Chronic Kidney Disease
Kidneys are bean-shaped organs about the size of your fist. They are located under your rib cage towards your back. The kidneys have several functions. One of the most important tasks of the kidneys is to help your body remove toxins. The kidneys also filter your blood and remove excess water and waste products from the body 24 hours a day. Excess body fluid and waste products are excreted through the urine.
What is kidney failure?
Chronic kidney failure or chronic kidney disease is the loss of function of the kidney over time. Chronic kidney failure that does not develop suddenly is experienced gradually. Depending on the underlying cause, the progressive loss of kidney function may eventually render the kidneys inoperable.
What are the symptoms of chronic kidney failure?
Chronic kidney failure usually progresses silently in the early stages and may not cause any symptoms. Symptoms usually occur in advanced stages when kidney functions begin to be lost. Symptoms of chronic kidney failure may not occur in the same way in every patient.
Symptoms of chronic kidney failure, which can be confused with other diseases, are generally as follows:
Fatigue and weakness
Swelling in the feet due to excess water retention
Loss of appetite
Sleep problems and puffy eyes, especially in the morning
Change in the amount of urine and frequent urination at night
Muscle twitching and cramps, especially at night
Swelling in feet and ankles
Persistent itching and dry skin
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath if fluid builds up in the lungs
Erection problems in men
What are the causes of chronic kidney failure?
The causes of chronic kidney failure can vary. Chronic kidney failure can occur due to preventable causes as well as different diseases.
Diabetes: The most common cause of chronic kidney failure is diabetes, popularly known as diabetes mellitus. High blood sugar levels can cause kidney failure by damaging the small filters in the kidneys.
Hypertension: Hypertension, popularly known as high blood pressure, is known as the cause of cardiovascular diseases and stroke, but it can also affect the kidneys. Over time, high blood pressure can strain the small blood vessels in the kidneys and stop the kidneys from working properly. High blood pressure can cause kidney failure, and vice versa, kidney failure can also cause high blood pressure.
Glomerulonephritis: The kidneys have small filtering units called glomeruli. Inflammation of the filtration units glomeruli can cause kidney failure.
Interstitial nephritis: Inflammation of the kidney ducts and surrounding structure can cause chronic kidney failure.
Polycystic kidney disease: Polycystic kidney disease is the most common inherited kidney disease. It occurs with the formation of kidney cysts that expand over time and can cause serious kidney damage and even kidney failure. Other inherited diseases affecting the kidneys are Polycystic kidney disease, Fabry Disease, Alport Syndrome, primary hyperoxaluria and cystinuria.
Causes that prevent blood flow to the kidney: Problems that stop or reduce blood flow to the kidneys, such as heart attack or heart diseases, liver failure, severe burns or an allergic reaction, may predispose to kidney failure.
Overexposure to toxins from heavy metals
Drugs and alcohol
Vasculitis is inflammation of the blood vessels.
Lupus, an autoimmune condition that can cause inflammation in your organs.
Certain types of cancer or chemotherapy drugs
Unnecessary drug use
How is chronic kidney failure diagnosed?
The first step in diagnosing kidney failure is a nephrologist's examination. The nephrologist may order additional tests to diagnose kidney failure after questioning diseases such as hypertension or diabetes that may cause kidney failure, medications that may cause kidney failure, or changes in urinary habits.
Blood tests: Complete blood count can give important clues in the diagnosis of chronic kidney failure. The rate of creatinine and urea in the blood can give an idea to the doctor about the presence of chronic kidney failure. However, the nephrologist may also order more detailed blood tests. The Glomerular Filtration Rate, called GFR, determines the filtration capacity of the kidneys. A decrease in the filtration capacity of the kidneys below a certain rate can determine the problem in kidney functions.
Urine test: The presence of blood or protein in the urine can identify problems with kidney function.
Measurement of urine volume: Determining urine output is one of the simplest tests to help diagnose kidney failure.
Imaging methods: Ultrasound or other imaging modalities can be used to evaluate the structure and size of the kidneys and urinary tract.
Biopsy: Kidney biopsy is usually performed under local anesthesia by entering a long and thin needle through the skin.
How is kidney failure treated?
