Acute and Chronic kidney disease

Acute and Chronic kidney disease

Usually, people's kidneys will deteriorate slowly with age. On average, kidney function will decrease by about 1% per year. If kidney is abnormal, kidney function will deteriorate faster than normal. When the kidneys deteriorate rapidly or stop function, this is known as "acute kidney failure". In this case, the kidneys may return to normal with proper treatment. If the kidney deteriorates slowly and continuously for more than 3 months, especially when the kidney function decreases 60%, it is called "chronic kidney disease".

Causes of chronic kidney disease

          Chronic kidney disease is caused by many reasons. The common cause includes the complications from diabetes and high blood pressure diseases. There are also many other causes, such as gout, kidney stones, nephritis, and repeated urinary tract infections. Moreover, it may be caused by side effects from drug usage and various chemicals, including painkillers called “NSAIDs” and some antibiotics, etc.

In addition, it is also caused by congenital or abnormalities from birth, such as children with a birth weight less than 2,500 grams. The kidneys of this child will work less than normal children. Children with congenital kidney abnormalities, such as small kidneys, a blockage in the urinary tract or gall bladder disease.

Chronic kidney disease prevention

Most patients with chronic kidney disease, especially in the early stages, often do not know that they have chronic kidney disease because there are not obvious symptoms or have symptoms but do not know about kidney deterioration. Therefore, it is unable to diagnose chronic kidney disease from the symptoms easily. It requires blood and urine tests. Therefore, those, who are in the risk group with chronic kidney disease, including people aged 60 years and over, should have blood and urine tests to screen for chronic kidney disease at least every year in order to be treated early.

Signs of kidney disease have 6 symptoms, which are:

• Difficult urination: it indicates that you have a problem with the urinary system. This may also have kidney disease. It can be divided into 2 groups:

1. Burning urination caused by a urinary tract infection which is more often found in females than males. For male, if you have this condition, you may have hidden stones in the kidney or enlarged prostate gland. In addition, sometimes you may have fever and waist pain as well.
2. Difficulty urination and nighttime urination indicate that there is a blockage of the urinary tract. The most common are enlarged prostate gland in males or prolapsed uterus in females.

• Frequent nighttime urination: in normal people, people sleep for 6 - 8 hours without waking up. Our urine can be contained about 250 cc or equal to 1 glass of water, so there is no need to get up for urination during the night. However, in people with chronic kidney disease, kidney cannot reduce the urine production at night, so there is a lot of urine. That’s why they need to urinate during the nighttime. In general, we will get up to urinate couple times during night if you drink water before bed. If you have symptoms like this that weren't before, you should consult a doctor. Nocturnal urination is not only a symptom of kidney disease, but it may also be found in diabetic patients, those who have swelling, or people who take diuretics. Therefore, if you have such symptoms, it is best to consult a doctor.
• Bloody, fleshy, or unusually cloudy urine: normally, urine is clear yellow. The color may be intense with less water and fade with more water. If the urine is reddish like blood, it indicates that there may be blood in the urine, which is caused by a urinary tract infection, kidney stones, kidney inflammation or a tumor in the urinary tract or blood diseases.
• Swelling around the eyes, face, feet: Swelling around the eyes and face may be easily noticed when you wake up. Swelling feet may be seen in the afternoon or when there is a long-time activity in a standing position. They can be observed from the ring or shoes, which will be tighter. When you press your fingers on your feet or shins, there will be a dimple. This condition may be caused by kidney disease. It can also be caused by heart disease or liver disease. The symptoms in chronic kidney disease are swelling on the back of the foot and shin. If it's a lot, it will press and make a dimple. There are many kidney diseases that patients come with swelling. However, it was found that many people with swelling ignored it because they do not suffer from the swelling. Some people may not want to be tested because they are afraid that the doctor will say that they have kidney disease. Therefore, they will let the time pass for months and years or there is so much swelling that they can't stand anymore, they will go to see a doctor.
• Back pain and waist pain: these symptoms are very common symptoms, but most of them are caused by muscle pain from work. This usually recovers by taking a break from work or taking painkillers. For back pain and waist pain caused by kidney disease, it is usually caused by stones in the kidneys or in the ureters. Pain is the result of ureteral obstruction or kidney aneurysm. The characters of the pain will be as follows: pain in the waist or the ribcage in the back and often have pain in the lower abdomen, thighs, or genitals. The pain is usually on one side. The abnormalities that are often found are the urine that has a flesh-colored or cloudy color or genital pain.
• High blood pressure: it is a key symptom of chronic kidney disease, especially those who have had high blood pressure for a long time and cannot be controlled. Kidney disease that doctors often think about is chronic kidney disease and renal artery disease. High blood pressure itself may have no symptoms or have minor symptoms, such as headache, dizziness, etc. Therefore, you should check your blood pressure regularly at least twice a year.

The above warning signs may indicate that your kidney function is already abnormal. Therefore, if these signals occur, you should consult with a doctor immediately. In some kidney diseases, if it is known and treated early, it can be recovered. In patients with severe kidney disease, treatment can only slow down the deterioration of the kidneys. There are often that patients come for treatment and discover that the kidneys have stopped working because the patient had symptoms for a long time but refused for treatment. Therefore, the only way to cure kidney is hemodialysis and patients may die prematurely.

Severity of chronic kidney disease

It can be divided the disease into 5 stages:

• Chronic kidney disease stage 1: the kidneys are still functioning normally, but abnormality of the kidneys was detected, for example, protein leakage in the urine or white blood cells and red blood cells were found in the urine. It may be called "initiation of kidney malfunction"
• Chronic kidney disease stage 2: 60-90% of kidney function remains, or early-stage chronic kidney disease.
• Chronic kidney disease stage 3: 30-60% of kidney function remains, or middle-stage chronic kidney disease.
• Chronic kidney disease stage 4: 15-30% of kidney function remains, or severe-stage chronic kidney disease.
• Chronic kidney disease stage 5: less than 15% of kidney function remains, or end-stage renal failure.

How to treat and manage when having kidney disease

          There are many aspects of chronic kidney disease management, which must be treated according to the stage of the disease as follows.

• Chronic kidney disease, stage 1: must stop smoking and control the diseases that cause kidney disease.
• Chronic kidney disease stage 2: must limit salty food.
• Chronic kidney disease stage 3: restrict protein diet.
• Chronic kidney disease stage 4: restrict fruit intake.
• Chronic kidney disease stage 5: must be treated by abdominal dialysis, hemodialysis, or kidney transplantation, which is the best method for late-stage patients.

At present, the medical treatment of chronic kidney disease in Thailand is similarly to one in developed countries, Europe and the United States. Patients with chronic kidney disease can therefore be confident in the efficiency of medical treatment of Thai physicians with potential comparable to foreign ones. It can reduce the cost of traveling for treatment or surgery abroad.

Thank you for information from The Kidney Association of Thailand