

Severity of the PKD varies. Although there is no cure for PKD, there are several treatment options that can ease symptoms and prolong life.


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Polycystic Kidney Disease: Signs and Symptoms

What are the symptoms of PKD?

The most common symptoms are pain in the back and the sides—between the ribs and hips—and headaches. The pain can be temporary or persistent, mild or severe.

People with PKD may also experience the following complications:

 high blood pressure

 urinary tract infections—specifically, in the kidney cysts

 cysts in the kidneys and other organs (liver and pancreatic cysts)

 hematuria—blood in the urine

 frequent urination

 pain in the abdomen

 kidney stones

 aneurysms—bulges in the walls of blood vessels—in the brain

 diverticulosis—small pouches bulge outward through the colon

 kidney failure


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Polycystic Kidney Disease: Causes

What causes polycystic kidney disease?

Cysts that form in the kidneys usually contain fluid. There are different types of cyst. Simple kidney cyst does not usually cause any symptoms and usually form in later years of life. It is not inherited, and usually does not require treatment if no complications are present.

Polycystic kidney disease, on the other hand, is caused by abnormalities in the genes. PKD is an inherited disorders, that is, they run in families. It has two types and is caused by different genetic abnormalities:

Autosomal Dominant Polycystic Kidney Disease (ADPKD). This is the most common form of inherited PKD. Signs and symptoms of ADPKD usually develop between the ages of 30 and 40, but they can begin earlier, even in childhood. About 85-90 percent of all PKD cases is autosomal dominant PKD. Autosomal dominant means that if one parent has the disease, there is a 50 percent chance that the disease gene will pass to a child. In some cases—perhaps 10 percent—autosomal dominant PKD occurs spontaneously in patients. In these cases, neither of the parents carries a copy of the disease gene.

ADPKD is often called "adult polycystic kidney disease" because many people with autosomal dominant PKD live for several decades without developing any symptoms. However, in some cases, cysts may form earlier in life and grow quickly, causing symptoms in childhood.

Autosomal Recessive Polycystic Kidney Disease (ARPKD). This is a rare inherited form of PKD. Signs and symptoms of autosomal recessive PKD begin in the earliest months of life, even in the womb. The signs of autosomal recessive PKD frequently begin before birth, so it is often called "infantile PKD." Children born with autosomal recessive PKD often, but not always, develop kidney failure before reaching adulthood.

Severity of the disease varies. Babies with the worst cases die hours or days after birth due to respiratory difficulties or respiratory failure. Liver scarring occurs in all patients with autosomal recessive PKD and tends to become more of a medical concern as the patient gets older.

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Polycystic Kidney Disease: Tests and Diagnosis

How is polycystic kidney disease diagnosed?

 Ultrasound imaging of kidney cysts. Ultrasound, which passes sound waves through the body to create a picture of the kidneys, is used most often. Ultrasound imaging does not use any injected dyes or radiation and is safe for all patients, including pregnant women. It can also detect cysts in the kidneys of a fetus, but large cyst growth this early in life is uncommon in autosomal dominant PKD.

 Computerized tomography (CT) scan. It is an imaging technique that uses x-rays to create cross-sectional pictures of the kidneys.

 Magnetic resonance imaging (MRI). This method is used to measure kidney and cyst volume and monitor kidney and cyst growth, which may serve as a way to track progression of the disease.

 Family medical history, including genetic testing. Genetic testing is used to detect abnormalities or mutations in the genes that can cause PKD.


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Polycystic Kidney Disease: Treatment

How is polycystic kidney disease treated?

Currently, there is no actual cure for PKD itself. But there are available treatments for several of the signs and symptoms to ease it and prolong life.

 High blood pressure. Keeping blood pressure under control may delay the effects of PKD. Lifestyle changes and various medications can lower high blood pressure (hypertension). Sometimes proper diet and exercise are enough to keep blood pressure controlled. Talk with your doctor about medications to treat hypertension.