Damage to the kidneys is usually permanent. Even if the damage to the kidneys is not corrected, it may be possible to stop or slow the kidney failure by controlling the underlying condition causing the failure. The treatment plan may vary depending on the disease causing kidney failure.
Treatments for complications experienced during kidney failure can be planned.
Blood pressure control: Patients with kidney failure often have high blood pressure problems that are difficult to control. The nephrologist can administer medication for high blood pressure to preserve kidney function. It is useful to have frequent check-ups, as high blood pressure medications can reduce kidney function at first.
Control of cholesterol level: Patients with kidney failure generally have bad cholesterol at a rate that increases the risk of heart disease. Cholesterol drugs can be used for this.
Anemia drugs: Anemia drugs can be used in cases of anemia.
Treatments for fluid accumulation: People with chronic kidney failure may experience fluid accumulation in their body. During the treatment process, drugs that prevent this condition can be used.
Low protein diet: In order to reduce the burden on the kidneys, a low protein diet is important in terms of reducing the problems that may be experienced.
There are two ways to treat end-stage kidney disease.
Dialysis: The process of cleaning the blood that the kidneys cannot do properly is performed with the help of a device. Dialysis does not cure kidney failure. However, it is necessary to undergo dialysis at certain intervals in order to survive. Dialysis can be performed in two ways as hemodialysis or peritoneal dialysis, depending on the patient's condition.
Kidney Transplant: It is the transplantation of a working kidney to replace a non-functioning or underactive kidney. Although there is a long waiting list in cadaveric kidney transplants, kidney transplants can be performed in a short time in live-to-live kidney transplants. After kidney transplantation, patients do not need to undergo dialysis.
FREQUENTLY ASKED QUESTIONS ABOUT KIDNEY FAILURE
What is the Role of the Kidneys in the Body?
The kidneys, which are approximately the size of a fist and located on both sides of the spine, perform the task of removing waste products and excess fluid from the body. The regulation of salt, potassium and acid content in the body is also the task of the kidneys. A normally functioning kidney performs the filtering and return process of 200 liters of liquid blood every day. In addition to excretion of waste products from the body, kidneys;
Balancing body fluid
Regulating hormones that regulate blood pressure
Producing an active form of vitamin D that supports bones
It has vital tasks such as controlling the production of red blood cells.
Which Doctor Should Be Seen for Chronic Kidney Failure?
Nephrology doctor should be consulted for kidney-related ailments. The treatment of kidney diseases such as nephritis and pyelonephritis, acute and chronic kidney failure, urinary tract infections, kidney-induced hypertension, albumin should be followed by a nephrologist. It is important to prefer nephrology doctors who are experts in kidney transplantation, especially as a result of chronic kidney failure.
Who Is More Common in Chronic Kidney Failure?
The risk group for chronic kidney failure can be listed as follows;
People with diabetes.
High blood pressure patients
People with heart and blood vessel (cardiovascular) disease.
Those who smoke and drink alcohol.
Those with a family history of kidney disease.People with abnormal kidney structure.
What Disorders Cause Chronic Kidney Failure?
Kidney failure can lead to many ailments, from cardiovascular diseases to lung problems.
Gout: Gout is one of the most common diseases in people with chronic kidney failure. The two diseases are related, as uric acid is filtered through the kidneys.
Fluid accumulation in the body: The kidneys not working properly can lead to excessive fluid accumulation along with electrolytes in the body. Excess fluid accumulation in the body can lead to problems with the heart and lungs, hypertension, and swelling in the arms and legs.
Increased potassium (hyperkalemia): Kidney failure can cause sudden increases in potassium level in the blood, that is, hyperkalemia. A sudden increase in potassium can cause serious problems with the work of the heart.
Heart diseases: While heart diseases can cause kidney failure, on the contrary, kidney failure can also pave the way for heart diseases. It is known that the most common cause of death in those receiving dialysis treatment is heart diseases.
Sensitive bones: Another function of the kidneys is to retain vitamin D and calcium. When the kidneys are not working as they should, excessive potassium builds up in the body. This, in turn, can cause calcium to be pulled from the bones. Non-functioning kidneys can also lead to problems in the use of vitamin D. Either way, it can cause unhealthy bones and easy bone fractures.
