Kidney Disease
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The kidneys are organs with several functions. They are an essential part of the urinary system. They serve the body as a natural filter of the blood, and remove wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the reabsorption of water, glucose, and amino acids. The kidneys also produce hormones including calcitriol, renin, and erythropoietin.

Located at the rear of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder.

Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with kidney diseases. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features. Common clinical conditions involving the kidney include the nephritic and nephrotic syndromes, renal cysts, acute kidney injury, chronic kidney disease, urinary tract infection, nephrolithiasis, and urinary tract obstruction. Various cancers of the kidney exist; the most common adult renal cancer is renal cell carcinoma. Cancers, cysts, and some other renal conditions can be managed with removal of the kidney, or nephrectomy. When renal function, measured by glomerular filtration rate, is persistently poor, dialysis and kidney transplantation may be treatment options. Although they are not severely harmful, kidney stones can be a pain and a nuisance. The removal of kidney stones includes sound wave treatment, which breaks up the stones into smaller pieces which are then passed through the urinary tract. One common symptom of kidney stones is a sharp pain in the medial/lateral segments of the lower back.

1. What do the kidneys do?

You have two kidneys. They are bean-shaped and about the size of a fist. They are located in the middle of your back, on the left and right of your spine, just below your rib cage. The kidneys' main job is to filter your blood, removing wastes and extra water to make urine. They also help control blood pressure and make hormones that your body needs to stay healthy.

2. What is kidney disease?

Kidney disease -- also known as chronic kidney disease (CKD) -- occurs when kidneys can no longer remove wastes and extra water from the blood or perform other functions as they should. Millions of people have kidney disease. Many more are at risk.

3. What causes kidney disease?

Kidney disease is most often caused by diabetes or high blood pressure.

Each kidney contains about one million tiny filters made up of blood vessels. These filters are called glomeruli. Diabetes and high blood pressure damage these blood vessels, so the kidneys are not able to filter the blood as well as they used to. Usually this damage happens slowly, over many years. As more and more filters are damaged, the kidneys eventually stop working

4. What are the risk factors for kidney disease?

Diabetes and high blood pressure are the two leading risk factors for kidney disease. Both diabetes and high blood pressure damage the small blood vessels in your kidneys and can cause kidney disease -- without you feeling it. There are several other risk factors for kidney disease. Cardiovascular (heart) disease is a risk factor. So is family history: if you have a mother, father, sister, or brother who has had kidney disease, then you are at increased risk.

5. What are the symptoms of kidney disease?

Kidney disease is often called a "silent" disease, because most people have no symptoms before they are diagnosed. In fact, you might feel just fine until your kidneys have almost stopped working. Do NOT wait for symptoms! Lab tests are the only way to know if you have kidney disease.

6. How can I keep my kidneys healthy?

You can keep your kidneys healthy longer by taking steps to control your diabetes and high blood pressure. Manage your diabetes and high blood pressure by eating healthy foods, staying active, taking your medicines as prescribed, and seeing your doctor regularly. If you keep these risk factors under control -- especially your blood pressure -- you may be able to postpone and even prevent kidney failure.

7. How do doctors diagnose kidney disease?

A blood test and a urine test are used to find kidney disease. If you have diabetes, you should get both of these tests every year. If you have high blood pressure, you should also get tested regularly -- ask your health care provider how often.

8. What does the blood test for kidney disease reveal?

The blood test for kidney disease is called a GFR. (GFR stands for glomerular filtration rate.) This test helps your doctor measure how much blood your kidneys filter each minute. This shows how well your kidneys are working.  GFR is reported as a number. A GFR of 60 or lower may mean you have kidney disease. However, because GFR decreases as people age, other information may be needed to determine if you actually have kidney disease if you are older and your GFR is decreased. You can't raise your GFR, but you can try to keep it from going lower. Ask your healthcare provider what you can do to keep your kidneys healthy.

9. What does the urine test for kidney disease reveal?

The urine test for kidney disease looks for protein in your urine, which is a sign of kidney damage. This test has several different names. You could be told that you are being screened for "proteinuria" or "albuminuria" or "microalbuminuria." ("Albumin" is a type of protein, and "micro" means a small amount of it.) Or you could be told that your "urine albumin-to-creatinine ratio" (UACR) is being measured. If you have albumin or protein in your urine, it could mean you have kidney disease. Your healthcare provider might do additional tests to be sure.