 Pain. Pain, in the area of the kidneys at the back or sides, is a common symptom of PKD. Your doctor may initially suggest over-the-counter pain medications, such as aspirin or acetamenophen. You should talk to your doctor before taking any over-the-counter medications because some of these medications may be harmful to the kidneys. Your doctor may suggest surgery to shrink the cysts if they are large enough to cause pain. However, surgery provides only temporary relief and does not slow the disease’s progression toward kidney failure.

 Urinary tract infections. People PKD tend to have frequent urinary tract infections, which can be treated with antibiotics. People with the disease should seek treatment for urinary tract infections immediately because infection can spread from the urinary tract to the cysts in the kidneys. Cyst infections are difficult to treat because many antibiotics do not penetrate

 End-stage renal disease (ESRD). PKD can cause the kidneys to fail after many years. Because kidneys are essential for life, people with ESRD must seek one of two options for replacing kidney functions: dialysis or transplantation. In hemodialysis, blood is circulated into an external filter, where it is cleaned before re-entering the body; in peritoneal dialysis, a fluid is introduced into the abdomen, where it absorbs wastes and is then removed. Transplantation of healthy kidneys into ESRD patients has become a common and successful procedure. Healthy—non-PKD—kidneys transplanted into PKD patients do not develop cysts.

Reference: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (November 2007). Polycystic Kidney Disease. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/polycystic/. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. U.S. Department of Health and Human Services. NIH Publication No. 08–4008, November 2007. Retrieved June 24, 2008.


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Kidney Diseases Dictionary

Kidney Diseases Dictionary Index

This dictionary defines words that are often used when people talk or write about kidney diseases. It is designed for people who have kidney diseases and their families and friends.

The words are listed in alphabetical order. Some words have many meanings; only those meanings that relate to kidney diseases are included.

This information is not a substitute for a visit to your doctor. Talk to a health professional if you have a kidney problem.

Index
A B C D E F G H I K L
M N O P R S T U V W



The National Kidney and Urologic Diseases Information Clearinghouse has provided this publication for public information. NIH Publication No. 03–4359, May 2003. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/kdictionary/. Retrieved June 24, 2008

Kidney Diseases Dictionary: A-C

Kidney Diseases Dictionary Index

A B C D E F G H I K L
M N O P R S T U V W


A

acute (uh-KYOOT):

Acute often means urgent. An acute disease happens suddenly. It lasts a short time. Acute is the opposite of chronic, or long lasting.

acute renal (REE-nul) failure:

Sudden and temporary loss of kidney function. (See also chronic kidney disease.)

acute tubular (TOO-byoo-lur) necrosis (neh-KRO-sis) (ATN):

A severe form of acute renal failure that develops in people with severe illnesses like infections or with low blood pressure. Patients may need dialysis. Kidney function often improves if the underlying disease is successfully treated.

albuminuria (AL-byoo-mih-NOO-ree-uh):

More than normal amounts of a protein called albumin in the urine. Albuminuria may be a sign of kidney disease.

allograft (AL-oh-graft):

An organ or tissue transplant from one human to another.

Alport syndrome (AL-port SIN-drome):

An inherited condition that results in kidney disease. It generally develops during early childhood and is more serious in boys than in girls. The condition can lead to end-stage renal disease, as well as hearing and vision problems. The common symptoms of this condition are chronic blood and protein in the urine.

amyloidosis (AM-ih-loy-DOH-sis):

A condition in which a protein-like material builds up in one or more organs. This material cannot be broken down and interferes with the normal function of that organ. In kidneys, amyloidosis can lead to proteinuria, nephrotic syndrome, and kidney failure.

analgesic (AN-ul-JEE-zik)-associated kidney disease:

Loss of kidney function that results from long-term use of analgesic (pain-relieving) medications. Analgesics that combine aspirin and acetaminophen are most dangerous to the kidneys.

anemia (uh-NEE-mee-uh):

The condition of having too few red blood cells. Healthy red blood cells carry oxygen throughout the body. If the blood is low on red blood cells, the body does not get enough oxygen. People with anemia may be tired and pale and may feel their heartbeat change. Anemia is common in people with chronic kidney disease or those on dialysis. (See also erythropoietin.)

