Water retention due to kidney problems: Chronic kidney disease: How effective are diet and exercise? – InformedHealth.org
Chronic kidney disease: How effective are diet and exercise? – InformedHealth.org
Diet recommendations vary according to the stage of chronic kidney disease. If you pay attention to what you eat and drink, and get enough exercise too, you can have a positive impact on the course of the disease and improve your wellbeing.
A lot of metabolic processes depend on the performance of the kidneys: If your kidneys stop working properly, it causes an imbalance in your energy and protein metabolism, for instance. The levels of salts and fluids in the body are also affected. Advanced kidney disease may then cause serious complications such as weight loss, acidosis (a build-up of acid), and fluid retention in organs and tissue.
So people who have chronic kidney disease are advised to follow a number of dietary recommendations. It’s often quite difficult to stick to this special “kidney-friendly” diet. But doctors and dietitians can help you to understand the recommendations and put them into practice. People who have chronic kidney disease often get used to these recommendations over time and use them as an opportunity to do something good for their wellbeing. Changes to your diet and exercise also have a positive effect on other medical conditions and risk factors, such as high blood pressure.
How much can you drink?
Most people who have chronic kidney disease can drink as much as they like at first. If the performance of the kidneys keeps getting worse, many people release less and less fluids. If you then also drink too much liquid, it can’t leave your body fast enough. This results in edema (swelling due to fluid retention) and rising blood pressure levels. Dialysis can only compensate for this to a certain extent, because the amount of water it can remove from the body is limited.
Depending on the type of dialysis and whether the kidneys are still excreting urine (and how much), the following recommendations apply: Ideally, you should only drink as much fluids as the kidneys excrete in the form of urine – plus 0. 5 liters per day in hemodialysis or 0.8 liters per day in peritoneal dialysis. This amount includes both drinks and liquid foods such as soups, yogurt and stewed fruit.
To make sure you don’t drink too much, it can help to use smaller glasses and cups, and to take medication with a meal instead of with an extra glass of water, if possible. You can help suppress your thirst by chewing on a sour candy, a slice of lemon or sugar-free gum. Drinking slowly and avoiding dry indoor air can also help.
Maintaining a normal weight
If you have chronic kidney disease and are also overweight, you can lower your risk of complications like heart attacks or strokes by losing weight.
But it is rare for people with advanced chronic kidney disease to be overweight – they are more likely to lose too much weight instead. To prevent being underweight, it is important to eat enough and to eat right. It is recommended that dialysis patients eat 30 to 40 kilocalories (kcal) per kilogram of normal weight. By “normal weight” we don’t mean your current weight, but the weight that is considered to be normal for your height according to the body mass index (BMI) formula. This would be 70 kg for a man who is 180 cm tall, for example. Based on that normal weight, the recommended amount of calories would be 2,100 to 2,800 kilocalories per day.
How much protein does your body need?
People who do not yet need to have dialysis should be careful to get the right amount of protein – not too much, but also not too little. Several studies have shown that in some people, a low-protein diet can delay the progression of chronic kidney disease and prevent complications. There is not yet enough evidence to say whether other types of diets might also have these positive effects. But it’s important to make sure that you don’t get too little protein either, because our bodies start breaking down the protein in our muscles if we don’t get enough protein in our diet.
According to current recommendations, people should get about 0. 8 to 1 gram of protein in their daily diet for each kilogram of normal weight. So if you weigh about 70 kilograms, this would mean you would ideally get about 60 grams of protein in your diet. To give you an idea of how much that is: A single beef steak (140 grams) typically has about 45 grams of protein in it, a hard-boiled egg has about 13 grams in it, and an apple has less than 0.5 grams in it.
People who are on dialysis will need more protein, though. People who are on hemodialysis are advised to get at least 1.1 grams of protein in their daily diet per kilogram of (normal) body weight, and those who are on peritoneal dialysis should get up to 1.5 grams per day and kilo. The reason why more protein is needed for peritoneal dialysis is because a lot of protein is lost to the dialysis fluid through the peritoneum.
How much salt is allowed?
High blood pressure and too much protein in urine can make chronic kidney disease get worse faster. Studies have shown that a low-salt diet can reduce blood pressure as well as the loss of protein. Based on initial research, experts think that it can help delay or lower the risk of complications like kidney failure or heart attacks. But these results still need to be confirmed in long-term studies.
Salt also causes your body to “hold onto” too much fluid and makes you more thirsty. So if someone is on dialysis and they aren’t allowed to drink a lot of liquids, it’s especially important that they use salt sparingly.
About 5 to 6 grams of salt are recommended per day. As a basic guide, one slice of bread contains about 0.5 grams of salt, a hot dog sausage has about 2 grams in it and a slice of pizza has over 4 grams in it. Avoiding salty foods can be difficult, especially at first. But after two to three weeks, your sense of taste becomes used to less salt. Some dishes can be made tastier by using herbs, onions, lemon, vinegar or other spices instead.
In advanced kidney disease, it’s not only salt (sodium chloride) that is a problem. The kidneys also have trouble regulating the levels of potassium and especially phosphate. So dialysis patients should stop eating foods that contain a lot of these minerals as much as possible. These foods include potatoes, bananas, dried fruit, potato chips, French fries, processed cheese (spreads), milk and nuts. Low-sodium or sodium-free salt substitutes should be used with caution: They have low amounts of sodium, but contain a lot of potassium.
How much exercise is good for you?
Getting exercise is good for you, even if you have chronic kidney disease. Regular exercise can help to lower your blood pressure, maintain muscle tissue and help you to feel better overall.
Experts recommend 30 minutes of low-intensity sports five times a week. If you can’t do that, it’s still important to get as much exercise as possible. Scheduling physical activity as part of your everyday routine and having friends and family support you in your goals can help. It’s even possible to exercise during a dialysis session – by pedaling on a specially designed bed exercise bike, for example.
Geberth S, Nowack R. Praxis der Dialyse. Berlin: Springer; 2014.
- United States Department of Agriculture (USDA), Agricultural Research Service. Nutrient Lists. (USDA Food Composition Databases).
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the
German health care system. The suitability of any of the described options in an individual
case can be determined by talking to a doctor. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a
health care professionals, scientists and editors, and reviewed by external experts. You can
find a detailed description of how our health information is produced and updated in
Hypervolemia and Fluid Overload | Fresenius Kidney Care
When you have too much sodium in your body, your body starts retaining water to balance it out. Unfortunately, this water retention can cause new problems throughout your body. Mild hypervolemia or water retention can be perfectly normal from time to time—caused by eating a lot of salty foods or by hormonal changes. Hypervolemia is usually caused by a more serious health issue that affects your body’s ability to regulate sodium and requires immediate attention from a doctor. These conditions may include:
- Kidney failure. Your kidneys are responsible for removing excess fluid from your body. When your kidneys aren’t working well, fluid can build up.
- Congestive heart failure. When your heart is not pumping enough blood, your kidneys aren’t able to work as well, leaving excess fluid in your body.
- Liver failure or cirrhosis. Your liver processes nutrients and filters toxins. When your liver isn’t working as it should, fluid can build up in your abdomen.
- Hormonal changes. Women may experience mild fluid retention as a normal part of premenstrual syndrome (PMS) or pregnancy. Excessive fluid retention related to hormonal changes may be a sign of high blood pressure and should be checked out by a doctor.
- IV fluids. Receiving too much IV fluid, especially if there are other health conditions present, can lead to fluid overload and swelling.
If you’re living with CKD: you may be at risk for hypervolemia—especially in later stages as kidney function declines. After a diagnosis of kidney failure, dialysis treatments replace some kidney function to help to remove excess fluid from your body and get you as close to your “dry weight” as possible. Dry weight is your “ideal weight”—the weight your care team determines you would be without the excess fluid in your body.
If you’ve never been diagnosed with CKD: your doctor may perform several tests to help determine the cause of your fluid overload. You’ll probably be given a test to determine the amount of sodium in your blood. You’ll likely also get a urine test to help doctor determine whether your hypervolemia is being caused by a kidney issue. Further testing for kidney function can help your doctor decide which steps to take next.
Nephrotic Syndrome | Cedars-Sinai
Not what you’re looking for?
What is nephrotic syndrome?
Nephrotic syndrome causes scarring or damage to the filtering part of the kidneys
(glomeruli). This causes too much protein to be lost from the blood into the urine.
People with nephrotic syndrome often have:
- Very high levels of protein in the urine (proteinuria)
- Low levels of protein in the blood (hypoalbuminemia)
- Swelling (edema), especially around the eyes, feet, and hands
- High cholesterol
What causes nephrotic syndrome?
Nephrotic syndrome results from damage to the kidneys’ glomeruli. These are the tiny
blood vessels that filter waste and excess water from the blood and send them to the
bladder as urine.
Your glomeruli keep protein in the
body. When they are damaged, protein leaks into the urine. Healthy kidneys allow less
than 1 gram of protein to spill into the urine in a day. In nephrotic syndrome, the
glomeruli let 3 grams or more of protein leak into the urine during a 24-hour
Nephrotic syndrome may happen with other health problems, such as kidney disease caused
by diabetes and immune disorders. It can also develop after damage from viral infections.
The cause of nephrotic syndrome
isn’t always known.
What are the symptoms of nephrotic syndrome?
Nephrotic syndrome is a set of symptoms. These are the most common:
- High blood pressure
- Swelling in the feet and hands, and around the eyes
- Weight gain with fluid retention and swelling
- Signs of infection such as fever, or an elevated white blood cell count
- Swelling and pain linked to blood
clots as the blood becomes thickened
- Urine that looks foamy, caused by
protein loss from the body into the urine
Many of these symptoms may be
caused by other health problems. Always talk with your healthcare provider for a
How is nephrotic syndrome diagnosed?
Your healthcare provider will
review your health history and do a physical exam. Other tests you may need are:
- Blood pressure checks
- Measurement of your cholesterol levels
- Measurement of protein levels in your urine and in the blood
- Kidney biopsy (exam of a sample of kidney tissue)
What is the treatment for nephrotic syndrome?
Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.
Your healthcare provider will try
to find the underlying cause. They will also try to control blood pressure and
cholesterol, and reduce protein in the urine.
Medicines can include:
angiotensin receptor blockers (ARBs).
These lower blood pressure and may be
used in people with diabetes to protect the kidneys.
Corticosteroids. These may be prescribed to reduce
swelling and inflammation within the glomeruli. They also help prevent your immune
system from attacking healthy tissue.
Diuretics. These are cautiously used to decrease the
amount of swelling.
Immune system modifying medicines. These medicines are
used to keep your immune system from attacking the glomeruli.
Cholesterol-lowering medicines. These may be prescribed if
your triglyceride and cholesterol levels are high.
Anticoagulants. These are blood-thinning medicines and may
be prescribed if blood clots develop.
Antibiotics or antiviral medicines. These are used to
treat the underlying infectious cause.
