Hi,
Thank you for your question.
Chronic kidney disease includes different types of diseases of the kidneys, like diabetes, high blood pressure, different types of inflammation of the kidneys, allergies, urine flow problems, rare diseases, recurrent infections, etc. So, the treatment will be divided in a) specific treatment to control the original disease, b) to treat other accompanying conditions to minimize further damage to the kidneys, and c) other general strategies to try to prolong the life of the kidneys.
It is not possible to mention all the specific treatments for specific diseases or associated conditions, but the principle is simple: if diabetes is the cause, aim for good sugar control; if blood pressure is the cause or accompanying factor, aim for good blood pressure control; if inflammation is the cause, assess whether disease-targeted or general anti-inflammatory drugs are necessary, etc. And there are many options to achieve those targets, that is, many ways to achieve good diabetic control, for example.
But in what I can expand is on the section related to general measures to protect the kidneys. The following measures are pertinent:
1.Aim for good blood pressure control, reduce salt intake and monitor your blood pressure at home.
2.Quit smoking.
3.Lose weight through diet improvements (reduce sugary, fatty food; ideally with the guidance of a dietician and a weight loss programme if too difficult to do it alone or you have tried and fail).
4.Do exercise (as tolerable, but consult your doctor first) to maintain your weight and improve your health.
5.Control your blood cholesterol, if high, with diet or medications.
6.If you have diabetes, reduce sugary food and sugary drinks and aim for good blood sugar control.
7.If your doctor prescribed certain diet restrictions, consult a dietician (it is simpler and more effective than figuring out on your own). In general, patients with kidney problems benefit from a diet low in sodium, fat and sugar; and in many occasions low in potassium and phosphate (requiring sometimes to take phosphate binders).
8.Protein restriction in the diet can benefit many patients, retarding in some the progression of kidney disease, but please check this with your doctor as it depends greatly in how advanced your disease is, your nutrition status and many other factors.
9.In advanced stages of kidney disease, water restriction might be necessary as progressively it is more difficult for ill kidneys to handle the excess of water and you can develop fluid retention. So, if your doctor prescribed fluid restriction, try to attach to it, otherwise, you can develop fluid overload with leg swelling, breathlessness, tiredness, potentially flooding the lungs and precipitating a heart failure episode. Frequently, patients need to take diuretics (water tablets) to eliminate excess of fluids retained.
10.Attend regularly your appointments and do not miss them, even if you feel ok.Kidney problems in early and moderate stages are typically asymptomatic (ie you do not feel anything wrong), so that can give you false reassurance. By missing appointments, you can miss to discover things on time and miss the chance to intervene opportunely with the aim of delaying progress of your kidney dysfunction.
11.Take all your medications as prescribed. Some patients are on anti-proteinuric medications, as they can protect your kidneys, but some patients might have contraindications and cannot use them. Check this with your doctor.
12.Many patients with high cardiac risk factors can benefit from taking aspirin or special types of blood pressure tablets, so ask your doctor if they are suitable for you as not everyone can take aspirin, for example.
13.If you have anaemia, take your iron supplements and/or administer your erythropoietin injections as prescribed to improve your haemoglobin levels to the recommended range.
14.If your blood is acidic (low serum bicarbonate), take your bicarbonate supplements.
15.If your uric acid is high, take care of your diet and take anti-uric acid medications if prescribed by your doctor
16.Ask your doctor if you need some vitamin supplements.
17.If you have a stressful life, check what can you do to minimise your stress.
18.Check with your doctor if your 25 vitamin levels must be checked, and if low, take supplements. In addition, some patients with advanced kidney disease might need also to take a more special active type of vitamin D or other medications to control the phosphorus and calcium in your body.
19.If you have high blood pressure and/or diabetes, you might need to see an eye doctor to examine the back of your eye.
20.Check what vaccinations are ideal for you. It varies patient to patient but typically, vaccinations against influenza, pneumococcus vaccination and hepatitis B vaccination are advisable.
21.If you do not drink alcohol, good for you. If you do, do it with moderation.
22.If you have chronic kidney disease and renal cysts, you might need monitoring of the appearance and size of the cysts by ultrasound, performed at different intervals. Consult your doctor to see if this is necessary for you.
23.Inform your doctor immediately after becoming pregnant as you might need to discontinue medications like anti-cholesterol and anti-proteinuric medications or any other special medication given for certain kidney problems (diseases with inflammation in the kidneys) like some immunosuppressants
24.Go back to consult your doctor if you have queries or worries about your health or side effects of therapies, which can be more common in patients with kidney problems, or if you do not respond as both expected to the strategy proposed by your doctor.
Finally, I need to mention there is no magical medication or strategy to make the kidneys recover, so in many patients the aim and expectation is to maintain the kidney function stable for as long as possible or if deteriorating, to deteriorate as slow as possible; that is, the aim is to prolong the life of the kidneys, hopefully for the rest of the lives of the patients.
Since the treatment is complex and needs to be personalized to your condition and wishes after carefully explained the rationale, pros and cons of all options, my practical recommendation is to allow your kidney doctor to explain all that to you, taking into account your personal priorities and preferences.
Dr Francisco, wishing you the best possible health.
