Hi,
Please let me define first what chronic kidney disease and renal failure are.
Chronic kidney disease is the consequence of many different disorders and diseases in the kidneys. Chronic kidney disease results in progressive damage, which eventually impairs all the functions of the kidneys.
On the other hand, renal failure is when your kidneys completely stop working as t and this is typically irreversible.
When your kidney function drops below 10%, patients can become very ill, the situation can be life-threatening, and dialysis or a transplant needs to be performed.
There are five stages of chronic kidney disease, from stage 1 to 5; stage 5 the most advanced.
The 5 stages are classified according to the so-called GFR, which stands for glomerular filtration rate. GFR is a measurement of kidney function, which is an approximate percentage of kidney function.
In stage 1, the GFR is normal. This means that the way your kidneys clean the blood is still normal and sufficient, but there is already detectable damage to the kidneys.
From stages 2, 3, and 4, the damage to the kidneys become progressively worse, and the kidney function starts dropping progressively.
By stage 4, patients probably already need to start preparing for dialysis or for a kidney transplant.
By stage 5, the patient can feel very ill. The situation can be life-threatening, and dialysis needs to be started, or a kidney transplant needs to be performed.
When does one start feeling signs and symptoms of kidney failure?
It is by stage 4, and definitively by stage 5, when the patient starts having symptoms or signs of kidney disease.
In earlier stages, typically the patient has no symptoms or only minor symptoms. Thus, it's common to be unaware that he or she is suffering from kidney problems.
As such, detecting chronic kidney disease early is important. In many instances, the disease's progression can be halted if lifestyle modifications and medications are started in time.
Why is it that most patients don't realise that they have kidney disease?
Unfortunately, chronic kidney disease has no symptoms in the earlier stages, what means that patients might not be aware there is an on-going problem.
Hence, they seek out medical attention late, which allows the kidneys to be progressively damaged.
Early detection is a critical step in the management of people who are at risk of kidney problems.
But from another perspective, having no symptoms in earlier stages can be good as patients can still enjoy life and perform all their activities as normal.
In early stages of kidney disease, patients must focus on protecting the kidneys and minimise disease progression with a better lifestyle and diet, medications and an adequate monitoring strategy.
What are the symptoms of chronic kidney disease?
When the kidneys are ill, they cannot control the water content of the body very well, so the patient starts retaining fluid and becomes breathless and easily fatigued.
The blood pressure of the patient becomes high, and this can give the patient a headache and can silently damage many organs.
The patient can also feel:
- very weak
- very lethargic
- nausea with vomiting,
- severe itch
- be unable to sleep or concentrate because toxins that the kidneys normally clear start to build up
- anaemic and weak because the kidneys are not producing the hormone erythropoietin to boost the red blood cell count. Hence, the patient will need to have erythropoietin injections.
Patients can also have bone pains, deformities and even fractures because the diseased kidneys are not activating the vitamin D necessary for calcium absorption and to make the bones stronger, and there is also dysregulation with phosphorus and other problems with mineral metabolism.
There can also be an imbalance in the blood levels of potassium, sodium, calcium, phosphorus, magnesium and many other minerals. This can be life-threatening on occasion, especially in advanced untreated stages.
Other organs can also be affected when you have kidney disease
When the kidneys are ill, many other organs are also affected.
For instance, patients with kidney failure are at increased risk of heart attacks, heart failure, or arrhythmias, which are erratic beats of the heart.
The blood pressure can go very high and damage many other organs. This may precipitate a heart attack or stroke. If the potassium levels go too high, it can even make your heart stop.
As I mentioned before, the bones and muscles can also become very weak.
What is uraemia?
Uraemia is when the patient becomes malnourished due to toxins in the blood.
This may cause patients to bleed from the stomach.
Uraemic blood means that many organs cannot perform their functions, such as the liver and the brain. This can affect mood, intellect and performance. The patient can become more anaemic, requiring very high doses of erythropoietin or maybe blood transfusions. With severe fluid retention, the oxygen levels drop and they can become drowsy.
Finally, there are also another set of symptoms for glomerulonephritis which are different from chronic kidney disease, but that is a separate discussion.
I hope you find the answer useful. Please do not get too alarmed and worried, although it is good to be aware of potential symptoms and signs especially if are already having kidney problems or relatives who suffer kidney diseases.
If in doubt, you can consult a nephrologist for further advice.
Dr Francisco, wishing you the best possible health.