Treatment may also include:
special diet can help delay the need for dialysis and to get rid of extra fluid
and toxins that build up. To prevent more swelling, don’t eat salt. Also stay away
from fats and cholesterol. Be sure to eat lean protein.
have severely impaired filtering.
What are possible complications of nephrotic syndrome?
Serious complications of nephrotic syndrome include kidney failure or
end-stage renal disease (ESRD). This requires short-term or long-term dialysis. Other
- Blood clots
- Decreased thyroid function
Can nephrotic syndrome be prevented?
Not all causes of nephrotic syndrome can be prevented. To prevent damage to the glomeruli:
- Make sure your blood pressure is well controlled.
- If you have diabetes, make sure your blood sugar is controlled.
- Keep up-to-date with vaccines that help to prevent common infections. This is especially
true if you work or live around people who have hepatitis and other viral infections.
- Finish all antibiotics as prescribed.
Don’t stop your antibiotics because you may be feeling better. And don’t save them
for a later date.
When should I call my healthcare provider?
If your symptoms get worse or you have new symptoms, let your healthcare provider
Key points about nephrotic syndrome
- Nephrotic syndrome develops when there
is damage to the filtering part of the kidneys (glomeruli). This results in protein
spilling into the urine.
- Loss of the proteins from your blood
allows fluid to leak out of the blood vessels into the nearby tissues, causing
- The blood in your blood vessels will
become thick with the loss of fluid into the tissue. This increases the risk for a
- Your body will try to replace the lost proteins by increased production through the
liver. This can result in high cholesterol.
- You will need to limit excess sodium
and fluids to prevent worsening fluid buildup in the tissue.
- Medicines are used to treat the underlying cause or help your body get rid of excess
- Dialysis may be needed if kidney
failure develops, which can happen in extreme cases.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider if you have questions.
Medical Reviewer: Walead Latif MD
Medical Reviewer: Donna Freeborn PhD CNM FNP
Medical Reviewer: Raymond Kent Turley BSN MSN RN
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
Not what you’re looking for?
End-stage renal disease // Middlesex Health
End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In end-stage renal disease, your kidneys no longer work as they should to meet your body’s needs.
Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When your kidneys lose their filtering abilities, dangerous levels of fluid, electrolytes and wastes can build up in your body.
With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you can also choose to opt for conservative care to manage your symptoms — aiming for the best quality of life during your remaining time.
Early in chronic kidney disease, you might have no signs or symptoms. As chronic kidney disease progresses to end-stage renal disease, signs and symptoms might include:
- Loss of appetite
- Fatigue and weakness
- Changes in how much you urinate
- Chest pain, if fluid builds up around the lining of the heart
- Shortness of breath, if fluid builds up in the lungs
- Swelling of feet and ankles
- High blood pressure (hypertension) that’s difficult to control
- Difficulty sleeping
- Decreased mental sharpness
- Muscle twitches and cramps
- Persistent itching
- Metallic taste
Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys can make up for lost function, signs and symptoms might not appear until irreversible damage has occurred.
When to seek care
Make an appointment with your health care provider if you have signs or symptoms of kidney disease.
If you have a medical condition that increases your risk of kidney disease, your care provider is likely to monitor your kidney function with urine and blood tests and your blood pressure during regular office visits. Ask your provider whether these tests are necessary for you.
Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. For some people, kidney damage can continue to progress even after the underlying condition is resolved.
Diseases and conditions that can lead to kidney disease include:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) — an inflammation of the kidney’s filtering units (glomeruli)
- Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney’s tubules and surrounding structures
- Polycystic kidney disease or other inherited kidney diseases
- Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
- Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
- Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)
A typical kidney has about 1 million filtering units. Each unit, called a glomerulus, connects to a tubule, which collects urine. Conditions such as high blood pressure and diabetes take a toll on kidney function by damaging these filtering units and collecting tubules and causing scarring.
A healthy kidney (left) eliminates waste from the blood and maintains the body’s chemical balance. With polycystic kidney disease (right), fluid-filled sacs called cysts develop in the kidneys. The kidneys grow larger and gradually lose the ability to function as they should.
Certain factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease, including:
- Diabetes with poor blood sugar control
- Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood
- Polycystic kidney disease
- High blood pressure
- Tobacco use
- Black, Hispanic, Asian, Pacific Islander or American Indian heritage
- Family history of kidney failure
- Older age
- Frequent use of medications that could be damaging to the kidney
Kidney damage, once it occurs, can’t be reversed. Potential complications can affect almost any part of your body and can include:
- Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
- A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart’s ability to function and may be life-threatening
- Heart disease
- Weak bones and an increased risk of bone fractures
- Decreased sex drive, erectile dysfunction or reduced fertility
- Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
- Decreased immune response, which makes you more vulnerable to infection
- Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium)
- Pregnancy complications that carry risks for the mother and the developing fetus
- Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival
If you have kidney disease, you may be able to slow its progress by making healthy lifestyle choices:
- Achieve and maintain a healthy weight
- Be active most days
- Limit protein and eat a balanced diet of nutritious, low-sodium foods
- Control your blood pressure
- Take your medications as prescribed
- Have your cholesterol levels checked every year
- Control your blood sugar level
- Don’t smoke or use tobacco products
- Get regular checkups
To diagnose end-stage renal disease, your health care provider may ask you about your family’s and your medical history. You may also have physical and neurological exams, along with other tests such as:
- Blood tests, to measure the amount of waste products, such as creatinine and urea, in your blood
- Urine tests, to check the level of the protein albumin in your urine
- Imaging tests, such as ultrasound, MRI or CT scan, to assess your kidneys and look for unusual areas
- Removing a sample of kidney tissue (biopsy), to examine under a microscope to learn what type of kidney disease you have and how much damage there is
Certain tests might be repeated over time to help your provider follow the progress of your kidney disease.
Stages of kidney disease
There are five stages of kidney disease. To determine what stage you have, your health care provider performs a blood test to check your glomerular filtration rate (GFR). The GFR measures how much blood the kidneys filter each minute, recorded as milliliters per minute (mL/min). As the GFR declines, so does your kidney function.
When your kidneys no longer work at a level that’s necessary to keep you alive, you have end-stage renal disease. End-stage renal disease usually occurs when kidney function is less than 15% of typical kidney function.
As a part of kidney disease staging, your provider also might test whether you have protein in your urine.
|Kidney disease stage||GFR, mL/min||Kidney function|
|Source: National Kidney Foundation|
|Stage 1||90 or above||Healthy kidney function|
|Stage 2||60 to 89||Mild loss of kidney function|
|Stage 3a||45 to 59||Mild to moderate loss of kidney function|
|Stage 3b||30 to 44||Moderate to severe loss of kidney function|
|Stage 4||15 to 29||Severe loss of kidney function|
|Stage 5||Less than 15||Kidney failure|
During a kidney biopsy, your doctor uses a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle is inserted through your skin and is often directed using the guidance of an imaging device, such as ultrasound.
End-stage renal disease treatments include:
- Kidney transplant
- Supportive care
A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly. A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis.
The kidney transplant process takes time. It involves finding a donor, living or deceased, whose kidney best matches your own. You then have surgery to place the new kidney in your lower abdomen and attach the blood vessels and ureter — the tube that links the kidney to the bladder — that will allow the new kidney to function.
You may need to spend several days to a week in the hospital. After leaving the hospital, you can expect frequent checkups to monitor your progress as your recovery continues. You may take a number of medications to help keep your immune system from rejecting your new kidney and to reduce the risk of post-surgery complications, such as infection.
After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis.
Dialysis does some of the work of your kidneys when your kidneys can’t do it themselves. This includes removing extra fluids and waste products from your blood, restoring electrolyte levels, and helping control your blood pressure.
Dialysis options include peritoneal dialysis and hemodialysis.
For dialysis to be successful, you may need to make lifestyle changes, such as following certain dietary recommendations.
If you choose not to have a kidney transplant or dialysis, you can choose palliative or supportive care to help you manage your symptoms and feel better. You also can combine palliative care with kidney transplant or dialysis.
Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. Death can occur quickly or take months or years. Supportive care might include management of symptoms, measures to keep you comfortable and end-of-life planning.
During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney’s urine tube (ureter) is connected to your bladder. Unless they are causing complications, your own kidneys are left in place.
Lifestyle and home remedies
As part of your treatment for kidney disease, your health care provider might recommend that you follow a special diet to help support your kidneys and limit the work they must do. Ask for a referral to a registered dietitian with expertise in kidney disease to learn ways to make your diet easier on your kidneys.
Depending on your situation, kidney function and overall health, your dietitian might recommend that you:
- Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses.
Choose lower potassium foods. Your dietitian might recommend that you choose lower potassium foods at each meal. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes.
Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure.
- Limit your protein. Your dietitian will estimate the grams of protein you need each day and make recommendations based on that amount. High-protein foods include lean meats, eggs, milk, cheese and beans. Low-protein foods include vegetables, fruits, breads and cereals.
Coping and support
Learning you’re in kidney failure can come as a shock, even if you’ve known about your kidney disease for a while. It might be difficult to manage the treatment schedule if you’re on dialysis.
To help you cope, consider trying to:
- Connect with other people who have kidney disease. It might help you to talk to other people with end-stage renal disease Ask your doctor about support groups in your area. Or contact organizations such as the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund for groups in your area.
- Maintain your routine, when possible. Try to continue to work and do the activities you enjoy, if your condition allows.
- Be active most days of the week. With your provider’s approval, aim for at least 30 minutes of physical activity most days of the week. This can help you with fatigue and stress.
- Talk with someone you trust. It might help to talk about your feelings with a friend or family member, a faith leader, or someone else you trust. Your provider might be able to recommend a social worker or counselor.
Preparing for an appointment
For end-stage renal disease, you’ll likely continue to see the same health care provider and care team you’ve been seeing for treatment of chronic kidney disease. If you’re not already being cared for by a doctor who specializes in kidney problems (nephrologist), you might be referred to one as your disease progresses.
What you can do
To get ready for your appointment, ask if there’s anything you need to do ahead of time, such as make changes to your diet. Then take note of:
- Your symptoms, including any that seem unrelated to your kidneys or urinary function, and when thy began
- All your medications and doses, vitamins or other supplements you take
- Your key medical history, including other medical conditions and family history of kidney disease
- Questions to ask your provider
Take a family member or friend along, if possible, to help you remember the information you’re given.
For end-stage renal disease, some basic questions to ask your provider include:
- What’s the level of damage to my kidneys?
- Is my kidney function worsening?
- Do I need more tests?
- What’s causing my condition?
- Can the damage to my kidneys be reversed?
- What are my treatment options?
- What are the potential side effects of each treatment?
- I have these other health conditions. How can I best manage them together?
- Do I need to eat a special diet?
- Can you refer me to a dietitian who can help me plan my meals?
- Are there brochures or other printed material I can have? What websites do you recommend?
- How often do I need to have my kidney function tested?
Don’t hesitate to ask any other questions you have.