antidiuretic (AN-tee-DY-uh-RET-ik) hormone (ADH):

A natural body chemical that slows down the urine flow. Some children who wet their beds regularly may lack normal amounts of antidiuretic hormone.

anuria (uh-NYOOR-ee-uh):

A condition in which the person stops making urine.

arteriovenous (ar-TEER-ee-oh-VEE-nus) (AV) fistula (FIST-yoo-luh):

Surgical connection of an artery directly to a vein, usually in the forearm, created in patients who will need hemodialysis (see dialysis). The AV fistula causes the vein to grow thicker, allowing the repeated needle insertions required for hemodialysis.

autoimmune (AW-toh-ih-MYOON) disease:

Any disorder in which the body is attacked by its own immune system. Examples are Goodpasture syndrome and lupus erythematosus (see lupus nephritis).

B

biopsy (BY-op-see):

A procedure in which a tiny piece of a body part, such as the kidney or bladder, is removed for examination under a microscope.

bladder (BLAD-ur):

The balloon-shaped organ inside the pelvis that holds urine.

blood urea (yoo-REE-uh) nitrogen (NY-truh-jen) (BUN):

A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases.

C

calcium (KAL-see-um):

A mineral that the body needs for strong bones and teeth. Calcium may form stones in the kidney.

chronic (KRAH-nik):

Lasting a long time. Chronic diseases develop slowly. chronic kidney disease may develop over many years and lead to end-stage renal disease.

chronic kidney disease (CKD):

Any condition that causes reduced kidney function over a period of time. CKD is present when a patient's glomerular filtration rate remains below 60 mL/min/1.73 m2 for more than 3 months.

congenital (kun-JEN-ih-tul) nephrotic (nef-RAH-tik) syndrome:

A genetic kidney disease that develops before birth or in the first few months of life. Congenital nephrotic syndrome usually leads to end-stage renal disease and the need for dialysis or a kidney transplant by the second or third year of life.

creatinine (kree-AT-ih-nin):

A waste product from meat protein in the diet and from the muscles of the body. Creatinine is removed from blood by the kidneys; as kidney disease progresses, the level of creatinine in the blood increases.

creatinine clearance:

A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function.

cyst (SIST):

An abnormal sac containing gas, fluid, or a semisolid material. Cysts may form in kidneys or in other parts of the body. (See also renal cysts.)

cystine (SIS-teen):

An amino acid found in blood and urine. Amino acids are building blocks of protein. (See also cystine stone and cystinuria.)

cystine stone:

A rare form of kidney stone consisting of the amino acid cystine.

cystinuria (SIS-tih-NOO-ree-uh):

A condition in which urine contains high levels of the amino acid cystine. If cystine does not dissolve in the urine, it can build up to form kidney stones.

cystitis (sis-TY-tis):

Inflammation of the bladder, causing pain and a burning feeling in the pelvis or urethra.

cystoscope (SIS-tuh-skope):

A tool for examining the bladder. The procedure is called cystoscopy (sis-TAH-skuh-pee).

Kidney Diseases Dictionary Index
A B C D E F G H I K L
M N O P R S T U V W

The National Kidney and Urologic Diseases Information Clearinghouse has provided this publication for public information. NIH Publication No. 03–4359, May 2003. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/kdictionary/. Retrieved June 24, 2008

Kidney Diseases Dictionary: D-E

Kidney Diseases Dictionary Index

A B C D E F G H I K L
M N O P R S T U V W



D

diabetes (dy-uh-BEE-teez) insipidus (in-SIP-ih-dus):

A condition characterized by frequent and heavy urination, excessive thirst, and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal. (See also nephrogenic diabetes insipidus.)

diabetes (dy-uh-BEE-teez) mellitus (MELL-ih-tus):

A condition characterized by high blood glucose (sugar) resulting from the body's inability to use glucose efficiently. In type 1 diabetes, the pancreas makes little or no insulin; in type 2 diabetes, the body is resistant to the effects of available insulin.