Anemia: (Anemia) The kidneys help the body make red blood cells. Inadequately functioning kidneys can predispose to red blood cell deficiency.
Men may experience erection problems, decreased sex drive, or decreased fertility in women.
Pregnancy complications can occur during pregnancy that pose a risk to the mother and the unborn baby.
Irreversible damage to the kidneys, that is, end-stage kidney disease, and depending on this, results such as dialysis or kidney transplantation may occur.
What are the Stages of Kidney Failure?
Chronic renal failure is handled in 5 stages according to the degree of dysfunction in the kidneys. In the early stages of kidney failure, the kidneys can fulfill their filtering function, albeit partially. In the later stages, dysfunction may increase and it may become completely inoperable. When dividing kidney failure into stages, the results of the GFR (Glomerular Filtration Rate) test are also taken into account.
Kidney failure Stage 1: Stage 1 kidney failure has mild kidney damage and usually has no signs of kidney failure. Protein leakage can be seen in the urine. The GFR rate can be greater than 90.
Kidney Failure Stage 2: In stage 2 kidney failure, there is mild kidney damage and there are usually no signs of kidney failure. GFR rates range from 60 to 89.
Kidney Failure Stage 3: In stage 3 kidney failure, there is moderate damage to the kidneys. The GFR rate can be between 30-59. Symptoms may occur in stage 3 renal failure. The most common symptoms in stage 3 renal failure are; swelling in the hands and feet, back pain, change in urine rate, high blood pressure and anemia can be seen.
Kidney Failure Stage 4: Stage 4 kidney failure has moderate or severe damage to the kidneys. Symptoms and problems seen in stage 3 kidney failure can be seen. The GFR rate is between 15-30. Nutrition should be very careful at this stage. It would be beneficial to conduct necessary research for dialysis or kidney transplantation.
Kidney Failure Stage 5: In stage 5 kidney failure, there is severe damage to the kidneys. Kidneys are almost inoperable. The GFR rate is less than 15. In this period, generally; itching, muscle cramps, nausea and vomiting, constant hunger, swelling in the hands and feet, back pain, breathing problems and sleep problems can be seen. A patient with stage 5 kidney failure must have dialysis or a kidney transplant to survive.
What should be considered in order not to experience kidney failure?
Caution should be exercised in the use of drugs. Even simple painkillers that are used frequently in daily life can cause kidney damage.
Maintaining weight control is very important for kidney health. Obesity can negatively affect kidney health, as well as pave the way for diabetes. It should not be forgotten that not neglecting daily physical activities helps in weight control.
Smoking can damage the kidneys as well as increase the existing kidney damage.
Diseases such as diabetes and hypertension that may trigger kidney failure should be taken under control.
Whenever possible, avoid exposure to chemicals such as cleaning materials, pesticides, and other toxic products.
Disorders such as urinary tract infections should be treated promptly. Pay attention to daily water and salt consumption
Is Kidney Failure a Common Disease?
Kidney failure, also known as end-stage renal disease (ESRD), is a major global health problem. Here are some statistics related to kidney failure:
According to the World Health Organization (WHO), an estimated 5-10% of the world's population has chronic kidney disease (CKD).
What Happens If Chronic Kidney Failure Is Not Treated?
If chronic renal failure is detected at an early stage, its progression can be prevented or slowed down. If untreated chronic kidney failure is not treated, the process leading to complete loss of kidney functions, dialysis or kidney transplantation may occur.
What is the recommended dietary approach for individuals with chronic kidney failure?
Patients with chronic renal failure should pay attention to their nutrition. It may be vital to avoid certain foods, especially for dialysis patients. Although dialysis tries to do the work of the kidneys, it cannot fulfill all the tasks that healthy kidneys do. During dialysis, the amount of fluid in the body may increase and excess waste may accumulate in the blood. Patients with kidney failure and undergoing dialysis treatment;
The patient needs to go on a sodium restriction.
The diet to be applied during dialysis varies from person to person. Nutrition and restrictions may not be the same for a patient with early-stage renal disease and a patient with end-stage renal disease. Dialysis patients should pay attention to protein consumption in general. The quality of the consumed protein can prevent problems to be experienced. In this regard, it is necessary to get support from a specialist nephrology doctor and dietitian.