What to expect from your health care provider
Your provider may ask you questions, such as:
- Have you noticed changes in your urinary habits or unusual fatigue?
- Have you been diagnosed or treated for high blood pressure?
How does chronic kidney disease (CKD) affect the handling of salt and water in the kidney and what are the effects?
O’Hare AM, Choi AI, Bertenthal D, Bacchetti P, Garg AX, Kaufman JS, et al. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol. 2007 Oct. 18(10):2758-65. [Medline].
[Guideline] Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003 Jul 15. 139(2):137-47. [Medline].
[Guideline] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013. 3:1-150. [Full Text].
Schnaper HW. Remnant nephron physiology and the progression of chronic kidney disease. Pediatr Nephrol. 2014 Feb. 29 (2):193-202. [Medline].
Lameire N, Van Biesen W. The initiation of renal-replacement therapy–just-in-time delivery. N Engl J Med. 2010 Aug 12. 363(7):678-80. [Medline].
Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011 Nov. 6(11):2567-72. [Medline].
Bash LD, Erlinger TP, Coresh J, Marsh-Manzi J, Folsom AR, Astor BC. Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2009 Apr. 53(4):596-605. [Medline]. [Full Text].
Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, et al. Age and association of kidney measures with mortality and end-stage renal disease. JAMA. 2012 Dec 12. 308(22):2349-60. [Medline]. [Full Text].
de Boer IH. Chronic kidney disease—a challenge for all ages. JAMA. 2012 Dec 12. 308(22):2401-2. [Medline]. [Full Text].
Friedman DJ, Kozlitina J, Genovese G, Jog P, Pollak MR. Population-Based Risk Assessment of APOL1 on Renal Disease. J Am Soc Nephrol. 2011 Nov. 22(11):2098-105. [Medline].
Isakova T, Xie H, Yang W, Xie D, Anderson AH, Scialla J, et al. Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA. 2011 Jun 15. 305(23):2432-9. [Medline]. [Full Text].
Ellis JW, Chen MH, Foster MC, Liu CT, Larson MG, de Boer I, et al. Validated SNPs for eGFR and their associations with albuminuria. Hum Mol Genet. 2012 Jul 15. 21(14):3293-8. [Medline]. [Full Text].
Pattaro C, Köttgen A, Teumer A, et al. Genome-wide association and functional follow-up reveals new loci for kidney function. PLoS Genet. 2012. 8(3):e1002584. [Medline]. [Full Text].
Nordfors L, Luttropp K, Carrero JJ, Witasp A, Stenvinkel P, Lindholm B, et al. Genetic studies in chronic kidney disease: basic concepts. J Nephrol. 2012 Mar-Apr. 25(2):141-9. [Medline].
Su SL, Lu KC, Lin YF, Hsu YJ, Lee PY, Yang HY, et al. Gene polymorphisms of angiotensin-converting enzyme and angiotensin II type 1 receptor among chronic kidney disease patients in a Chinese population. J Renin Angiotensin Aldosterone Syst. 2012 Mar. 13(1):148-54. [Medline].
Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014. 9(1):e84943. [Medline]. [Full Text].
Chronic Kidney Disease in the United States, 2021. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/kidneydisease/publications-resources/CKD-national-facts.html. March 4, 2021; Accessed: April 1, 2021.
Centers for Disease Control and Prevention. Deaths and Mortality. Available at http://www.cdc.gov/nchs/fastats/deaths.htm. March 1, 2021; Accessed: March 31, 2021.
Kidney Disease Statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. Available at https://www. niddk.nih.gov/health-information/health-statistics/kidney-disease#urologic. December 6, 2016; Accessed: April 1, 2021.
CKD in the General Population. United States Renal Data System. Available at https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-general-population. 2020 Annual Report; Accessed: April 1, 2021.
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb 29. 395 (10225):709-733. [Medline]. [Full Text].
Vart P, Powe NR, McCulloch CE, Saran R, Gillespie BW, Saydah S, et al. National Trends in the Prevalence of Chronic Kidney Disease Among Racial/Ethnic and Socioeconomic Status Groups, 1988-2016. JAMA Netw Open. 2020 Jul 1. 3 (7):e207932. [Medline]. [Full Text].
Choi AI, Rodriguez RA, Bacchetti P, Bertenthal D, Hernandez GT, O’Hare AM. White/black racial differences in risk of end-stage renal disease and death. Am J Med. 2009 Jul. 122(7):672-8. [Medline]. [Full Text].
Schold JD, Srinivas TR, Braun WE, et al. The relative risk of overall graft loss and acute rejection among African American renal transplant recipients is attenuated with advancing age. Clin Transplant. 2011 Sep. 25(5):721-30. [Medline].
Hicks PJ, Langefeld CD, Lu L, Bleyer AJ, Divers J, Nachman PH, et al. Sickle cell trait is not independently associated with susceptibility to end-stage renal disease in African Americans. Kidney Int. 2011 Dec. 80(12):1339-43. [Medline].
Wong CS, Pierce CB, Cole SR, Warady BA, Mak RH, Benador NM, et al. Association of proteinuria with race, cause of chronic kidney disease, and glomerular filtration rate in the chronic kidney disease in children study. Clin J Am Soc Nephrol. 2009 Apr. 4(4):812-9. [Medline]. [Full Text].
Norris KC, Agodoa LY. Unraveling the racial disparities associated with kidney disease. Kidney Int. 2005 Sep. 68(3):914-24. [Medline].
United States Renal Data System. Incidence, Prevalence,Patient Characteristics, and Treatment Modalities. 2018 Annual Data Report. Volume 2: ESRD in the United States: [Full Text].
Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011 Apr 20. 305(15):1553-9. [Medline].
Suri RS, Larive B, Sherer S, Eggers P, Gassman J, James SH, et al. Risk of vascular access complications with frequent hemodialysis. J Am Soc Nephrol. 2013 Feb. 24(3):498-505. [Medline]. [Full Text].
McNamara D. More frequent dialysis increases risk for complications. February 13, 2013. Medscape Medical News. Available at http://www.medscape.com/viewarticle/779265. Accessed: August 29, 2013.
Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E. Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure. Kidney Int. 2011 Nov. 80(9):970-7. [Medline].
Wald R, Yan AT, Perl J, et al. Regression of left ventricular mass following conversion from conventional hemodialysis to thrice weekly in-centre nocturnal hemodialysis. BMC Nephrol. 2012 Jan 19. 13(1):3. [Medline].
Raphael KL, Wei G, Baird BC, Greene T, Beddhu S. Higher serum bicarbonate levels within the normal range are associated with better survival and renal outcomes in African Americans. Kidney Int. 2011 Feb. 79(3):356-62. [Medline].
Navaneethan SD, Schold JD, Arrigain S, et al. Low 25-Hydroxyvitamin D Levels and Mortality in Non-Dialysis-Dependent CKD. Am J Kidney Dis. 2011 Oct. 58(4):536-43. [Medline]. [Full Text].
Kendrick J, Cheung AK, Kaufman JS, Greene T, Roberts WL, Smits G, et al. Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease. Am J Kidney Dis. 2012 Oct. 60(4):567-75. [Medline]. [Full Text].
Navaneethan SD, Schold JD, Arrigain S, Jolly SE, Jain A, Schreiber MJ Jr, et al. Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. Am J Kidney Dis. 2011 Oct. 58(4):536-43. [Medline]. [Full Text].
Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ. Validation of depression screening scales in patients with CKD. Am J Kidney Dis. 2009 Sep. 54(3):433-9. [Medline].
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012 Jul 5. 367(1):20-9. [Medline].
Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate?. Clin Chem. 2002 May. 48(5):699-707. [Medline].
Lemoine S, Panaye M, Pelletier C, Bon C, Juillard L, Dubourg L, et al. Cystatin C-Creatinine Based Glomerular Filtration Rate Equation in Obese Chronic Kidney Disease Patients: Impact of Deindexation and Gender. Am J Nephrol. 2016 Jul 12. 44 (1):63-70. [Medline].
Barclay L. ACP Guidelines: Do Not Screen Asymptomatic Adults for CKD. Medscape Medical News. Oct 21 2013. January 8, 2018. [Full Text].
Barclay L. CKD: ASN Recommends Screening, Rejects ACP Statement. Medscape Medical News. Oct 23 2013. January 8, 2018. [Full Text].
Galbraith LE, Ronksley PE, Barnieh LJ, Kappel J, Manns BJ, Samuel SM, et al. The See Kidney Disease Targeted Screening Program for CKD. Clin J Am Soc Nephrol. 2016 Jun 6. 11 (6):964-72. [Medline].
[Guideline] National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Available at http://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm. 2002; Accessed: February 28, 2018.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999 Mar 16. 130(6):461-70. [Medline].
Stevens LA, Schmid CH, Greene T, Zhang YL, Beck GJ, Froissart M, et al. Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis. 2010 Sep. 56(3):486-95. [Medline]. [Full Text].
Silveiro SP, Araújo GN, Ferreira MN, Souza FD, Yamaguchi HM, Camargo EG. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation pronouncedly underestimates glomerular filtration rate in type 2 diabetes. Diabetes Care. 2011 Nov. 34(11):2353-5. [Medline]. [Full Text].
[Guideline] Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR, et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ. 2014 Feb 4. 186(2):112-7. [Medline]. [Full Text].
Harrison L. Canada Guidelines Call for Kidney Dialysis Delay. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/820114. Accessed: February 10, 2014.
Hsu TW, Liu JS, Hung SC, et al. Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia. JAMA Intern Med. 2013 Dec 16. [Medline].
Park M, Hsu CY. An ACE in the hole for patients with advanced chronic kidney disease?. JAMA Intern Med. 2013 Dec 16. [Medline].
O’Hare AM, Hotchkiss JR, Kurella Tamura M, et al. Interpreting Treatment Effects From Clinical Trials in the Context of Real-World Risk Information: End-Stage Renal Disease Prevention in Older Adults. JAMA Intern Med. 2014 Jan 13. [Medline].
Perkovic V, et al; CREDENCE Trial Investigators. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019 Jun 13. 380 (24):2295-2306. [Medline]. [Full Text].
Cherney DZI, Dekkers CCJ, Barbour SJ, Cattran D, Abdul Gafor AH, Greasley PJ, et al. Effects of the SGLT2 inhibitor dapagliflozin on proteinuria in non-diabetic patients with chronic kidney disease (DIAMOND): a randomised, double-blind, crossover trial. Lancet Diabetes Endocrinol. 2020 Jul. 8 (7):582-593. [Medline].
Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8. 383 (15):1436-1446. [Medline]. [Full Text].
Mosenzon O, Wiviott SD, Cahn A, Rozenberg A, Yanuv I, Goodrich EL, et al. Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial. Lancet Diabetes Endocrinol. 2019 Aug. 7 (8):606-617. [Medline].
Bakris GL, et al; FIDELIO-DKD Investigators. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. October 23, 2020. [Full Text].
