The Missing Million: Let's clear up the facts about kidney disease

Nobody wants another life to go to waste

LET’S CLEAR UP THE FACTS ABOUT KIDNEY DISEASE

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YOUR KIDNEYS SAVE YOUR LIFE EVERY DAY

What do your kidneys do?

Very simply, your kidneys take away the rubbish from your body and keep the good stuff like amino acids and hormones in. They also play a vital role in maintaining a good balance of fluid and salts. If we take on too much, they take the excess away. If we need to retain minerals and salts, they make sure we do.

Where would we be without someone to take away the rubbish? Everything that comes in must go out somewhere.

If waste hangs around, it infects us, poisons us and threatens our health.

So it’s a good job our bodies have their very own pair of dustmen to keep us clean and healthy. They’re called our kidneys and they are well worth looking after.

Importantly they secrete a hormone involved in controlling high blood pressure, and another which prevents anaemia by stimulating the production of red blood cells. Finally, they play an important role in activating Vitamin D and making sure our bodies can absorb calcium and keep bones strong and healthy.

They work away quietly in the background. It’s easy not to notice them and they are often taken for granted, but they perform an essential service – keeping our bodies clean and healthy.

What is kidney disease?

The kidneys are a pair of organs found in the small of the back on either side of the spine, roughly the size of your fist or a computer mouse.

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Bloodwithout without waste or excess Blood waste or excess water water leaves through the renal leaveshere here through the vein. renal vein.

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Kidneys become less efficient in a slow, steady way after we reach middle age. Because the kidneys are so efficient, it is usually a long time before there are obvious signs of something wrong. Doctors describe any long-term, progressive damage or abnormality in the kidneys, as chronic kidney disease, or CKD. The trouble with your kidneys is that they are very Blood, waste and water enter complex and delicatehere organs made upartery of millions of tiny through the renal parts called nephrons. When some nephrons fail, the others have to work even harder to compensate and so they begin to fail too. A chain-reaction begins, which can be very difficult to stop.

Depending on the problem, early diagnosis and treatment can help slow down any damage to the kidneys. Left unchecked, however, it can lead to renal failure, which is fatal without treatment by dialysis or Blood, waste and water enter Blood without waste or excess water here through the renal artery a kidney transplant. leaves here through the renal vein.

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04/03/2014 14:59

MILLIONS ARE AT RISK FROM A SILENT KILLER Research suggests that over three million people in the UK are at risk of chronic kidney disease. The illness is extremely common in older people and is expected to rise over the next ten years.

Worryingly, up to one million of these are undiagnosed and these are the missing million Kidney Research UK is urgently trying to find.

What are the causes of kidney disease?

The condition sometimes gets missed because it is quite hard to detect. There are few obvious and unique symptoms that can easily pin it down. More often it sneaks up on us, under the guise of other conditions such as: ■ Diabetes ■ High blood pressure ■ Vascular disease (e.g. heart attack, poor circulation or stroke) If you have any of these conditions you should be particularly concerned, because once kidneys become damaged a vicious spiral begins. The kidney damage actually makes your high blood pressure or heart condition even worse, which in turn goes on to compound the kidney damage.

And so it goes on until one or other of the organs fail.

Other less common causes include inflammation (glomerulonephritis) or infection (pyelonephritis). Sometimes kidney disease is inherited (polycystic disease) or the result of a longstanding blockage (such as enlarged prostate or kidney stones).

Some drugs can cause CKD, especially certain pain-killing and anti-inflammatory drugs if taken over a long time. Often it isn’t possible to say what has caused the problem.

Unfortunately, your risk of having kidney failure is also increased if you are from an African-Caribbean or South Asian background, or have a family history of kidney disease.

If you already have one or more of these conditions, you should get your kidney health tested regularly by your GP.

Kidney disease is even more common if the blood pressure or the diabetes hasn’t been controlled as well as it could be. If you continue to smoke, drink too much alcohol or have a poor diet while suffering from these conditions, you are at greater risk.

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How can my doctor test for kidney disease?

Simple blood and urine tests can lead to an early diagnosis of potential kidney problems.

The blood test in particular uses a measure called eGFR (estimated glomerular filtration rate) to tell roughly how well the kidneys are working, compared to normal.

The results are broken down as follows.

Any declines in kidney function up to stage 3 can be much reduced or even halted with a combination of a diet, lifestyle and medication.

Stage

IT’S DANGEROUS TO

IGNORE SIGNS LIKE THESE

In most people, mild to moderate CKD does not display any obvious symptoms. Sometimes there are no obvious signs at all until just before your kidneys start to fail.

When the kidneys are not working properly, harmful toxins and excess fluids build up in the body, which may cause the symptoms of kidney failure.

Description

Making these changes is even more important when you bear in mind that even relatively mild kidney damage like this puts you at a much greater risk of heart disease.

