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How Do I Know If I Have It?

For a diagnosis, your physician will have you undergo blood and urine tests, and frequently an ultrasound. If the diagnosis remains unclear, your doctor may also do a needle biopsy, using a special needle device to remove a small sample of kidney tissue for microscopic examination.

What Are the Treatments?

Kidney disease is a life-threatening condition that requires medical care. Alternative treatments may be used to supplement that care, but before trying them you should discuss them thoroughly with your doctor.

Medications, especially those that control diabetes and high blood pressure, can sometimes help slow the progress of chronic kidney disease. Some medical practitioners have found that certain restrictive diets are useful, particularly if the condition is caught early. But if these measures fail, and the kidneys deteriorate to the point where they can no longer function at all, there are only two treatments: dialysis, in which artificial devices clean the blood of waste products, or a kidney transplant.

If you are diagnosed with one of the more serious forms of kidney disease, your doctor may prescribe several medications. Because high blood pressure is both a cause and a symptom of the condition, you will probably receive a prescription for one or more blood pressure lowering medications including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, and others. Since your kidneys help balance the chemicals in your blood, your doctor will have you take various supplements including calcium and vitamin D. Calcium acetate (Phoslo) is especially useful for preventing the absorption of phosphorus, which your kidney's would normally control.

The kidneys also manufacture a substance called erythropoietin, which regulates the manufacture of red blood cells. Your doctor will most likely give this in the form of shots or during your dialysis session to maintain your blood count. Along with this, your doctor may have you take iron supplements. Because many drugs are excreted through the kidneys, you will also need to consult with your doctor before taking any over-the-counter medications. You may be told to avoid ibuprofen and acetaminophen, which have been implicated as possible contributors to kidney disease.

Although the approach remains controversial in conventional medical circles, a growing number of physicians now encourage dietary changes to help manage chronic kidney disease. Some studies have shown that rigid adherence to a diet that severely restricts protein can delay or even prevent continued kidney deterioration. This is especially true of people whose kidney disease is the result of diabetes. Studies have shown that diabetics who follow a diet that keeps their blood glucose levels within a tight range can help retard the progression of kidney disease.

Dialysis treatment, which uses artificial devices to perform the kidneys' functions, is necessary for cases of advanced kidney disease. Two types of dialysis are commonly used today. Hemodialysis involves a mechanical filter that cleans the blood. A surgeon implants a shunt, a small tube that connects an artery and a vein in the patient's arm or leg. Several times a week, for three or four hours at a time, another tube is connected to the shunt and the patient's blood is pumped out of the body into the hemodialyzer and then pumped back in.

Another method, called peritoneal dialysis, makes use of the inner lining of the abdomen, or peritoneal membrane - which has many of the kidneys' filtering characteristics - to help clean the blood. A plastic tube is surgically implanted in the patient's abdomen. Then, during each treatment, a fluid called dialyzate is infused through the tube into the abdomen. Waste products carried by the blood circulating through tiny vessels in the peritoneal membrane filter into the dialyzate, which is drained out after several hours. This process is repeated three to five times a day. While the fluid is in the abdomen, the patient can go about normal daily activities.

Both types of dialysis present possible complications and risks, most notably that of infection. The stress of having to continually do the procedure can also take its toll on a patient's emotional well-being. For these reasons, people with advanced kidney disease often opt for a kidney transplant. New anti-rejection drugs and improved follow-up care have greatly increased the success rate for such surgery.

Not every person with kidney disease is a candidate for a transplant; a patient may have an underlying condition or other medical factor that rules out such an operation.

A special restricted diet can decrease the workload on diseased kidneys, keep body fluids and chemicals in balance, and fend off a buildup of waste products in the body. Although such diets should be specifically tailored to each patient's individual needs, they all typically incorporate the following general restrictions:

• Protein: no more than 0.8 gram per kilogram of body weight per day.
• Potassium and sodium are restricted based on the levels of these electrolytes in your blood.
• Phosphorus restriction is usually accomplished by adhering to protein restrictions. If dietary changes are not enough, your doctor will usually prescribe "phosphorus binders" to further lower your levels of phosphorus.
• Calcium supplements (1,000 to 1,500 mg per day) are frequently recommended in order to counteract the bone weakening that frequently accompanies kidney disease. You may also need a vitamin D supplement, as failing kidneys have problems producing active vitamin D.