Chronic kidney disease (CKD) is a progressive condition that affects millions of people worldwide, often silently compromising kidney function over time. This common yet frequently underdiagnosed health issue can have far-reaching implications for overall health and quality of life. As the kidneys play a crucial role in filtering waste, balancing electrolytes, and regulating blood pressure, the gradual decline in their function can lead to a cascade of health problems. Understanding CKD, its risk factors, and treatment options is essential for early detection and management, potentially slowing the progression to end-stage renal disease and improving long-term outcomes.

What Do the Kidneys Do?

The kidneys are important organs that play a vital role in maintaining overall health. These bean-shaped organs, each about the size of a fist, are located on either side of the spine just below the rib cage. Healthy kidneys perform several crucial functions that keep the body in balance. Their efficiency is often measured by the glomerular filtration rate (GFR), which estimates how much blood passes through the tiny filtering units called glomeruli each minute. A healthy GFR is typically above 90 mL/min/1.73 m². Here are the main functions of healthy kidneys:

  • Filtration: The kidneys filter about 120-150 quarts of blood daily, removing waste products, excess water, and other impurities from the blood.
  • Regulation of fluids and electrolytes: Kidneys help maintain the proper balance of water and electrolytes like sodium, potassium, and calcium in the body.
  • Blood pressure control: By regulating fluid levels and producing hormones, kidneys play a crucial role in maintaining healthy blood pressure.
  • Red blood cell production: Kidneys produce erythropoietin, a hormone that stimulates the bone marrow to make red blood cells, preventing anemia.
  • Vitamin D activation: Kidneys activate vitamin D, which is crucial for maintaining strong bones and a healthy immune system.
  • pH balance: Kidneys help maintain the proper acid-base balance in the body, crucial for various metabolic processes.

What Is Chronic Kidney Disease?

Chronic kidney disease represents a spectrum of disorders affecting kidney structure and function. This progressive condition typically develops over months or years, as the kidneys gradually lose their ability to filter blood effectively and perform other vital functions. As CKD advances, waste products accumulate in the body, leading to a cascade of health complications that can impact multiple organ systems.

CKD is defined as abnormalities in kidney structure or function present for more than three months. These abnormalities can manifest in various ways, including decreased glomerular filtration rate (GFR), presence of albuminuria (protein in the urine), or structural changes detected through imaging studies. The severity of CKD is typically categorized into five stages based on the GFR, which provides an estimate of how much blood the kidneys can filter per minute. This staging system helps healthcare providers assess the progression of the disease and determine appropriate treatment strategies:

  • Stage 1: Normal GFR (≥90 mL/min/1.73 m²) with other evidence of kidney damage
  • Stage 2: Mildly reduced GFR (60-89 mL/min/1.73 m²) with other evidence of kidney damage
  • Stage 3: Moderately reduced GFR (30-59 mL/min/1.73 m²)
  • Stage 4: Severely reduced GFR (15-29 mL/min/1.73 m²)
  • Stage 5: Kidney failure (GFR <15 mL/min/1.73 m²), also known as end-stage renal disease (ESRD)1

    As kidney function declines, CKD can have far-reaching effects on the body. The kidneys’ diminished ability to regulate fluid and electrolyte balance often leads to swelling and elevated blood pressure, which in turn can strain the cardiovascular system. This strain is compounded by the reduced production of erythropoietin, a hormone crucial for red blood cell formation, resulting in anemia that manifests as persistent fatigue and weakness. Bone health also suffers as the kidneys struggle to activate vitamin D and maintain mineral balance, increasing the risk of fractures.

    The progressive nature of CKD means that these issues often worsen over time, with advanced stages bringing additional challenges. Metabolic acidosis can develop as the blood becomes too acidic, affecting various bodily functions. In later stages, the accumulation of waste products in the blood can cause a constellation of symptoms including nausea, loss of appetite, and cognitive changes. Throughout the course of CKD, cardiovascular complications remain a primary concern, significantly contributing to the overall morbidity and mortality associated with the disease.2

    What Causes Chronic Kidney Disease?