dialysis (dy-AL-ih-sis):

The process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.

 hemodialysis (HEE-moh-dy-AL-ih-sis):
The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body.

 peritoneal (PEH-rih-tuh-NEE-ul) dialysis:
Cleaning the blood by using the lining of the belly (abdomen) as a filter. A cleansing solution, called dialysis solution, is drained from a bag into the belly. Fluids and wastes flow through the lining of the belly and remain "trapped" in the dialysis solution. The solution is then drained from the belly, removing the extra fluids and wastes from the body. There are three types of peritoneal dialysis:

 continuous ambulatory (AM-byoo-luh-TOH-ree) peritoneal dialysis (CAPD): The most common type of peritoneal dialysis. It needs no machine. With CAPD, the blood is always being cleaned. The dialysis solution passes from a plastic bag through the catheter and into the abdomen. The dialysis solution stays in the abdomen with the catheter sealed. After several hours, the person using CAPD drains the solution back into a disposable bag. Then the person refills the abdomen with fresh solution through the same catheter, to begin the cleaning process again.

 continuous cycling peritoneal dialysis (CCPD): A form of peritoneal dialysis that uses a machine. This machine automatically fills and drains the dialysis solution from the abdomen. A typical CCPD schedule involves three to five exchanges during the night while the person sleeps. During the day, the person using CCPD performs one exchange with a dwell time that lasts the entire day.

 nocturnal (nok-TURN-ul) intermittent (IN-ter-MIT-unt) peritoneal dialysis (NIPD): A machine-aided form of peritoneal dialysis. NIPD differs from CCPD in that six or more exchanges take place during the night, and the NIPD patient does not perform an exchange during the day.

dialysis solution:

A cleansing liquid used in the two major forms of dialysis—hemodialysis and peritoneal dialysis. Dialysis solution contains dextrose (a sugar) and other chemicals similar to those in the body. Dextrose draws wastes and extra fluid from the body into the dialysis solution.

dialyzer (DY-uh-LY-zur):

A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysis solution. The other holds the patient's blood.

dwell time:

In peritoneal dialysis, the amount of time a bag of dialysis solution remains in the patient's abdominal cavity during an exchange.

E

edema (eh-DEE-muh):

Swelling caused by too much fluid in the body.

electrolytes (ee-LEK-troh-lites):

Chemicals in the body fluids that result from the breakdown of salts, including sodium, potassium, magnesium, and chloride. The kidneys control the amount of electrolytes in the body. When the kidneys fail, electrolytes get out of balance, causing potentially serious health problems. Dialysis can correct this problem.

end-stage renal (REE-nul) disease (ESRD):

Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys.

erythropoietin (eh-RITH-roh-POY-uh-tin):

A hormone made by the kidneys to help form red blood cells. Lack of this hormone may lead to anemia.

ESRD:

See end-stage renal disease.

ESWL:

See extracorporeal shockwave lithotripsy.

exchange:

A cycle in peritoneal dialysis in which the patient fills the abdominal cavity with dialysis solution, carries it for a specified dwell time, and then empties it from the abdomen in preparation for a fresh bag of dialysis solution.

extracorporeal (EKS-truh-kor-POR-ee-ul) shockwave lithotripsy (LITH-oh-TRIP-see) (ESWL):

A nonsurgical procedure using shock waves to break up kidney stones.

Kidney Diseases Dictionary Index
A B C D E F G H I K L
M N O P R S T U V W

The National Kidney and Urologic Diseases Information Clearinghouse has provided this publication for public information. NIH Publication No. 03–4359, May 2003. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/kdictionary/. Retrieved June 24, 2008

Kidney Diseases Dictionary: F-I

Kidney Diseases Dictionary Index

A B C D E F G H I K L
M N O P R S T U V W



F

fistula (FIST-yoo-lah):

See arteriovenous fistula.