[Guideline] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15. 71 (19):2199-2269. [Medline]. [Full Text].
[Guideline] Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021 Mar. 99 (3):559-569. [Medline]. [Full Text].
Peralta CA, Norris KC, Li S, et al. Blood Pressure Components and End-stage Renal Disease in Persons With Chronic Kidney Disease: The Kidney Early Evaluation Program (KEEP). Arch Intern Med. 2012 Jan 9. 172(1):41-47. [Medline].
Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD. J Am Soc Nephrol. 2011 Dec. 22(12):2313-21. [Medline].
Levey AS, Adler S, Caggiula AW, et al. Effects of dietary protein restriction on the progression of moderate renal disease in the Modification of Diet in Renal Disease Study. J Am Soc Nephrol. 1996 Dec. 7(12):2616-26. [Medline].
Kasiske BL, Lakatua JD, Ma JZ, Louis TA. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis. 1998 Jun. 31(6):954-61. [Medline].
Fishbane S, Chittineni H, Packman M, Dutka P, Ali N, Durie N. Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial. Am J Kidney Dis. 2009 Oct. 54(4):647-52. [Medline].
Douglas D. Vitamin D Curbs Albuminuria in Kidney Disease. Medscape Medical News. Available at http://www.medscape.com/viewarticle/810806. Accessed: September 16, 2013.
Molina P, Górriz JL, Molina MD, Peris A, Beltrán S, Kanter J, et al. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant. 2013 Aug 24. [Medline].
Plantinga L, Grubbs V, Sarkar U, et al. Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States. Ann Fam Med. 2011 September-October. 9(5):423-430. [Medline]. [Full Text].
Brown T. Potentially Unsafe Prescribing Common in Patients With CKD. Medscape Medical News. Available at https://www.medscape.com/viewarticle/893606. March 8, 218; Accessed: March 9, 2018.
Hallan SI, Orth SR. Smoking is a risk factor in the progression to kidney failure. Kidney Int. 2011 Sep. 80(5):516-23. [Medline].
Busko M. L-thyroxine dampens renal function decline in CKD with SCH. June 19, 2013. Medscape Medical News [serial online]. Available at http://www.medscape.com/viewarticle/806543. Accessed: June 25, 2013.
Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, et al. Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism. Thyroid. 2013 Jun. 23(6):654-61. [Medline]. [Full Text].
Shurraw S, Hemmelgarn B, Lin M, Majumdar SR, Klarenbach S, Manns B, et al. Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease: A Population-Based Cohort Study. Arch Intern Med. 2011 Nov 28. 171(21):1920-1927. [Medline].
[Guideline] Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, et al. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med. 2018 Feb 20. S1-130. [Medline]. [Full Text].
Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutiérrez OM, et al. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis. 2017 Dec. 70 (6):737-751. [Medline].
[Guideline] Dasgupta I, Shroff R, Bennett-Jones D, McVeigh G, NICE Hyperphosphataemia Guideline Development Group. Management of hyperphosphataemia in chronic kidney disease: summary of National Institute for Health and Clinical Excellence (NICE) guideline. Nephron Clin Pract. 2013. 124 (1-2):1-9. [Medline]. [Full Text].
Shaman AM, Kowalski SR. Hyperphosphatemia Management in Patients with Chronic Kidney Disease. Saudi Pharm J. 2016 Jul. 24 (4):494-505. [Medline]. [Full Text].
Rizk R. Cost-effectiveness of phosphate binders among patients with chronic kidney disease not yet on dialysis: a long way to go. BMC Nephrol. 2016 Jul 8. 17 (1):75. [Medline]. [Full Text].
Block GA, Wheeler DC, Persky MS, Kestenbaum B, Ketteler M, Spiegel DM, et al. Effects of phosphate binders in moderate CKD. J Am Soc Nephrol. 2012 Aug. 23(8):1407-15. [Medline]. [Full Text].
de Brito-Ashurst I, Varagunam M, Raftery MJ, Yaqoob MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009 Sep. 20(9):2075-84. [Medline]. [Full Text].
Harrison P. Sodium Bicarbonate Slows Chronic Kidney Disease Safely. Medscape Medical News. Available at https://www.medscape.com/viewarticle/914574. June 18, 2019; Accessed: July 19, 2019.
Barclay L. CKD: KDIGO Guidelines Recommend Wider Use of Statins. Medscape Medical News. Available at http://www.medscape.com/viewarticle/817504. Accessed: December 16, 2013.
[Guideline] Tonelli M, Wanner C. Lipid Management in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2013 Clinical Practice Guideline. Ann Intern Med. 2013 Dec 10. [Medline].
Ha JT, Neuen BL, Cheng LP, Jun M, Toyama T, Gallagher MP, et al. Benefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease: A Systematic Review and Meta-analysis. Ann Intern Med. 2019 Jul 16. [Medline].
Piccoli GB, Capizzi I, Vigotti FN, Leone F, D’Alessandro C, Giuffrida D, et al. Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?. BMC Nephrol. 2016 Jul 8. 17 (1):76. [Medline]. [Full Text].
Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010 Dec 8. CD006763. [Medline].
Slagman MC, Waanders F, Hemmelder MH, et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ. 2011 Jul 26. 343:d4366. [Medline]. [Full Text].
Vegter S, Perna A, Postma MJ, et al. Sodium Intake, ACE Inhibition, and Progression to ESRD. J Am Soc Nephrol. 2012 Jan. 23(1):165-73. [Medline].
Romanowski A. Diets for Patients With CKD: What’s New, What’s Best?. Medscape Medical News. Available at https://www.medscape.com/viewarticle/910884. March 27, 2019; Accessed: May 1, 2019.
Clegg DJ, Hill Gallant KM. Plant-Based Diets in CKD. Clin J Am Soc Nephrol. 2019 Jan 7. 14 (1):141-143. [Medline]. [Full Text].
Goraya N, Simoni J, Jo C, Wesson DE. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney Int. 2012 Jan. 81(1):86-93. [Medline].
Mallamaci F, Pisano A, Tripepi G. Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial. Nephrol Dial Transplant. 2020 Mar 1. 35 (Suppl 2):ii18-ii22. [Medline]. [Full Text].
Barcellos FC, Santos IS, Umpierre D, Bohlke M, Hallal PC. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J. 2015 Dec. 8 (6):753-65. [Medline].
Sakaguchi Y, Shoji T, Kawabata H, Niihata K, Suzuki A, Kaneko T, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol. 2011 May. 6(5):995-1000. [Medline]. [Full Text].
Fluid Weight Gain: Investigate the Cause When You Have Kidney Disease
Provided by DaVita® Dietitians
Are you a dialysis patient who has been struggling with weight gains that are too high? If so, it’s time to investigate the cause.
For dialysis patients, there are two types of weight: dry weight and fluid weight. Dry weight refers to your weight when your blood pressure is controlled and there is no excess fluid in your body. Fluid weight is the weight you gain between dialysis treatments from the foods and fluids you take in.
Healthy kidneys remove excess fluid from the body when you eat or drink liquids. When kidneys do not work well, they do not make enough urine to remove the extra fluid from the body, causing fluid weight gain.
What are the symptoms of too much fluid?
Between your dialysis treatments, gaining too much fluid can cause:
If you gain too much fluid between treatments, you may experience the following symptoms during dialysis:
Anything that is liquid at room temperature is considered to be fluid. This includes ice, gelatin, Popsicles® and soup. Be careful that you don’t consume foods high in sodium, or salt, because they will make you thirsty, and you are likely to then consume more fluids.
What causes fluid weight gain?
If you are gaining too much fluid weight, some detective work is needed to uncover the cause. The following clues will help you solve the case.
Are you using salt or eating salty foods? These are examples of salty foods you may be overindulging in:
- Cured meats, such as ham, bacon, sausage, hot dogs or luncheon meats
- Frozen dinners, canned soups or soup mixes
- Foods in brine, such as pickles, olives or sauerkraut
- Bouillon cubes, soy sauce or steak sauce
- Foods coated with salt, including crackers, popcorn, potato chips or pretzels
- Foods from fast food restaurants
- Meat or poultry that has been “enhanced” or “infused” with a sodium phosphate solution
- Salty seasonings such as garlic salt, onion salt, celery salt, lemon pepper or monosodium glutamate (MSG)-based flavor enhancers
There are other ways that you might be adding too much fluid to your body:
- Using chewing tobacco or snuff, which causes thirst
- Drinking more than 32 ounces (1 quart) of fluid each day (or the amount prescribed by your doctor)
- Not counting “hidden fluids” such as ice, soup, gelatin and Popsicles® as part of your fluid allowance
Solve the problem by limiting your fluid intake so that you do not gain excessive fluid weight between dialysis treatments. Your renal dietitian can help you determine the appropriate amount of fluid to take in. Remember that it is important to come to all scheduled dialysis treatments so that the fluid you have gained can be removed.
Excess fluid can be harmful to the body and difficult to get rid of when you have kidney disease and need dialysis. Now that the clues have been put together you can avoid excess fluid weight gain between dialysis treatments. By avoiding high-sodium food and sources of hidden fluids, you are less likely to gain too much fluid weight between dialysis treatments.
Nephrotic Syndrome – Kidney and Urinary Tract Disorders
Drugs, often including an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB)
When a person who already has nephrotic syndrome is treated with an ACE inhibitor or ARB, symptoms may decrease, the amount of protein excreted in the urine usually decreases, and fat concentrations in the blood are likely to decline. However, these drugs can increase the potassium levels in the blood in people who have moderate to severe kidney failure, which can cause potentially dangerous heart rhythm abnormalities.
General therapy for nephrotic syndrome includes a diet that contains normal amounts of protein and potassium but that is low in saturated fat, cholesterol, and sodium.
If fluid accumulates in the abdomen, the person may need to eat frequent, small meals because the fluid reduces the capacity of the stomach.
High blood pressure is usually treated with diuretics. Diuretics can also reduce fluid retention and tissue swelling but may increase the risk of blood clots.
Anticoagulants may help control clot formation if it occurs. Infections can be life threatening and must be treated promptly.
Statins, drugs that lower the amount of cholesterol in the blood, may also be needed if people have increased levels of fats (lipids) in the blood.
Whenever possible, specific treatment is aimed at the cause. Treating an infection that causes nephrotic syndrome may cure the syndrome. If a treatable disease, such as certain cancers, causes the syndrome, treating that disease can eliminate the syndrome. If a heroin user with nephrotic syndrome stops using heroin in the early stages of the disease, the syndrome may resolve. If other drugs are responsible for the syndrome, stopping the drugs may be curative. People who are sensitive or allergic to poison oak, poison ivy, or insect bites should avoid these irritants.
If no reversible cause can be found, the person may be given corticosteroids and other drugs that suppress the immune system, such as cyclophosphamide. However, corticosteroids cause problems, particularly for children, in whom these drugs can stunt growth and suppress sexual development (see sidebar Corticosteroids: Uses and Side Effects Corticosteroids: Uses and Side Effects Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints. … read more ).