    Chronic kidney disease can result from a variety of conditions that damage the kidneys over time. While some causes of CKD are directly related to kidney-specific diseases, many cases stem from systemic health issues that affect kidney function as a secondary consequence. The risk of developing CKD increases with age, particularly after 60 years old, and can be influenced by family history. Additionally, certain racial and ethnic groups, including African Americans, Hispanics, and Native Americans, have a higher risk of developing CKD. Here are some of the primary causes and risk factors associated with chronic kidney disease:

    • Diabetes: The leading cause of CKD, diabetes can damage blood vessels in the kidneys, impairing their ability to filter blood effectively.
    • Hypertension: High blood pressure can damage blood vessels throughout the body, including those in the kidneys, leading to reduced kidney function over time.
    • Glomerulonephritis: This group of diseases causes inflammation and damage to the kidney’s filtering units (glomeruli).
    • Polycystic kidney disease: An inherited disorder characterized by the growth of numerous cysts in the kidneys.
    • Prolonged obstruction of the urinary tract: Conditions such as kidney stones, an enlarged prostate, or certain cancers can obstruct urine flow and damage the kidneys.
    • Recurrent kidney infections: Frequent or chronic kidney infections can scar and damage kidney tissue.
    • Autoimmune diseases: Conditions like lupus can affect kidney function as part of their systemic impact.
    • Certain medications: Long-term use of some medications, including certain pain relievers and antibiotics, can cause kidney damage.
    • Obesity: Being overweight or obese increases the risk of developing conditions that can lead to CKD, such as diabetes and hypertension.
    • Smoking: Tobacco use can damage blood vessels and increase the risk of kidney disease.

    Diagnosis and Treatment

    Diagnosing chronic kidney disease often involves a combination of blood tests, urine tests, and imaging studies. Healthcare providers typically look for signs of kidney damage and assess overall kidney function to determine the presence and stage of CKD. Blood tests measuring levels of creatinine and blood urea nitrogen (BUN) are used to estimate glomerular filtration rate (eGFR), while urine tests check for albumin and other proteins that might indicate kidney damage. Imaging tests such as ultrasound or CT scans help visualize kidney structure and look for abnormalities. In some cases, a kidney biopsy may be performed to examine a small sample of kidney tissue and determine the cause of kidney disease.

    Treatment for CKD focuses on slowing the progression of kidney damage and managing complications. The approach varies depending on the underlying cause and stage of the disease, with the goal of maintaining quality of life and preventing or managing associated complications. Key elements of CKD treatment include:

    • Controlling underlying conditions: Managing diseases like diabetes and hypertension is crucial in slowing CKD progression.
    • Dietary changes: A kidney-friendly diet, often low in protein, sodium, and potassium, may be recommended.
    • Medications: Various drugs may be prescribed to manage complications such as high blood pressure, anemia, or bone disease. These might include ACE inhibitors, ARBs, erythropoiesis-stimulating agents, or phosphate binders.
    • Lifestyle modifications: Quitting smoking, maintaining a healthy weight, and regular exercise can help manage CKD and its complications.
    • Treating anemia: This may involve iron supplements or erythropoiesis-stimulating agents to boost red blood cell production.
    • Managing mineral imbalances: Medications and dietary changes may be needed to maintain proper levels of minerals like calcium and phosphorus.
    • Dialysis: For advanced CKD (Stage 5 or end-stage renal disease), hemodialysis or peritoneal dialysis may be necessary to filter waste and excess fluid from the blood.
    • Kidney transplant: In some cases, surgical placement of a healthy kidney from a donor can restore kidney function.3

    Request an Appointment

    Chronic kidney disease is a complex condition that requires professional medical management. If you’re experiencing symptoms that may be related to kidney dysfunction, such as persistent fatigue, swelling, or changes in urination patterns, it’s important to consult with a healthcare provider. The experienced team at Cary Gastro specializes in diagnosing and treating a wide range of diseases and disorders connected to the digestive system. Please contact us today for more information or to request an appointment.


    1https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease
    2https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd
    3https://www.nhs.uk/conditions/kidney-disease/diagnosis/