What do kidneys do? - The kidneys are a pair of bean-shaped organs at the back of the body. Each kidney is attached to the bladder, which is a distensible bag that collects urine. The kidneys make the urine, flowing downwards through two tubes called the ureters, and collects in the bladder. Normal kidney function keep in balance many things in the body by altering the composition of urine they produce.
The functions of the kidneys include:
What is it? - Chronic kidney disease (CKD) is a condition when the kidneys stop working as well as they should. The kidneys are critical for survival; without them, patients develop multiple problems. These may range from excessive water retention, breathlessness, sleeplessness, poor appetite, and high blood pressure. In chronic kidney disease, the kidneys slowly lose their functions, and in time, the kidney can stop working altogether.
The kidneys have a large reserve, and a large amount of kidney must be damaged before a person develops symptoms of chronic kidney disease. For this reason, a patient may have significant kidney damage but still feel perfectly well and see a doctor only very late in the course of his condition. A patient with mild chronic kidney failure may not have any symptoms initially and may feel totally well. However, as the kidney disease progresses, symptoms become more apparent. Patients may develop:
Not every patient develop all these symptoms. Some may develop these symptoms at different stages of their disease. Also, it is important to realise that these symptoms do not necessarily only mean that one has kidney disease. Each disease affects each patient differently and to a different extent.
There are many causes of kidney disease. These affect the kidney to different degrees, causing them to fail at different rates. Some of these are inherited, while others are related to existing conditions such as diabetes, other inflammatory diseases or infections. A list of common causes of kidney failure are as follows:
A) Diabetic nephropathy
Diabetic nephropathy is kidney failure resulting from long-standing and poorly controlled diabetes. It is now the most important cause of end-stage kidney disease in Singapore and elsewhere in the world. Patients with diabetes mellitus commonly have many other associated problems such as heart attacks, strokes, eye disease, gangrene, numbness of the feet, and rapid swings in blood pressure from a lying to a standing position. They are also prone to infections of the abdomen, skin, ears, and feet.
B) Chronic glomerulonephritis
Chronic glomerulonephritis refers to a group of different kidney diseases that initially affect a specific microscopic structure of the kidney called the glomerulus. The most common form is called Ig A (pronounced as I G A) nephropathy. This kidney disease can take 3 to 40 years before reaching end-stage kidney disease. There are many other forms of glomerulonephritis, such as focal and segmental glomerulosclerosis, membranous glomerulopathy, membranoproliferative glomerulonephritis, to name a few.
C) Polycystic kidney disease
This is a form of inherited kidney disease associated with the development of multiple sacs of fluid (cysts) within the substance of the kidney. These patients tend to develop hypertension, kidney stones, and recurrent urine infection or infections of the cysts of the kidney. They can have other associated problems, the most serious of which is a rupture of the brain's blood vessels (called a leaking berry aneurysm), which can bring on a sudden and severe headache.
D) Lupus Nephritis
Systemic lupus erythematosus (SLE) is an autoimmune condition that can affect various parts of the body. Patients with SLE commonly develop kidney disease, namely lupus nephritis. The patterns of kidney disease vary widely, and their responses to therapy vary. Patients with SLE usually suffer from many other manifestations, including hair loss, joint pain of the hands, wrists and knees, facial rash, mouth ulcers, and gut, lungs, and blood involvement.
E) Reflux nephropathy
This is another inherited disease characterised by recurrent urine infection in childhood associated with a backwash of urine from the bladder upwards into the kidney during urination. This leads to kidney scarring, loss of kidney tissue and kidney failure.
Kidney disease can be silent in the early stages and the patient may be perfectly well without any symptoms. However, patients usually need urine and blood tests to detect renal disease apart from a physical check-up.
The urine is usually tested for:
Once chronic kidney disease is advanced, it usually will progress to end-stage kidney failure. Nevertheless, some common treatments can benefit most patients with established kidney disease.
What happens when the kidneys stop working (end-stage kidney disease)
Chronic kidney disease can progressively worsen over time. Some patients will eventually need to consider starting dialysis or getting a kidney transplant . Planning for dialysis in advance is an important component of treatment for patients with CKD. There are two types of dialysis: haemodialysis and peritoneal dialysis. Some patients may choose not to start dialysis when it is unlikely to extend their life or improve quality of life.