G

Glomerular (gloh-MEHR-yoo-ler) filtration rate (GFR):

A calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a fluid that is later measured in a 24-hour urine collection. A modified GFR calculation requires only that the creatinine in a blood sample be measured. Each laboratory has its own normal range for measurements. Generally, the normal range for men is 97 to 137 mL/min/1.73 m2 of body surface area. The normal range for women is 88 to 128 mL/min/1.73 m2.

glomeruli (gloh-MEHR-yoo-lie):

Plural of glomerulus.

glomerulonephritis (gloh-MEHR-yoo-loh-nef-RY-tis):

Inflammation of the glomeruli. Most often, it is caused by an autoimmune disease, but it can also result from infection.

glomerulosclerosis (gloh-MEHR-yoo-loh-skleh-ROH-sis):

Scarring of the glomeruli. It may result from diabetes mellitus (diabetic glomerulosclerosis) or from deposits in parts of the glomeruli (focal segmental glomerulosclerosis). The most common signs of glomerulosclerosis are proteinuria and chronic kidney disease.

glomerulus (gloh-MEHR-yoo-lus):

A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney.

Goodpasture syndrome:

An uncommon disease that usually includes bleeding from the lungs, coughing up of blood, and inflammation of the kidneys that can lead to kidney failure. This condition is an autoimmune disease.

graft:

In hemodialysis (see dialysis), a vascular access surgically created using a synthetic tube to connect an artery to a vein. In transplantation (see transplant), a graft is the transplanted organ or tissue.

H

hematocrit (hee-MAT-uh-krit):

A measure that tells what portion of a blood sample consists of red blood cells. Low hematocrit suggests anemia or massive blood loss.

hematuria (HEE-muh-TOOR-ee-uh):

Blood in the urine, which can be a sign of a kidney stone, glomerulonephritis, or other kidney problem.

hemodialysis:

See dialysis.

hemolytic (HEE-moh-LIT-ik) uremic (yoo-REE-mik) syndrome (SIN-drome) (HUS):

A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure.

hormone (HOR-mone):

A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. The kidney releases three hormones: erythropoietin, renin, and an active form of vitamin D that helps regulate calcium for bones.

hydronephrosis (HY-droh-nef-ROH-sis):

Swelling of the top of the ureter, usually because something is blocking the urine from flowing into or out of the bladder.

hypercalciuria (HY-per-kal-see-YOO-ree-uh):

Abnormally large amounts of calcium in the urine.

hyperoxaluria (HY-per-ox-uh-LOO-ree-uh):

Unusually large amounts of oxalate in the urine, leading to kidney stones.

hypertension (HY-per-TEN-shun):

High blood pressure, which can be caused either by too much fluid in the blood vessels or by narrowing of the blood vessels.

I

IgA nephropathy (nef-RAHP-uh-thee):

A kidney disorder caused by deposits of the protein immunoglobulin A (IgA) inside the glomeruli (filters) within the kidney. The IgA protein damages the glomeruli, leading to blood and protein in the urine, to swelling in the hands and feet, and sometimes to kidney failure.

immune (im-YOON) system:

The body's system for protecting itself from viruses and bacteria or any "foreign" substances.

immunosuppressant (im-YOON-oh-suh-PRESS-unt):

A drug given to suppress the natural responses of the body's immune system. Immunosuppressants are given to transplant patients to prevent organ rejection and to patients with autoimmune diseases like lupus.

interstitial (IN-ter-STISH-ul) nephritis (nef-RY-tis):

Inflammation of the kidney cells that are not part of the fluid-collecting units, a condition that can lead to acute renal failure or chronic kidney disease.

intravenous (IN-truh-VEE-nus) pyelogram (PY-loh-gram):

An x ray of the urinary tract. A dye is injected to make the kidneys, ureters, and bladder visible on the x ray and show any blockage in the urinary tract.

Kidney Diseases Dictionary Index
A B C D E F G H I K L
M N O P R S T U V W

The National Kidney and Urologic Diseases Information Clearinghouse has provided this publication for public information. NIH Publication No. 03–4359, May 2003. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/kdictionary/. Retrieved June 24, 2008