90,000 Administration of human albumin for the treatment of edema in people with nephrotic syndrome
What is the problem?
Nephrotic syndrome is a kidney disorder in which large amounts of protein are excreted in the urine. The loss of protein leads to fluid retention, which normally should be excreted in the urine, and the swelling usually begins in the ankles, sometimes spreading to the hands and face.
Treatment of edema is often carried out with the use of diuretics (drugs that stimulate the kidneys to increase the excretion of salt and water from the body).However, diuretics alone are often ineffective in nephrotic syndrome. Human albumin is used to replace lost protein. This can lead to migration of fluid from the area of edema back into the bloodstream, followed by excretion through the kidneys. Albumin can be given as monotherapy or in combination with diuretics. We wanted to find out if albumin is effective in treating edema in people with nephrotic syndrome.
What have we done?
We searched for randomized controlled trials (RCTs) or quasi-RCTs that compared (1) albumin with placebo or no treatment, (2) albumin with diuretics (diuretics), (3) a combination of albumin and diuretics with diuretics in monotherapy and (4) albumin with other therapies.We excluded crossover studies, but could include data from the first period before the crossover if available. The last search was done in June 2019.
What have we found?
One small RCT (26 patients) meeting the inclusion criteria was found during the preparation of the review, in which the combination of human albumin and the diuretic furosemide was compared with placebo. We found nine studies in people with nephrotic syndrome that made and evaluated these comparisons.However, these were cross-sectional studies that we found unsuitable. To find out if albumin leads to any improvement, the study measured weight loss and serum sodium levels. The assessed adverse effect was a change in blood pressure. Although the authors reported a greater reduction in body weight, we were unable to confirm this due to the inconsistency (inconsistency) between the data indicated in the table and in the text. There was no change in serum sodium or blood pressure.We rated the certainty for all of these outcomes as very low. There were no reports of mortality, quality of life, and kidney function.
Since only one small study was found, we cannot say if albumin is effective in people with nephrotic syndrome, and based on the studies we reviewed, we do not know if it is safe. There is no evidence for adult patients. We rated the certainty of the evidence as very low.Therefore, further RCTs are required.
Pyelonephritis in pregnant women. The author of the article: gynecologist Pavlova Irina Aleksandrovna.
03 December 2019
Family Health Magazine
Pyelonephritis is an inflammatory
the process in the renal pelvis caused by various microorganisms (translated from
Greek “pyelos” – pelvis, “nephros” –
bud).Kidney disease among extragenital pathological processes in pregnant women takes the second place.
- Causes of occurrence
Mechanical cause: associated with the characteristic feature of pregnancy – growth
uterus. As the uterus grows, the ratio of all internal organs also changes
abdominal cavity; the uterus begins to press
and the intestines, and the diaphragm, and other organs.
The ureters, the channels that conduct
urine from the kidneys to the bladder.They are located so that the growing uterus in the pelvic area begins to squeeze and
squeeze them, making it difficult to pass
urine through the ureters. The causative agent of pyelonephritis is
gram-negative bacteria, most often
Escherichia coli. An infectious process in the kidneys leads to the threat of rejection of the ovum: the tone increases
uterus, there are signs of a threat of miscarriage. Fetal miscarriage with pyelonephritis is observed 5 times more often than with
pregnancy in healthy women.The infection enters the placenta, where it occurs
inflammation up to necrosis (necrosis)
and fetal death.
Another reason is hormonal changes in the body of a pregnant woman. Quantity
some hormones increase, while others, on the contrary, decrease. These changes contribute to the fact that the peristalsis of the ureters is also difficult.
Thus, conditions are created for
incomplete emptying, stagnation of urine in the renal pelvis. Even minimal stagnation
is fraught with urine infection.
In addition, for the normal functioning of the kidneys and urinary
systems, it is desirable to maintain an active image
life.And as the gestation period increases, women are often more and more passive – they move little (more often they lie or
Especially often pyelonephritis occurs
in pregnant women who have suffered in childhood or
adolescence, cystitis (inflammation of the bladder) or pyelonephritis. By
statistics, it is exacerbated in 20-30% of such
Childbirth is often complicated by abnormalities in the labor force. In the postpartum period may
develop inflammation of the uterus, infection of wounds.
- Effect of pyelonephritis on
At first, pregnancy creates the prerequisites for the development of pyelonephritis, but in
In case of illness, pyelonephritis itself adversely affects pregnancy.
Late toxicosis, spontaneous abortion is more often observed
early or late, develops
- Effect of pyelonephritis on
At first, pregnancy creates the prerequisites for the development of pyelonephritis, but in
In case of illness, pyelonephritis itself adversely affects pregnancy.Late toxicosis, spontaneous abortion is more often observed
early or late, develops
It is mandatory to perform a general blood and urine test, as well as urine culture, (i.e.
laboratory diagnostics) before starting antibiotic therapy.
X-ray and radionucleide research methods are contraindicated. Greatest Benefits in Pregnancy
has an ultrasound examination (ultrasound),
which makes it possible to assess the condition of the mother’s kidneys and the condition of the fetus.This
the method allows you to identify the expansion of the renal cavity system, indicating
about a violation of the outflow of urine from the kidney, stones
in the urinary tract and changes in the perineal tissues. Ultrasound of the urinary system should be the first step.
Treatment must be timely
and complex. Acute pyelonephritis without signs of urinary tract obstruction is primarily subject to antibiotic therapy. If ultrasound shows signs of urinary tract obstruction
(expansion of the calyx-pelvis system),
then treatment of the pregnant woman begins with restoring the outflow of urine using a stent catheter, which can be held in
urinary tract before delivery, during labor and
after them.If the passage (outflow) of urine is not restored in a timely manner, then there may be a threat of endotoxic shock.
Treatment is stationary, as it is necessary to clarify which antibiotic
the pathogen is sensitive, constantly monitor blood and urine parameters. V
depending on the severity of the disease in a hospital ward, you can spend from a week to
The main components in the treatment of pyelonephritis are antibiotics and other
antibacterial drugs prescribed by a doctor (herbal antiseptics, drugs that improve renal blood flow).Against the background of the treatment of pyelonephritis
the signs of the threat of termination of pregnancy decrease. With progression
severe forms of the disease, despite
treatment, it is necessary to raise the question of termination of pregnancy, in view of the threat to
life of a woman. An even greater threat to the life of a pregnant woman is chronic
pyelonephritis. In chronic pyelonephritis, in view of prolonged inflammatory
the process is thinning of the cortical
layer, thickening of the walls of the calyx and pelvis, hardening of blood vessels, and as a result – wrinkling of the kidney and its violation
functions.Exacerbation of chronic pyelonephritis during pregnancy can
lead to additional stress on the kidneys, as well as hypothermia, infectious diseases, poor working conditions.
In this case, it is imperative to “flush” the kidneys. You can drink vegetable
kidney tea, cranberry juice, decoctions
Pregnancy flowing in the background
chronic pyelonephritis, characterized by frequent threats of termination of pregnancy – 10-20%; 3-6% – miscarriages;
12-15% – premature birth.In women with chronic pyelonephritis, pregnancy in 80% of cases
complicated by preeclampsia, which significantly worsens the prognosis. Development is possible
severe complications: acute renal failure, bacterial toxic
shock, sepsis. Chronic pyelonephritis in
pregnant women are characterized by a persistent course, difficult to treat, often combined with urolithiasis and
can itself contribute to nephrolithiasis,
In 10% of cases, it is necessary to carry out an early delivery.In women with chronic pyelonephritis
pregnancy is often complicated by intrauterine growth retardation (15
%), chronic placental insufficiency (35%), chronic fetal hypoxia
(thirty %). Often cause of premature
termination of pregnancy is often a severe combination of gestosis that has arisen
against the background of chronic pyelonephritis. Gestosis often occurs with abnormalities in the development of the kidneys (polycystic, the risk of developing
obstetric complications in pregnant women with
abnormalities of the urinary tract
increases in the absence of pregravid
preparation).Children born to a mother with inflammatory diseases of the genitourinary
tract, often have signs of intrauterine infection, malformations of the genitourinary system (MPS). That’s why
in mothers suffering from MPS, it is necessary
timely conduct an ultrasound scan in order to identify anomalies in the structure of various organs and systems in the fetus.
Prevention of pyelonephritis in pregnant women is aimed at identifying various
signs of illness, timely
adequate treatment of asymptomatic bacteriuria, prevention of exacerbations of the inflammatory process.As pregnancy progresses
the role of the mechanical factor in
the occurrence of urodynamic disorders. In this regard, positional therapy is used for the knee-elbow position, the position on the side, opposite
to the side of the lesion to improve outflow
Qualitatively, the composition of food does not differ
any features. Fluid intake should not be limited. Necessary
monitor bowel function, as constipation supports kidney inflammation.In case of constipation, it is recommended to introduce into the diet foods that cause weakening of the intestines (prunes, beets,
compote or rhubarb jelly), or set
bowel function with herbal laxatives. Calorie content
food should be 2000-3000 kcal. At
in the acute stage of the disease, the amount of fluid can be increased to 2.5-3 liters
per day. The amount of table salt is not
needs to be limited, since with pyelonephritis there is no salt retention and
- If not treated!
The consequences of letting it go or
poorly treated pyelonephritis are known. First of all, this disease adversely affects the fetus. The fruit can
suffer from an intrauterine infection from the mother. This infection can
lead to spontaneous abortion or premature birth.
Intrauterine infection manifestations
in a newborn child can be different: from the simplest disease
eye – conjunctivitis, not representing
special danger for a child, up to severe
infectious lesions of the lungs, kidneys and
other organs.In addition, intrauterine growth develops.
fetal hypoxia, when, due to changes in the mother’s body, the fetus receives
less oxygen than he needs to
normal growth. This threatens with fetal malnutrition – less weight, insufficient
its development. During the neonatal period
these children are more likely to get sick.
All women who have had pyelonephritis
during pregnancy, need follow-up. After discharge
from the maternity hospital they should be examined by a local therapist and put on a dispensary
accounting.This is important because these women have
kidney damage may remain, and although
it is not sufficiently expressed, it follows
heal. Therefore, a medical
follow-up and appropriate follow-up studies until the end of pregnancy and
To prevent the development of pyelonephritis or any other complication of pregnancy, it is necessary as much as possible
consult a doctor earlier about pregnancy, regularly visit a woman’s
consultation, listen to advice
doctor and carry out his appointment.
Share on social networks
How to maintain kidney health – Clinical Hospital №6 named after G.A. Zakharyina
Published: 26 March 2019
How to keep your kidneys healthy: 10 habits you need to give up.