Beyond stage 3, the situation becomes more serious. Your GP will recommend a consultation with a kidney specialist and dialysis or transplantation may come into the equation depending on how far gone your kidney damage might be.

eGFR Level

Action

Normal kidney Healthy kidneys function

90% or more

Discuss your health and lifestyle with your doctor

Stage 1

Kidney damage with normal or high GFR

90% or more

Discuss your health and lifestyle with your doctor

Stage 2

Kidney damage and mild decrease in GFR

60 to 89%

Make lifestyle changes on the advice of your doctor

Stage 3

Moderate decrease in GFR

30 to 59%

As above and check kidney function every 6 months – 1 year.

Stage 4

Severe decrease in GFR

15 to 29%

Referral to a kidney specialist

Stage 5

Established renal failure (ERF)

Less than 15%

Active treatment such as dialysis or transplant

These symptoms can include: ■ ■ ■ ■ ■ ■ ■ ■ ■

High blood pressure Extreme tiredness or lethargy Difficulty concentrating Persistent headaches Poor appetite and weight loss Feeling sick Itchy skin Swelling in the face and ankles Fluid retention and/or lower back pain

While these signs can indicate other problems besides kidney disease, it’s best to get any worries you have checked out by your GP. In most cases, CKD does not cause any symptoms and is detected because tests are abnormal.

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SO IT’S VITAL TO CATCH IT EARLY If kidney damage is identified early enough, the good news is that there are things you can do to stop the kidney function getting worse.

These include:

Control of high blood pressure and cholesterol

Good management of diabetes

Avoiding high blood pressure is particularly important because it puts strain on the small blood vessels in the kidneys, preventing the filtering process from working properly.

Have your blood pressure checked regularly and note down your numbers.

Diabetes is the most common cause of end-stage renal failure in the UK. The condition is becoming more common and it is estimated that numbers will double in the UK over the next few years.

Most people with kidney damage should have a blood pressure below 140 (top number) and below 90 (bottom number).

If you have kidney damage and diabetes, the numbers should be below 130 (top number) and below 80 (bottom number).

High blood sugar levels can damage the filters in the kidneys, causing them to fail. 30-40 per cent of people with diabetes may eventually develop kidney complications.

So if you have diabetes, it is vital you manage it well, in line with the advice from your GP.

Stop smoking

Eat well

Keep fit

Smoking is thought to have a number of effects on the kidney, particularly by raising blood pressure. If you smoke, seek advice on how to give up.

Your GP or nurse can advise you on ways to make this easier for you.

It is important that you try to eat a healthy, well-balanced diet and try to maintain a healthy weight. We’re all different so ask your GP or nurse what they recommend for you.

There are no special exercises for people with kidney problems, but like anybody, you should try to be active several times a week.

Ask your GP or nurse what they recommend for you.

This is particularly important if you have existing medical conditions.

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IF YOU’RE WORRIED SEE YOUR DOCTOR If you recognise yourself in Dusty, or in any of the information we’ve talked about today, there’s no harm in contacting your GP to discuss any concerns you may have. They should be able to give you any reassurance, checks or tests you might need.

We hope everything is fine and there’s no need to worry, but if you do have a kidney problem it’s worth knowing what to expect from any treatment you might need.

Treatment for early stage kidney disease

Treatment for later stage kidney disease

Increasingly, stages one to three of kidney disease are managed by your local GP’s surgery. As we’ve described, the treatments are generally simple steps you can take to protect your kidneys through good management of blood pressure, diabetes (if it exists) and lifestyle issues such as stopping smoking, healthy eating and exercise.

If your kidney disease looks as though it is going to progress beyond stage 3, your GP will refer you to a kidney specialist (nephrologist or renal physician) at your nearest renal unit.

Your doctor will measure your blood pressure and take the necessary urine and blood tests to make sure your condition has stabilised.

Renal units have teams of specialist staff to help with all forms of treatment for kidney disease, including dialysis and transplantation. The teams consist of doctors, surgeons, renal nurses, laboratory scientists, transplant co-ordinators, dieticians, renal technicians and others as required.

They will all work together to provide treatment, advice, training and support, be it physical, psychological or financial – even arranging transport requirements to and from treatments (if appropriate). Their objective is to give you the most up-to-date treatment and support available, so you can return to as independent a lifestyle as possible.

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LEARN MORE AND TAKE OUR KIDNEY HEALTH CHECK

AT:

Kidney Research UK offers a health information service for kidney patients, their families and carers, as well as medical professionals and researchers. Â It provides general information only and is not intended to provide personal medical advice, or act as a substitute for the advice of your doctor. If you have any questions or concerns about kidney health matters please consult a medical health professional. Users should seek such advice before taking, or deciding not to take, any action as a result of this information.

So far as is permissible by law, Kidney Research UK accepts no liability to any person relating to the use of the information contained herein.

Registered Charity No. 252892 Scottish Charity No. SC039245.

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