Protein consumption: Patients receiving peritoneal or hemodialysis may need higher protein than people without dialysis. Inadequate protein intake is very important as it can reduce the ability to fight infections along with weight and muscle loss. Containing high quality protein during dialysis diet; meat, poultry, fish, eggs, yogurt, milk and cheese can be consumed. However, it is very important that the foods consumed have a certain balance in terms of potassium, phosphorus and fluid accumulation.
Potassium: Potassium is a mineral found in almost all foods. Potassium is especially needed for muscles. But for kidney failure patients, too much potassium can create dangerous results. While on dialysis, the potassium level may be too low or too high. Too little or too much potassium can cause muscle cramps, weakness, and irregular heartbeats.
Whole grains, bread and biscuits
Nuts, seeds, chocolate, peanut oil
All fruit and vegetable juices
Brown sugar, molasses, maple syrup, coffees
Avocados, bananas, kiwis and dried fruits contain high amounts of potassium.
Phosphorus: Phosphorus found in many foods works together with calcium and vitamin D to keep bones healthy. Healthy functioning kidneys help to maintain the correct phosphorus balance in the body. During kidney failure, phosphorus can accumulate in the blood and a condition called hyperphosphotemia may occur. It should be noted that processed and packaged foods contain particularly high levels of phosphorus.
Foods that dialysis patients with high phosphorus levels should avoid:
Milk, cheese, yogurt
Bone broth soups
Whole wheat bread, brown rice, wholemeal noodles
Foods rich in both phosphorus and potassium are:
Dry beans and peas
Foods such as milk are gras rich in both potassium and phosphorus. It is important to avoid these foods during dialysis.
Fluid buildup: Excess fluid can build up in the body while on dialysis. Excess fluid buildup can lead to serious health problems such as high blood pressure, difficulty breathing, and heart failure. During dialysis, it is important to keep the daily fluid intake and liquid-containing foods under control. Dialysis when there is fluid accumulation in the body can lead to increased problems. The most practical method to be applied in fluid restriction is to stay away from salt.
Plain water, tea, coffee, milk
Pudding or ice cream
Fruits and vegetables such as cantaloupe, watermelon, grapes, apples, oranges, tomatoes, lettuce or celery
Salty snacks such as chips and crackers should be avoided as they can make you thirsty.
Sodium: Sodium is necessary for a healthy life. Properly functioning kidneys are effective in regulating the correct sodium ratio in the body. However, sodium can accumulate in the blood of chronic kidney failure patients. Excess sodium accumulation in the blood also causes the body to retain excess water.
Do not use salt in food or reduce it as much as possible. Try flavoring food with fresh herbs, lemon juice, or unsalted seasonings instead of salt.
Choose fresh vegetables instead of canned vegetables.
Avoid foods such as ham, bacon, sausage.
Opt for fresh fruits and vegetables instead of crackers or other salty snacks.
Avoid pickled foods such as olives and pickles.
Limit high-sodium seasonings like soy sauce, barbecue sauce, and ketchup.
What type of bread should be selected for a dialysis diet?
Choosing the right bread when on a dialysis diet can be confusing. For healthy individuals, wholemeal or whole wheat bread is generally recommended instead of refined white flour bread. Whole wheat bread is a nutritious and healthy choice in terms of high fiber content. However, consuming whole grain breads that are rich in phosphorus and potassium can cause problems for chronic kidney patients.Likewise, brown rice contains more potassium and phosphorus than white rice.
Is it acceptable to consume orange juice as part of a dialysis diet?
Oranges and orange juice are arguably one of the best stores of vitamin C. However, oranges are also a very good source of potassium. Considering the potassium content, orange and orange juice should be restricted in the kidney diet. Grape, apple or cranberry juice, which contains less potassium, can be preferred instead of orange juice. It should be known that apricots, like oranges, contain high potassium. It is important to avoid dried apricots, especially in dialysis.
Is it safe for kidney failure patients to include potatoes in their diet?
Potatoes are very rich in potassium. If possible, patients with kidney failure should avoid potatoes. However, if the potato is to be consumed, cutting it into thin pieces and keeping it in water for a long time reduces the potassium content in the potato. However, consuming potatoes by portion control is the healthiest choice. Like potatoes, tomatoes contain high potassium. Red pepper sauce can be tried instead of tomato to flavor the dishes.