The kidneys perform an essential function: they cleanse the blood of those metabolic products that cannot be used by the body for energy and the construction of new cells. With the urine produced by the kidneys, most of the toxins that enter it with food and water are removed from the human body. Normal kidney function ensures the elimination of excess fluid from the body and maintenance of ionic balance. In the event of malfunctions in the excretory system, toxic substances are retained in the body, which causes severe complications, and in a neglected situation can lead to death.Like all important organs, the kidneys are highly resistant to harmful influences and for some time they work normally, not responding to nutritional disorders, increased loads and other aggressive factors. However, this cannot last forever: sooner or later, habits that adversely affect the state of the excretory system lead to disorders, sometimes irreversible. This is why everyone should know how to keep their kidneys healthy. Smoking and alcohol consumption About 10% of the nicotine absorbed by a smoker enters the bloodstream unchanged and is transferred by the kidneys into the urine.In addition, poisonous tar and other tobacco combustion products are filtered out. All of these substances have a destructive effect on the most important structure of the kidney – the basement membrane. As a result, its permeability is disrupted, proteins begin to enter the urine, and over time, renal failure develops. The risk of severe renal disease such as glomerulonephritis is 18 times higher in regular smokers than in non-smokers. A direct relationship between tobacco consumption and kidney cancer has also been established: after several years of smoking, the likelihood of tumors doubles.Alcohol intake creates a huge additional burden, forcing the excretory system to function in an enhanced mode. As a result, the body becomes dehydrated, the blood becomes thicker, which makes it extremely difficult for the kidneys to filter it. Not without reason, after active libations, many people experience pulling, obsessive lower back pain: this is how the body reacts to truly ruthless exploitation. If these episodes are repeated regularly, kidney damage is inevitable. Kidney-damaging habits: smoking and drinking.Lack of sleep.
During sleep, the cells of the body are restored, including the kidney tissue. Chronic lack of sleep leads to the fact that this process is not active enough. People who spend less time sleeping than necessary often suffer from hypertension. The blood pressure in the vessels is directly related to the work of not only the cardiovascular system, but also the kidneys: chronic excess of the norm provokes the gradual development of renal failure. Kidney-damaging habits: Not getting enough sleep Excessive caffeine consumption Caffeine is a powerful diuretic.An excess of it in the body causes dehydration and an increase in blood viscosity, which negatively affects the functioning of the kidneys. Contrary to popular belief, a person gets caffeine not only from coffee. Tea contains no less of this substance. Many soft drinks (especially tonics) as well as chocolate are rich in caffeine. Kidney-damaging habits: Excessive caffeine intake. Avoiding foods rich in vitamin B6 The largest amount of vitamin B6 (pyridoxine) is found in meat, eggs, offal, milk, cabbage (especially cauliflower and broccoli), sea fish (tuna, cod), garlic, melon, wheat bran.An adult needs to get from 2 to 2.3 mg of this vitamin daily. Pyridoxine is involved in protein metabolism and nucleic acid synthesis. Its deficiency in the body leads to the development of many serious pathologies, including kidney stones. Kidney-damaging habits: avoiding foods rich in vitamin B6
Sedentary lifestyle. Sedentary work, daily routine that does not include walking, lack of physical activity have a bad effect on all organs and systems of the body.In particular, these factors contribute to the stagnation of fluids, a decrease in the speed of blood flow, a change in the composition of the blood, that is, the complication of the work of the excretory system. Normally, the kidneys pass more than 1500 liters of blood through themselves every day. As a result of filtration, about 2 liters of urine is formed, containing toxins and metabolic end products. In a person who avoids exercise and excess movement, blood flow is slowed down, due to which the kidneys cannot completely purify the blood. It is gradually oversaturated with harmful substances, which, in turn, makes the kidney filters work with increased stress.As a result, the body may become intoxicated, and the kidneys may wear out prematurely. Experts note that people leading a sedentary lifestyle often suffer from inflammatory diseases of the excretory system and kidney stones. Kidney-damaging habits: sedentary
Delayed emptying of the bladder. In the hustle and bustle of city life, a person often does not immediately respond to the signals sent by an overflowing bladder. Meanwhile, regular delays in emptying it are fraught with the development of renal failure, as well as urinary incontinence.Habits that harm the kidneys: delayed emptying of the bladder Passion for salty food Table salt is necessary for normal metabolism, but its intake into the body should not exceed 5 g per day. Unfortunately, most people are fond of salty foods: chips, crackers, dried and salted fish products, deli meats, smoked meats, canned food, and fast food. The modern city dweller, as a rule, receives from 10 to 20 g of salt per day. An excess of it in the diet causes fluid retention in the body and seriously hinders the functioning of the kidneys.The problem is solved simply: you need to consume industrially made food and dishes as little as possible and slightly undersalted homemade food. Habits that harm the kidneys: addiction to salty foods. Inadequate adherence to diets In their quest to find an ideal figure, women often overuse diets. The result can be a chronic disease of the excretory system. The fact is that the kidneys are surrounded by a layer of fat. Low-calorie diets lead to the fact that the body begins to use internal fat reserves to obtain the necessary energy.With excessive weight loss, the kidneys are deprived of their natural defenses, in addition, their prolapse (ptosis) can occur – a severe pathology that causes severe pain and seriously reduces the patient’s quality of life. Kidney-damaging habits: inadequate dietary intake. Excess protein in the diet. Today, protein diets are very fashionable, involving increased protein intake to the detriment of carbohydrates and fats. With such a diet, the kidneys work with unnecessary stress. An excess of protein breakdown products in the blood causes an increased concentration of calcium in the urine and, accordingly, a high risk of developing kidney stones.Habits that harm the kidneys: excess protein in the diet. Limiting water intake. Some people believe that by reducing their water intake, they can avoid swelling. In fact, drinking less than 2 liters of liquid per day is very risky. Such a regime has a bad effect on the composition of the blood, deteriorating its rheological properties and increasing its viscosity. It becomes difficult for the kidneys to filter out harmful substances that remain in the bloodstream and poison the body. As for edema, it is not an excess of fluid that is usually to blame for their appearance, but a violation of its excretion.Kidney-damaging habits: limiting water intake. Everyone can keep their kidneys in working order. To do this, it is enough not to overcool, lead an active lifestyle, prevent unjustified eating disorders and give up bad habits. Of course, if you experience discomfort in the lumbar region, problems with urination, changes in the color and structure of urine, you should immediately consult a doctor.
90,000 types of diseases, diagnosis, treatment and prevention
The kidneys are one of the most important organs in the human body, as they provide the normalization of pressure, the removal of toxins and toxins, as well as the control of blood elements.
Constantly experiencing stress, they are exposed to various pathologies.
Often, kidney disease, which is treated by urologists and nephrologists, occurs when:
- Excessive alcohol consumption
- Lack of rest
- Disorders in the work of other organs
- Bladder overflow and even weight loss
Such pathologies cannot be ignored! When you find the first signs, you should contact a specialist.
Doctors of the MEDSI clinics will conduct an examination and, having quickly diagnosed, will prescribe a treatment that takes into account the stage of the pathology and the patient’s condition.
The first signs of kidney disease
As a rule, at the onset of kidney disease signal about themselves with general discomfort and mild chills. Because of this, renal pathologies are often confused with the common cold. Nevertheless, many patients manage to help themselves on their own.
Experienced patients who have already experienced kidney diseases warm up their legs, drink hot tea and go to bed.Symptoms may indeed recede, but this does not mean that the disease itself has receded.
Often, resting and warming up the legs is not enough. The disease will progress and will require more serious treatment. Therefore, you cannot ignore the symptoms, and self-medication is simply dangerous!
Symptoms of kidney disease in men and women
Also, patients complain of discomfort and pain, concentrating in the zone of the kidney projection (to the left and right of the lower back).
The main symptoms of kidney disease include:
- Difficulty urinating
- Frequent urge (mainly at night)
- Increased body temperature and blood pressure
- Swelling of the lower extremities
- Face puffiness
- Appearance of blood and / or foam in urine
Women are more likely to suffer from kidney infections. Their signs are more pronounced and appear already 40–48 hours after the infection has entered the body.In women, the main symptom of pathology is often pain, which can be either aching and dull, or rather acute.
Painful urination also becomes an unpleasant symptom. With some pathologies, even a delay in menstruation is possible. Women often complain of swelling of the legs and face, which is especially pronounced in the morning, immediately after sleep.
Men usually do not pay attention to unexpressed symptoms and go to the clinic already with severe pain, cloudy urine and a serious fever.The main complaints also include dry mouth, drowsiness and flaky skin.
Kidney disease in women and men
The most common diseases include:
- Renal failure
- Acute and chronic glomerulonephritis
Also, men suffer from urinary obstruction and renal colic.Often, pathologies are quite dangerous and rapidly progressing. This is due to the fact that men often start the disease and go to the doctor quite late.
Kidney disease in women 90 105
Common diseases are :
- Ascending pyelonephritis
Cystitis and urethritis are very often provoked by simple hypothermia.
Women, as a rule, monitor their health more closely, but are more vulnerable to kidney pathologies. To start the mechanism of the disease, a simple cold is often enough and the weakening of the immune system causing it.
Diet for kidney disease
In case of any kidney diseases, patients must be prescribed a dietary meal. It is based on the presence of carbohydrates and the restriction of fats and proteins. Particular attention is paid to products with a minimum salt content.
Proper nutrition in case of illness allows not only to reduce the severity of symptoms , but also to recover faster.
Recommended for patients:
- Eat small meals and often enough
- Drink no more than 1.5 liters of liquid
- Refuse alcoholic beverages
Should be excluded:
- Broths based on meat, fish and mushrooms
- Fatty meat
- Pickles and marinades
- Spices, condiments and hot sauces
Include in the diet:
- Low-fat dairy
- Raw and steamed vegetables
- Butter and olive oil
- Dried fruits
- Steamed lean meat
- Natural juices
- Vegetable broth
- Eggs (no more than 2-3 per day)
- Cereals and pasta
Kidney disease: treatment by conservative methods
Treatment of kidney diseases is always carried out in a comprehensive manner.Pharmaceuticals are combined with a variety of treatments and proper nutrition. Particular attention is paid to herbal medicine. In case of kidney disease, patients are prescribed special teas, decoctions and infusions.
Important! Herbal medicine is ineffective without medicines!
With minor inflammations, drugs are prescribed that improve urination and relieve spasms. If small stones and sand are found, agents that dissolve them are recommended. To relieve the pain symptom, special drugs are also prescribed.
Specialized fees are recommended in some cases. With their prolonged use, the work of the kidneys is significantly improved, and the urinary tract is cleared.
Important! Folk remedies are ineffective for serious pathologies. In some cases, they can even harm the patient rather than benefit.
Any treatment should be prescribed only by a doctor, after a comprehensive diagnosis. During therapy, the patient’s condition is constantly monitored. This allows you to monitor the effectiveness of certain drugs, if necessary, replace them or change the dosage.
Kidney disease: surgical treatment
If conservative therapy does not give the desired result, they resort to surgical treatment.
