Often considered a silent killer, the symptoms of chronic kidney disease (CKD) fail to present until function as measured by glomerular filtration rate (GFR) is severely decreased. The signs and symptoms may be nonspecific and caused by other illnesses, which may delay diagnosis, leading to continued damage of the kidneys. People with early stage kidney disease may not feel sick because of the adaptability of the kidneys and major symptoms may not appear until the kidneys are irreversibly damaged. Medical research is constantly working on treatment options for this condition.
Stages of Chronic Kidney Disease
Kidney disease is measured in 5 stages, each progressing toward more severe complications. The first stage may reflect only structural changes or abnormal urine analysis, such as blood or proteinuria. Most people will not know they have stage 1 kidney disease, because the kidneys adapt and compensate for lost function.
Much like stage 1, stage 2 is defined by further reduction in kidney functions (slight decrease in GFR), yet patients are not aware of any problems
nor experience recognizable symptoms.
Complications occur when the disease reaches stages 3 and 4. The reduction in kidney functions can be as much as 50 – 75% less filtration rates. Patients begin to feel fatigue, retain fluids, experience nausea and stomach pain, neuropathy, and other symptoms of varying severity. Because there is no cure, early diagnosis is very important to start treatments right away.
Stage 5 is end stage kidney disease and requires dialysis and/or a kidney transplant. The kidneys have lost the ability to function properly. Toxins and waste build up in the blood, causing damage to other tissues and organs in the body. Patients are at a very high risk for cardiovascular injury and congestive heart failure.
Treatments and Medical Research
Diabetes Mellitus is the most common cause of CKD. “Kidney disease is one of the comorbidities of diabetes,” explained Dr. Louis B. Chaykin, a physician and endocrinologist at Meridien Research. “It presents major complications with the microvascular system and leading cause for patients going on dialysis or to receive transplants.”
Finding albumin in the urine of diabetic patients indicates a decrease in kidney filtration. In addition to leading to kidney failure, the finding of albumin in the urine is a marker for increased risk of cardiomyopathy. Controlling blood sugar levels and blood pressure can delay or reverse the damage.
Therapeutic options for diabetics with CKD are found in medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) and losartan. These new therapies relax the blood vessels through preventing the production of angiotensin II. Results from early studies with these drugs show a decrease in total mortality and can delay the need for dialysis.
Dipeptidyl peptidase-4 (DPP-4) inhibitors are another promising therapy being studied for patients with CKD. Current research suggests that this class of inhibitors manage glycemic levels with fewer side effects, such as severe hypoglycemia or weight gain. They may potentially reduce the incidence of albuminuria and diabetic nephropathy. However, more research is needed to prove the kidney-protective properties DPP-4 may provide.
Complications from CKD disease can affect almost every part of the body. People who have the following conditions may increase their risk for kidney disease:
- Diabetes (type 1 and 2)
- High blood pressure
- Cardiovascular disease
- Family history and older age
For people with CKD, medications still in trials can manage many of the complications that arise from loss of kidney function. Promising research is appearing on the horizon toward better therapies for people stricken with this pernicious disease.