A nephrologist diagnoses and treats kidney diseases. The kidneys are paired organs that filter your blood, remove harmful substances from the body, regulate blood pressure, maintain electrolyte balance and blood acidity (pH levels), help regulate blood sugar levels and bone health, and produce a hormone necessary for red blood cell production.
Chronic Kidney Disease
Chronic kidney disease is a global health issue. Over 840 million people suffer from it, or about one in ten people.
What is chronic kidney disease? It is any problem with the kidneys (their function or structure) that lasts longer than three months.
Why is it important to recognize and treat chronic kidney disease? Because, if left untreated, it can lead to kidney failure and dialysis or kidney transplant. And importantly, this disease significantly increases the risk of developing cardiovascular diseases, such as heart attacks.
Chronic kidney disease has five stages, based on how well your kidneys can filter waste from your blood. Kidney function is measured by creatinine levels in the blood and an abbreviation you often see in your test results—eGFR (estimated glomerular filtration rate). If there are no significant issues with kidney function, the eGFR is >60 ml/min. If eGFR is <60 ml/min, you should see a nephrologist.
Who is at risk of developing chronic kidney disease?
Svako može dobiti hroničnu bubrežnu bolest. U većem ste riziku za hroničnu bubrežnu bolest ako:
- Anyone can develop chronic kidney disease. You are at higher risk if:
- You have diabetes mellitus
- You have high blood pressure
- You have heart disease or any other cardiovascular disease
- You have a family history of kidney disease
- You have an abnormal kidney structure or size
- You are over 60 years old
- You have a long history of using NSAIDs (non-steroidal anti-inflammatory drugs) and other medications harmful to the kidneys (including over-the-counter products)
- You have body weight issues – you are obese
Kidney Diseases Caused by Diabetes
How does diabetes cause kidney disease?
High blood sugar levels, also known as blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, the kidneys do not function properly. Many people with diabetes also develop high blood pressure, which can also harm the kidneys.
How long does it take for diabetes to damage the kidneys?
Almost all patients with type 1 diabetes develop some evidence of functional changes in the kidneys within two to five years of diagnosis. Around 30 to 40 percent progress to more serious kidney disease, usually within 10 to 30 years.
Kidney Disease Due to High Blood Pressure
High blood pressure is one of the leading causes of chronic kidney disease. Additionally, kidney disease can cause high blood pressure. Regardless of which came first, high blood pressure damages the small blood vessels in the kidneys, which reduces blood flow and impairs proper kidney function. When this happens, the kidneys are unable to remove all waste and excess fluid from your body. If you have high blood pressure, it is important to treat it.
What are the complications of chronic kidney disease?
Some of the complications of chronic kidney disease include:
- Low red blood cell count (anemia)
- Weak and brittle bones
- Gout
- Metabolic acidosis. This is a chemical imbalance (acid-base) in your blood caused by reduced kidney function, which can be life-threatening.
- High blood pressure
- Heart disease and vascular disease, including an increased risk of stroke and heart attack
- Nerve damage
- High potassium levels (hyperkalemia), which affect your heart’s ability to function properly
- High phosphorus levels (hyperphosphatemia)
- Increased risk of infection due to a weakened immune system
- Fluid retention, leading to swelling in your feet, limbs, and hands
How is kidney disease diagnosed?
A nephrologist will take your medical history, conduct a physical exam, ask about any medications you are currently taking, and inquire about any symptoms you have noticed.
The nephrologist will request blood and urine tests to check kidney function.
Specifically, blood tests will check:
- Serum creatinine levels, which show how well your kidneys are removing this waste product. Creatinine is a waste product from muscle metabolism and is usually excreted in the urine. High creatinine levels in your blood mean that your kidneys are not functioning well enough to eliminate it in the urine.
- Your glomerular filtration rate (GFR). This describes how efficiently your kidneys filter blood. Your GFR is used to determine the stage of your kidney disease.
A very important test is a urine examination. It is simple, painless, accessible, and very informative. It includes a physical-chemical examination and examination of the urine sediment. You should not have positive proteins or albumin in your urine, nor an increased number of red and white blood cells.
Other tests may include imaging diagnostics to check for problems with the size and structure of your kidneys—such as ultrasound, magnetic resonance imaging (MRI), and/or computed tomography (CT). A nephrologist may also order a kidney biopsy to define the type of kidney disease and based on that, prescribe specific treatment.
Warning signs of kidney problems
Unfortunately, chronic kidney disease is often asymptomatic for a long time. This is why it’s important that if you are at an increased risk of developing this disease, you regularly check kidney function.
When you start having symptoms, it is a sign that the disease has advanced.
- You are always tired
The kidneys filter waste from your blood and excrete it in urine. When the kidneys do not function properly, toxins can accumulate. One of the common signs is fatigue. You may feel exhausted, weak, or have trouble concentrating. The kidneys produce a hormone that signals your body to make red blood cells. If you have fewer of them, your blood cannot deliver enough oxygen to your muscles and brain.
- Poor sleep
Studies show a possible connection between sleep apnea and chronic kidney disease, which over time can damage your organs and lead to kidney failure. Sleep apnea can partially damage the kidneys by preventing proper oxygenation. Chronic kidney disease can cause sleep apnea by narrowing your throat, accumulating toxins, and in other ways.
- Itchy skin
This can happen if your kidneys cannot flush out toxins, which then accumulate in your blood. This can cause rashes or make you scratch all over your body. Over time, your kidneys may not be able to balance minerals and nutrients in your body, leading to mineral and bone diseases, which can make your skin dry and itchy.
- Swelling of the face and feet
When your kidneys cannot effectively excrete fluid, it accumulates in your body. This can lead to swollen hands, feet, ankles, legs, or a bloated face. You may notice swelling especially in your feet and limbs. Elevated protein in the urine can also indirectly cause water retention in the body.
- Muscle cramps
Leg cramps and cramps in other parts of the body can be a sign of poor kidney function. An imbalance in sodium, calcium, potassium, or other electrolytes can interfere with your muscles and nerves.
- Shortness of breath
When you have kidney disease, your organs do not produce enough of a hormone called erythropoietin. This hormone signals your body to make red blood cells. Without it, you may develop anemia and feel fatigued. Another cause can be fluid accumulation. You may have trouble catching your breath. In severe cases, lying down may cause you to feel like you are suffocating.
- Foggy brain
When your kidneys do not filter all the waste from your body, toxins can affect your brain. Anemia can also prevent your brain from getting the necessary amount of oxygen. You may feel dizzy and have trouble concentrating or remembering. You might become so confused that you have difficulty with simple tasks.
- Loss of appetite
Kidney disease can cause nausea or vomiting and discomfort in the stomach. This can reduce your appetite, which may sometimes lead to weight loss.
- Unpleasant breath
When your kidneys cannot filter waste, it can cause a condition called uremia. This can make your breath unpleasant. Additionally, toxins in your blood can give food a metallic or bad taste.
- Foamy or bloody urine
Foamy urine may be a sign of excessive protein in the urine. This could be a result of kidney problems. Blood in the urine can be caused by kidney stones, tumors, infections, or diseases of the kidneys themselves. It is always a reason to see a doctor, who will refer you to a urologist or nephrologist.
If you experience any symptoms that indicate kidney problems or simply want a preventive check-up with a nephrologist, you can visit the Puls Cardiological Center for a clinical consultation with Dr. Milica Kravljača, a nephrologist working at the University Clinical Center of Serbia.