The main ways are:
- Nephrostomy. This operation is aimed at restoring the outflow of urine and allows you to eliminate pain and avoid the occurrence of an infectious process
- Stenting. It is aimed at normalizing the patency of the urinary tract
- Nephrotomy is aimed at removing the kidney or part of it
Chronic kidney disease
Chronic kidney disease is a dangerous phenomenon with a complex course that develops over three or more months and occurs when an organ is damaged or its function decreases.Such a pathology requires not only constant treatment, but also regular visits to the urologist, as well as strict adherence to a number of recommendations.
Chronic kidney disease occurs if acute forms of disease are not treated on time. Concomitant pathologies also lead to the aggravation of the patient’s condition, including:
- Diabetes mellitus
- Chronic infectious processes
Chronic illness is characterized by increased blood pressure, anemia (a decrease in hemoglobin in the blood), a decrease in sodium and calcium levels with an increased content of potassium and magnesium in the blood.For an accurate diagnosis, you need to conduct a comprehensive examination.
Prevention allows to improve kidney function and keep them healthy for many years.
Preventive measures include:
- Compulsory consumption of fresh fruits, berries and vegetables, dairy and seafood
- Sauna visit. Dry heat is the key to healthy kidneys, as it ensures their filtration function and increases the supply of blood and nutrients to organs
- Drinking a sufficient amount of fresh clean water (at least 1.5-2 liters per day)
For kidney health, it is important to give strong tea and coffee, replacing them with herbal tea or mineral drinking water.
Benefits of kidney disease treatment in MEDSI
- Full range of services for the diagnosis and treatment of kidney diseases
- Collaboration of experienced urologists and nephrologists with therapists, cardiologists and endocrinologists
- Modern methods of treatment
- Individual approach
Doctor of the highest qualification category
Head of the Center for Urology, Andrology and Oncourology
Deputy Chief Physician for Clinical and Diagnostic Work, urologist
Doctor of the highest qualification category
- Standards of the International Association of Urology
- High-precision diagnostics using state-of-the-art equipment
- Modern high-tech operating rooms and hospitals
- Da Vinci Unique Robot Surgeon
- Minimally invasive techniques
- Reduced risk of perioperative complications
- Accelerated Rehabilitation and Recovery
90,000 Chronic renal failure in cats
CKD (Chronic Renal Failure) in cats is a disease characterized by impaired renal function.This disease is caused by chronic kidney disease (CKD), which often occurs in cats over seven years of age and often has no clinical manifestations.
In chronic renal failure, renal function is already impaired by 60-75%, and clinical signs appear, which we will talk about later. Renal failure can be acute or chronic. Acute renal failure can occur with acute urinary retention with urolithiasis, nephrotoxic poisoning and other reasons. In this article, we will talk in more detail about the chronic process.
Main functions of the kidneys in cats:
- Blood filtration and urine formation
- Maintaining the balance of body fluids and electrolytes
- Synthesis of erythropoietin, calcitriol, renin
- catabolism of polypeptide hormones (growth hormone, glucagon, etc.)
What triggers this process or symptoms of renal failure?
- Renal perfusion disorders, dehydration (dehydration), hypovolemia (decrease in circulating blood volume), arterial hypertension.
- Trauma, urinary tract obstruction.
- Urinary tract infections, tumors, toxins.
This disease usually occurs in older cats. But it also occurs in younger pets in a number of cases. For example, with genetic pathologies (amyloidosis, polycystic disease) or chronic viral infections (VIC, VLC, viral infectious peritonitis), as well as with poisoning (ethylene glycol, lily plants) and treatment with drugs that affect kidney function (NSAIDs, diuretics).
Also, some breeds have a genetic predisposition, for example, Scottish, British, Russian Blue, Abyssinian, Burmese, Siamese, and Maine Coons. The main mechanisms of the development of the disease can be explained by the fact that due to ischemia or when exposed to nephrotoxins on the kidney tissue, the narrowing of the organ vessels leads to insufficient tissue perfusion and cell hypoxia, metabolism is impaired. As a result of these processes, the membrane and epithelium of the renal tubules are damaged.
With vasodilatation, the hydrostatic pressure in the renal tubules decreases, and the glomerular filtration rate also decreases. As a result of these processes, diuresis decreases, and the reabsorption of solutes and water decreases. These processes lead to the death of nephrons (kidney cells) and a gradual decrease in kidney size and, as a result, to a decrease in organ function.
Symptoms of renal failure in cats
Unfortunately, these symptoms appear when the kidneys are severely affected, and these changes are usually irreversible.All of these clinical signs are usually caused by intoxication.
- Deterioration of coat quality / bad breath (often due to uremic ulceration)
- Weight loss to wasting
- Polyuria / polydipsia (increased urine volume / increased thirst)
- Decreased appetite / anorexia
- Nausea / vomiting (often due to uremic gastritis)
- Decreased activity, lethargy / behavioral change
- Diarrhea or constipation (constipation)
- Impaired coordination and even seizures, coma and others.
Diagnosis of chronic renal failure
- General urinalysis (OAM)
- Urine protein / creatinine ratio
- Bacteriological culture of urine
- General clinical and biochemical blood test, T4 general
- SDMA (is a marker of early kidney damage)
- ultrasound of the kidneys
In the general blood test at stages 1-2, there may not be any changes, and at 3-4 stages according to IRIS, there will most likely be anemia, a decrease in hematocrit (blood viscosity), sometimes an increase in the level of leukocytes during infection.
In a biochemical blood test, the level of creatinine, urea, phosphorus, total protein, and sometimes calcium will be increased. Potassium is often reduced.
A general urinalysis (OAM) test generally has decreased density, protein may be elevated, and bacteria can be detected in case of infection.
The protein / creatinine ratio will be increased.
On ultrasound, as a rule, we can reveal a decrease in the size of the kidneys, polycystic, hydronephrosis, neoplasia.
Increased level of T4 hormone total.in the blood will indicate concomitant hyperthyroidism, and it can also “mask” high levels of urea and creatinine.
Stages of chronic renal failure according to IRIS
- 9041 stages: creatinine less than 140 mmol / l, SDMA less than 14, blood pressure less than 150/95 mm Hg.
Determination of the stage and prognosis of the disease is carried out only in a stabilized patient.
Substages of CPN:
- Non-proteinuric less than 0.2 protein
- Boundary proteinuric 0.2-0.4 protein
- Proteinuric more than 0.4 protein
Treatment of Feline Chronic Renal Failure
Chronic renal failure cannot be cured, but the development of the disease can be successfully controlled and the quality and duration of life can be improved.
The treatment strategy for feline chronic renal failure depends primarily on the stage of the disease. In the first and second stages, cats primarily need to monitor blood pressure, body weight, appetite and general condition. With arterial hypertension, drugs with an antihypertensive effect are prescribed. Prescribing a renal diet for such patients is not always required. Since these foods do not have a high palatability, some cats are reluctant to eat them, and accordingly, they will lose body weight, which can accelerate the development of the disease.First of all, such patients need monitoring every 4-6 months, subject to a stable condition and good appetite.
Patients with stage 3-4 need control over the same parameters if the animal is stable. The approach to unstable patients is quite different. These cats are admitted to the clinic in a severe state of decompensation. Often they have to be stabilized in a hospital setting for several days and, unfortunately, not always successfully. These cats are placed with an intravenous catheter for constant access to the vein and infusion therapy for rehydration.
The infusion volume is calculated taking into account the body weight and the percentage of dehydration. That is, the cat is connected to a special device (infusion pump), which allows for continuous intravenous infusion of the solution. Monitoring of body weight, blood pressure, hematocrit or complete clinical and biochemical blood test is mandatory. In the case of arterial hypertension, such patients are prescribed hypotension, as a rule, it is Amlodipine or Enalopril, and sometimes their combination. The dosage is selected starting from the starting one and increased if necessary.
Cats with vomiting and anorexia are prescribed gastroprotective agents and antiemetic drugs such as Maropitant or Metoclopramide, Omeprazole, Mirtazapine and others. Blood tests are monitored to control inflammation and anemia. With inflammation, antibiotics are prescribed, with anemia and a decrease in the hematocrit level, blood transfusion is often required. For this, whole blood or erythrocyte mass is used.
Purpose of blood transfusion in case of chronic anemia: to raise the hematocrit level by 10%.Control is carried out 24-48 hours after transfusion. Maintain hematocrit levels with Erythropoietin or Darbepoetin alfa by subcutaneous injections once a week. And also prescribe iron preparations and cyanocobalamin (vitamin B12).
With positive dynamics and patient stabilization, the doctor prescribes long-term therapy. As a rule, these are periodic subcutaneous injections of electrolyte solutions, and with an increased level of phosphorus, drugs that reduce it (phosphate baenders).Telmisartan for proteinuria (cats with increased protein loss, according to studies, live shorter), hypotension and, of course, dietary renal foods with a low protein content. Nowadays, a sufficiently large amount of high quality food is produced and, most importantly, with different tastes and different consistencies, to please even the most fastidious cats. Such patients also need to control pressure, weight and donate blood every 3-6 months.
Prevention of renal failure
In order to avoid problems in older cats, doctors recommend that cats over 5 years of age should be examined.Early detection of pathologies is always a safer and less costly scenario.
90,000 Edema is a manifestation of the disease
Swelling of the legs in the evenings from fatigue, swelling of the face with lack of sleep and eyes after a particularly sentimental movie at night looking or a heavy dinner with something particularly salty, swelling with bruises and sprains is a fairly common phenomenon that most of us consider a purely cosmetic problem – Well, what if your legs are swollen?
At first, a not very disturbing condition may later cost you too much.
Despite the opinion of some about the “normality” of edema, it is better to worry about their elimination.
Edema that is very well observed towards the end of the day – for example, edema of the lower extremities. We spend most of the daytime in an upright position, so by the evening it becomes clearly visible that the legs are swollen – during the night the liquid is distributed more or less evenly over the body and the swelling disappears for a while.
Swelling can be easily identified by shoes – the ankle joint can increase in size by 1 cm or more.Those who wear rings can also notice swelling on their hands, or rather fingers – if there is swelling, the ring will leave a depressed mark on the finger or it will be very difficult to remove it. In severe cases, edema spreads throughout the body, from the legs to the face.
Latent edema can be recognized at home only in pregnant women and only if the arrow on the scales indicated a specific weight gain per week, clearly outside the normal range.
How and why?
Edema appears with water retention in the body, and at the first appearance of edema, water retention is not attributed to impaired renal function. Most often this is due to improper water-salt metabolism, when sodium salts are not excreted from the body, or with hormonal dysfunction, in which antidiuretic hormone and aldesterone exhibit increased activity.
Edema in itself is only a symptom of the disease, therefore, first of all, it is necessary to look for the cause and treat it.
Causes and Features
Edema is different in the mechanism of occurrence and location. Although the diagnosis and treatment can only be prescribed by a specialist, it is within our power to understand the causes and prevent complications.