10. How is kidney disease treated?

Treatments for early kidney disease include both lifestyle changes and medications. Lifestyle changes, such as eating less and exercising regularly to maintain a healthy weight, can help prevent the diseases that cause kidney damage. If you already have diabetes and/or high blood pressure, keeping these conditions under control can keep them from causing further damage to your kidneys.

11. What changes in diet can help with kidney disease?

Restricting your use of salt can be an important dietary change, since this helps control blood pressure. For people with greatly reduced kidney function, another change often recommended by experts is to follow a moderate-protein diet. Because protein makes your kidneys work harder, eating less protein may help delay progression to kidney failure. Anyone considering dietary changes because of kidney disease should work with a dietitian to ensure that they are getting proper nutrition.

12. What kinds of medicines are used for kidney disease?

Two types of blood-pressure medications --angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) -- have been shown to slow down kidney disease and delay kidney failure. These medications have been shown to protect kidney function in people who have either diabetes or high blood pressure, as well as those with various types of kidney disease. Many people need two or more types of medicines to keep their blood pressure below recommended levels (130/80 mmHg) to keep the kidneys healthy. A diuretic (water pill) also can be important. Your healthcare provider will determine which medication or combination of medications is right for you. Some older adults with kidney disease may be taking medications for other diseases as well. As kidney disease progresses, it is likely that the doctor will need to adjust the dosages of all medications being taken.

13. What is kidney failure?

When your kidneys fail, they lose their ability to filter blood and remove waste and excess fluid from your body. Kidney failure (sometimes called end-stage renal disease, or ESRD) causes harmful waste and excess fluid to build up in your body. Your blood pressure may rise, and your hands and feet may swell. Since the kidneys have now stopped working, the goal is to find treatments that can replace kidney function. There are two main options for this: dialysis and transplantation.

14. What is dialysis and how is it used to treat kidney failure?

Dialysis is a treatment to filter wastes and water from your blood. There are two major forms of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, blood is run through an external filter and the clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week. Each session usually lasts between three and four hours.
Peritoneal dialysis is another way to remove wastes from your blood. This kind of dialysis uses the lining of your abdominal cavity (the space in your body that holds organs like the stomach, intestines, and liver) to filter your blood. It works by putting a special fluid into your abdomen that absorbs waste products in your blood as it passes through this lining. This fluid is then drained away. A key benefit of peritoneal dialysis is that it can be done at home, while you sleep.

15. Is dialysis a cure for kidney failure?

No. Hemodialysis and peritoneal dialysis are treatments that help replace the work your kidneys did. These treatments help you feel better and live longer, but they don't cure kidney failure. Although patients with kidney failure are now living longer than ever, over the years kidney disease can cause problems such as heart disease, bone disease, arthritis, nerve damage, infertility, and malnutrition. So to stay as healthy as possible for as long as possible while on dialysis, follow your doctor's recommendations, take your medications, and continue to follow the lifestyle and dietary habits you adopted to slow the progression of kidney disease.

16. What special issues face older adults who have dialysis?

Dialysis can be a special challenge for older adults, especially those who have other diseases or conditions. For example, hemodialysis requires that a person be able to leave home, travel to the dialysis facility, and sit for 4 hours during treatment. Peritoneal dialysis can be done at home, but requires someone to help. Often, older adults require assistance with some or all of these activities, and they and their families need to consider these issues as they choose treatment options and living facilities.

17. What is involved in a kidney transplant?

Instead of dialysis, some people with kidney failure -- including older adults -- may be able to receive a kidney transplant. This involves having a healthy kidney from another person surgically placed into your body. The new, donated kidney does the work that your two failed kidneys used to do. The donated kidney can come from an anonymous donor who has recently died, or from a living person -- usually a relative. But you might also be able to receive a kidney from an unrelated donor, including your spouse or a friend.

Kidney transplantation is a treatment for kidney failure -- not a cure. You will need to see your healthcare provider regularly. And you will need to take medications for as long as you have your transplant to suppress your immune system so it doesn't reject the transplanted kidney.

18. What research is taking place on kidney disease?

There are many researchers who are working on kidney disease. They are looking for ways to improve diagnosis, make treatments more effective, and make dialysis and transplantation work better
Several areas of research supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) hold great potential. Emphasis is being placed on research related to prevention and early intervention in kidney disease.

Another focus is on the interaction between diabetes, kidney disease, and cardiovascular disease. Advances in treatments for diabetes and high blood pressure may help reduce the damage these conditions do to the kidneys in the first place. Research into how to predict who will develop kidney disease may improve prevention.

( Courtesy: http://nihseniorhealth.gov/  )