What specific foods or nutrients are recommended for patients with kidney failure to consume?
Cauliflower: Cauliflower, which is very rich in C, K and B vitamins, is also a good source of fiber. Cauliflower puree can be preferred instead of potatoes.
Blueberries: One of the best sources of antioxidants. Blueberries, which are low in sodium, potassium and phosphorus, can be recommended for both diabetics and kidney diets.
Seabass: Seabass, which is very rich in omega 3, contains less phosphorus than other sea products. Portion control is important when consuming.
Red Grapes: Red grapes, which are rich in vitamin C, are also a good antioxidant. Red grapes are also suitable for heart health and diabetes patients.
Egg White: Although the yolk of the egg is very nutritious, it contains a high amount of phosphorus. Egg white is a better choice in kidney diet. It can also meet the high protein needs of patients receiving dialysis treatment.
Garlic: It is a source of manganese, vitamin C and vitamin B6 and contains sulfur compounds with anti-inflammatory properties. It can be used as a flavor additive instead of salt in people with kidney problems.
Buckwheat: Many whole grains contain high phosphorus. Buckwheat is a good choice instead. It provides B vitamins, magnesium, iron and fiber. It's also a gluten-free grain, making buckwheat a good choice for people with celiac disease or gluten intolerance.
Olive oil: Olive oil is an excellent option in the kidney diet, as it does not contain phosphorus and is nutritious.
Bulgur: It is a good kidney-friendly alternative to other cereals with high phosphorus and potassium. It is a source of B vitamins, magnesium, iron and manganese.
Cabbage: A great source of vitamins K, C and B. In addition, it ensures the healthy functioning of the digestive system by providing regular bowel movements.
Bell Pepper: Bell pepper, which has high nutritional value, is also low in potassium. Especially red bell peppers are a good source of vitamin C. It is also rich in vitamin A, an important nutrient for the immune system that is often damaged in people with kidney disease.
Onions: Sodium-free onions are a good alternative to add flavor to dishes. Onions are also rich in vitamin C, manganese and B vitamins.
Arugula: A nutrient low in potassium, arugula is a good choice for kidney-friendly salads and side dishes. Arugula is a good source of vitamin K and contains manganese and calcium, which are important for bone health.
Radish: Radish, which makes a healthy contribution to the kidney diet, is a nourishing vegetable with a low potassium and phosphorus ratio.
Turnip: An excellent substitute for vegetables that are higher in potassium, such as potatoes and winter squash. Turnip is also rich in vitamins C and B6, manganese and calcium.
Pineapple: It is a good alternative to many potassium-rich fruits such as orange, banana, kiwi.
Cranberry: It benefits both the urinary tract and kidneys.
What Should Patients With Diabetic Kidney Failure Pay Attention To?
Diabetes is the cause of almost 40% of patients who start dialysis treatment. The treatment process of diabetic nephropathy, that is, kidney patients with diabetes, should be followed carefully.
The best way to prevent or delay diabetic nephropathy is to maintain a healthy lifestyle and keep diabetes and hypertension under control.
Blood glucose levels can fluctuate widely in patients with chronic renal failure due to the various effects of dialysis.
Hemoglobin A 1c may be falsely elevated in chronic renal failure patients, but it is still a reasonable measure of glycemic control in these patients.
Most diabetes medications are excreted by the kidney. Therefore, patients with chronic renal failure are at risk of hypoglycemia.
Insulin is the cornerstone of treatment. Insulin doses should be reduced in patients with low Glomerular Filtration rates.
What is a diabetic dialysis diet?
The diabetic dialysis diet is specific for patients with diabetes as well as stage 5 chronic kidney disease, also called end-stage kidney disease. The goal of the diet is to manage blood sugar levels. Like dialysis diets, a diabetic dialysis diet should contain nutritious and high-quality protein. Phosphorus, potassium and sodium restriction should still be. Care should be taken to control the intake of carbohydrates, which affect blood sugar. Bread, cereal, pasta, rice, starchy vegetables, fruits, fruit juices can raise blood sugar because they contain carbohydrates.
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