- Pregnancy – edema during pregnancy has a special mechanism due to a violation of the water-salt balance in the body of a pregnant woman and compression of the lymphatic and venous vessels by the growing uterus, which impedes the outflow of fluid from the lower parts of the body
- Kidney disease – edema appears on the face and eyelids in the morning, depending on the condition of the kidneys, it can either decrease in the evening or increase
- Heart disease – symmetrical edema, occurs on the legs in the late afternoon and disappears in the morning.With the development of heart failure, the edema spreads up the legs, and does not go away by morning. Swelling is one of the first manifestations of heart failure and an unconditional reason for seeking medical attention
- Diseases of the veins – dense, asymmetric edema, accompanied by pain in the legs, a feeling of heaviness in them, swelling of the veins of the lower extremities, redness of the feet, appear and increase during the day
- Edema in liver diseases – manifested by ascites – the accumulation of fluid in the abdominal cavity – and edema of the anterior abdominal wall.May be accompanied by the appearance of spider veins and itching of the skin, yellowness of the skin and mucous membranes
- Allergic reaction – edema can be local – at the site of skin contact with the allergen, and generalized – edema of the whole body. Quite a common variety – Quincke’s edema – swelling of the face, lips, neck, larynx. Requires the provision of timely medical care, without it, it leads to asphyxia and respiratory arrest
- Diseases of the joints – edema is accompanied by pain when moving in large joints, redness and an increase in local temperature in the area of the joint.Separately, it is worth mentioning such a phenomenon as lymphostasis – a violation of lymph outflow causes the formation of dense edema of a permanent nature with a gradual change in the contour of the surrounding tissues
- Swelling in metabolic disorders – develops against the background of fasting or an unbalanced diet with insufficient intake of protein from food, digestive disorders, after surgery on the intestines, in case of intestinal diseases – due to impaired absorption of proteins into the blood
- Diseases of the endocrine organs – when the thyroid gland is dysfunctional, edema occurs on the hands and feet.Changes in general condition are characteristic – drowsiness, lethargy, low temperature, rare heart rate
How to prevent the danger?
- Most of the advertised “anti-edema” ointments have a prophylactic rather than therapeutic effect. They can improve blood microcirculation and venous outflow, but they will not remove the root cause of edema, so you should not rely on them, it is better to start with a lifestyle change
- Pay attention to your food – revise the menu and exclude salinity, various liquids where possible
- To avoid the appearance of edema, do not sit still – in the literal sense of the word.Water sports, aerobics and all dynamic sports: walking, running, skiing, cycling, skating – will help improve the condition of blood vessels and reduce the appearance of puffiness
- Everyone has heard of the simplest method of reducing swelling in the legs – lying with raised legs, in this case, the so-called postural drainage occurs, in which blood and lymph drain under its own weight from tired legs
- In the evenings before bed, go out for some fresh air.If possible, set aside time for sleep during the day
You must inform your doctor about the signs of puffiness that you could detect on your own for examination and selection of therapy. The elimination of the problem is solved only at the medical level with the obligatory finding out of the cause.
There are contraindications. Read the instructions or consult a specialist.
General principles of kidney support and prevention of edema syndrome
The problem of edema worries many women, and my clients are no exception.Symptoms often appear in the late afternoon, when the extremities are swollen – because of this, some of us even find it difficult to be in shoes! Others feel an increase in fluid retention in the pre-menstrual period, and this is reflected in the scale – we can gain about 1 to 2 kg at the end of the cycle and during menstruation. Some of my clients suffer from edema all year round, others only in the summer. Today I propose to talk about the most common causes of edema and how to support the kidneys.
In the previous article, “Water balance and fluid retention,” we started talking about this and looked at the classification of causes of fluid retention from a functional medicine perspective.We also discussed salt and its effect on edema . Now let’s move on to reasons that are less obvious, but quite common.
SDK and allergy
There are 2 main types of allergic reactions:
- True, classic allergy (reaction of type 1 immunoglobulins E or G4, genetic hypersensitivity), in which there are such well-known symptoms as redness of the skin, rashes, tearing, coughing, shortness of breath, etc. Extreme manifestations – Quincke’s edema, anaphylactic shock. Example: allergies to oranges, seafood, eggs, nuts, etc. Another example: celiac disease. Correction of this type of allergy: Lifetime elimination of the allergen product.
- Latent food allergy (type 3 reaction, IgG activation, caused by leaky gut syndrome (SDS)). Example: Intolerance to lactose, gluten, black or red pepper, or just about anything. Correction: temporary elimination (removal, exclusion) of products that irritate the immune system; decreased intestinal permeability + improved digestion and gastrointestinal health (ideally, a full 4R program).
In both types, there may be excess fluid accumulation in the body – edema. At the same time, the first type is much less common, because its causes lie in genetics. While the second type is much more widespread and much less often detected due to the non-specificity of symptoms and the delay of their manifestation in time.
Latent food allergy / intolerance symptoms:
- Headache, migraine
- Weight gain
- IBS, diarrhea
- Joint pain
- Chronic fatigue
- Aggressiveness, mood swings
- Decreased memory and concentration, etc.
It’s amazing how varied and non-specific are the symptoms that may indicate intolerance! At the same time, there may be no reaction on the skin at all, and latent food intolerance, as a rule, does not threaten life (unlike a true allergy, in which suffocation and anaphylactic shock may occur). The time period during which a reaction can occur after a meal is up to two to three days, despite the fact that few people perceive food as a trigger for their discomfort : well, which of you will correlate your headache with the roll that you eat each day?
Therefore, very often a person simply does not know why he has this or that state, and gets used to it.People live like this for years, decades … But if you try to identify an inappropriate offender product, then within 1-4 months you can reduce the level of antibodies to it and get rid of the tormenting symptoms!
In addition, with latent food intolerance , the function of the gastrointestinal tract is also reduced, and a situation arises when incompletely digested food enters the lower intestine, which is an irritating factor for the intestinal walls. As a result, histamine is released, which makes the walls more porous – “leaky”, and in addition, by itself, increases inflammation and provokes fluid retention.
Inflamed intestine is not able to fully absorb nutrients, pathogenic microflora grows , and healthy flora is suppressed (everyone has probably heard about the syndrome of bacterial or fungal overgrowth). The toxic load increases , intestinal motility changes (constipation or diarrhea occurs, or they alternate). Toxins overload the liver, which further reduces digestion and detoxifies.because these functions largely depend on the health of the liver. A vicious circle occurs: inflammation – decreased digestion – toxins – inflammation.
With SDK, “ nephrotic syndrome m” may occur: foreign particles, penetrating through the intestinal “holes” into the blood, enter the kidneys, settle there for a while, causing the excitation of the immune system, which tries to destroy these particles. At some point, the immune system may begin to perceive the kidney tissue as an “enemy” (the effect of molecular mimicry).In the case of the kidneys, the result can also be an autoimmune reaction (glomerulonephritis) and nephrotic syndrome (edema, low protein and albumin levels in the blood against a background of high cholesterol).
If eliminate the cause of – temporarily remove food that causes intolerance (elimination-reintroduction diet), and “patch” holes in the intestines (4R program), then edema also disappears, and excess weight can be lost much faster.
General principles of kidney support
- Compliance with the drinking regime (1.5-2 liters of water per day, especially in summer).Why exactly so much water do we need, we discussed in this article. At the same time, it is better to drink the main amount in the first half of the day, and not in the evening. In hot weather, the amount of water can (and should) be increased. Pay attention : juice, tea, coffee, compote, soup, smoothie is not water!
- It is important to get enough nutrients , which will help to reduce the level of internal inflammation and, as a consequence, the need to store water (i.e., swelling).Antioxidants will be used: vitamins C, A, E, vit. B6, selenium and other variants including glutathione and its precursors, astaxanthin, coenzyme Q10, curcumin, green tea epigallocatechins, resveratrol, etc. This also includes omega-3 as it reduces inflammation (at a dosage of 1.5 – 2 grams of EPA + DHA). Omega-6, on the other hand, will promote fluid retention as has a pro-inflammatory effect. Therefore, it is worth limiting it in your diet (read more about omega fats in this article).
- It is important to limit sugar intake and alcohol .All this will increase inflammation and return us to edema.
- Connect aerobic exercise ( en aerobic exercise will, on the contrary, provoke fluid retention).
- It is important to monitor your weight – a normal body weight and the absence of a “life buoy” around the waist will contribute to normal kidney function without overloading them.
- Maintain a stable blood pressure . With low blood pressure, the kidneys work slower, which is not good, and with high blood pressure, the load on the kidneys increases, which can damage them.The balance of potassium and sodium has a significant effect on blood pressure (more on this below).
- Limit (but don’t cut it at all!) sodium in your diet, and make sure enrich your diet with fresh plant foods that are naturally rich with potassium . The cells contain the so-called. sodium-potassium pump, which regulates cellular “respiration”, the transport of substances into and out of the cell, osmosis and self-purification of the cell, the synthesis of proteins, enzymes and other vital components with the help of K and Na ions.It is on the balance of Na and K that the life of the cell largely depends. Due to the excess sodium in our diet and the body’s tendency to accumulate it, as well as the leaching of potassium in the urine (especially during stress, physical and mental stress), the balance is disturbed, which can lead to premature cell death, low energy and decreased activity of various functions.
- Limit the use of NSAIDs (pain relievers such as aspirin, ibuprofen, etc.). They increase intestinal permeability – what is dangerous, we have discussed above, as well as in this article.
- Watch out for to avoid spikes in blood sugar levels and insulin . This is critical because high sugar damages the vessels of the kidneys (and all vessels in general). High insulin stimulates fluid accumulation and should be monitored as well.
- You can connect various herbal teas or mono- herbs : alfalfa, thyme, lingonberry leaf, oregano, calendula, St.
- You can gently stimulate urination using foods (and additives from them) such as celery, cranberries, dandelion, parsley, elderberry, etc.
- In PMS magnesium is good or foods rich in them – dark leafy greens, nuts , dark chocolate (more than 75% cocoa). If you use magnesium in dietary supplements, then it is better to choose the form of malate or citrate.
- Gentle lymph massage stimulates lymph flow and helps to get rid of swelling faster.
- Incorrectly selected drugs for the correction of cardiovascular problems can lead to edema. If the swelling is caused by diseases of the heart, as well as of the liver, lungs or the kidneys themselves, it is imperative that work with the root cause of . You also need to maintain venous health .
- Pay attention to absorption of protein by your body and its amount in the blood – low protein levels will negatively affect kidney health. At a minimum, you can take a coprogram and blood biochemistry: the presence of muscle fibers and connective tissue in the coprogram and a low total protein in the blood are a reason to think about GIT health .
Cover photo by Chris Ralston on Unsplash.
Like this article? I would be grateful if you share it in social. networks with your friends.
P.S .: If you need an individual consultation, see more details here.
In order not to miss anything, join my groups on Instagram, Facebook and VKontakte, and also subscribe to the blog newsletter (in the right column).