page 14 Living with kidney failure Your extensive guide

2
page 15 Kidney disease

2.1 Testing for kidney disease

Chronic Kidney Disease is silent because it is possible
to lose 90% of kidney function before even feeling sick.
Doctors use three simple tests to assess your kidney
function and help plan treatment.

Blood pressure test

Blood pressure can be measured in a variety of ways but
the standard method is using an arm cuff and a stethoscope.
It is recorded as two numbers e.g. 130/70. The first number
is the systolic reading. This is the pressure in the arteries as
the heart pumps out blood during a beat. The second number
is the diastolic reading, which is the pressure of the blood
in the arteries when the heart relaxes before the next beat.
Since blood pressure varies from person to person
and during the day, there are no fixed rules about what
blood pressure reading is normal. These figures can be
a useful guide:
– Normal blood pressure: less than 120/80
– High Normal: 120-139/80-89
– High: more than 140/90

Urine tests
Proteinuria is the term used to describe excessive
amounts of protein in the urine. Normally, protein is not
removed from the blood when the kidneys filter waste from
the blood. However, when the kidneys are damaged protein
leaks through the damaged filters and appears in the urine.
It can be detected in the urine using a simple dipstick.
The appearance of protein in the urine may be the first
sign of an otherwise silent kidney condition.
Protein leaks into the urine in very small or ‘micro’
amounts. The two commonest proteins that appear in
the urine when this happens are albumin, an important
blood protein, and globulin, which is largely made up
of antibody proteins.
Your microalbumin level can be measured by a special
urine test either on a single urine sample or timed urine
collection. A microalbumin test should be done at least
once a year if you have diabetes.
page 16 Kidney disease

Blood test
A blood test can measure how well your kidneys filter the
waste products and toxins from your blood, so it is the best
indicator of kidney function. By combining the result of your
blood creatinine level with your age and your gender, your
kidney function is measured using a special formula to
provide an ‘estimated Glomerular Filtration Rate’ or eGFR.

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eGFR readings are grouped into five levels or stages

of kidney function. The stages are only a guide
as function can vary. The closer the value is to zero,
the less kidney function you have.

p io
Descript n
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Stage
eGFR 2
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am
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idn
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Stage 2 on
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Moderate losss in kidne
Stage 3 n
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Severe loss in kidne
Stage 4
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Kidney failure
Stage 5
15 – 29
page 17 Kidney disease

2.2 Chronic Kidney Disease (CKD)

FAST FACTS
ears
Auustralian ad dults over 25 ye
– One in seven rker of CK KD su ch
have a att least one ma i n.
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Australians are
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If your kidneys function at a reduced level for a period of

greater than three months, you have Chronic Kidney Disease
or CKD. In some cases, kidney function can progressively
decline with time.
There are many factors that affect the progressive decline
of CKD and these are not completely understood. If CKD
is diagnosed at an early stage, medication, changes to diet,
lifestyle and careful attention to blood pressure can increase
the life of your kidneys and keep you feeling your best for
as long as possible. It is important to work with your health
care team and follow their advice to slow down its progress.
However even with the best treatment, CKD sometimes
leads to kidney failure, which requires dialysis or a kidney
transplant to maintain life.
page 18 Kidney disease

2.3 Kidney Failure

Kidney failure can be short term or permanent. It means your
kidneys are only working at 10-15% or less. Some people stop
passing urine completely while others still pass some weak,
watery urine. Either way your kidneys are unable to properly
filter waste, remove extra fluid and maintain the blood’s
chemical balance.

Acute kidney failure

Kidney failure can happen quickly, caused for example
by a sudden loss of large amounts of blood or the result
of an accident. This is called ‘acute kidney failure’. Although
life threatening, it is often short lived and kidney recovery
is usually complete. Occasionally there can be some lasting
kidney damage. Acute kidney failure is more common
in males than females.
Sometimes there are treatable causes for acute kidney
failure but often it is simply a case of waiting for the kidneys
to recover. Blood pressure and blood chemistry are monitored
while waiting for function to return and some people may
require dialysis for a short period.

End stage kidney failure

End stage kidney failure is permanent, and it means that
kidney function is reduced to 10 percent or less of normal
function. At this stage, it is time to consider starting dialysis
or a kidney transplant to keep you alive.
page 19 Kidney disease

2.4 Stages of chronic kidney disease

CKD can progress through a number of stages before
reaching kidney failure.

Early stages
There may be no symptoms and blood tests can be normal.
However there is more risk of dehydration and a higher
sensitivity to medications. It is very important to talk to
your doctor before starting any new medications including
over the counter and natural or herbal medications. The
risk of cardiovascular disease also starts to increase. Proper
treatment including maintaining a healthy blood pressure
and making healthy lifestyle choices can delay or prevent
progress to the next stage. It is important to be aware that
these guidelines sometimes need to be modified depending
on your kidney function. Check with your kidney doctor
or dietitian.

Middle stages
Discovery of CKD during this stage is more common as the
level of waste in the blood rises. You may begin to feel unwell
and notice changes in the number of times you urinate. As
kidney function slows down, blood pressure rises. Early signs
of bone disease and anaemia may appear. Proper treatment
can slow the progress of kidney disease and reduce the
likelihood of further complications.

Later stages
Changes may occur in the amount of urine passed and
high blood pressure is almost always present. The amount of
protein in the urine increases, as do the levels of creatinine
and potassium in the blood. You are more likely to feel
unwell, and you may also experience other complications
of kidney disease, such as anaemia.

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page 20 Kidney disease

2.5 Signs and symptoms

Chronic kidney disease is often found by chance as many
of its symptoms are wrongly linked to other causes. The
symptoms may gradually worsen over time so you may
not notice how severe they have become until the disease
is well advanced. Symptoms can include:
– Increased blood pressure
– Changes in the amount and number
of times urine is passed
– Discomfort or burning when passing urine
– Blood in the urine
– Frothy or foaming urine
– Puffiness, e.g. around the eyes and ankles
– Pain in the kidney area
– Tiredness
– Loss of appetite
– Difficulty sleeping
– Headaches
– Trouble thinking clearly
– Itching
– Shortness of breath
– Nausea and vomiting
– Bad breath and a metallic taste in the mouth
– Pins and needles, e.g. in the fingers and toes
– Muscle cramps

Kidney disease often has no symptoms at all. It is common

for people to lose up 90 per cent of their kidney function
before developing any symptoms.

I went to see my doctor about some constant headaches

that I had. He took my blood for testing as well as urine.
That night I was admitted into Royal Adelaide and started
dialysis two days later. Christopher

I knew for a long time before my doctor told me that

my kidney was failing. I felt so unwell that I was looking
forward to dialysis because I knew once I had started
I would get better and feel better. Lisa
page 21 Kidney disease

2.6 Kidney diseases

There are many different types of kidney disease,
which can lead to kidney failure, including:

Diabetic nephropathy
Diabetes is a major cause of chronic kidney disease. Diabetes
is caused by problems with the production and/or action of
insulin. The pancreas does not make enough insulin (Type 1)
or the body cannot use the insulin effectively (Type 2).
Insulin is a hormone that controls the amount of sugar
in your blood.
About one third of people with diabetes will end up with
some kidney damage. This is called diabetic nephropathy.
It is a serious outcome of diabetes as chronic kidney
disease worsens diabetic complications such as nerve and
eye damage. Diabetic nephropathy damages blood vessels
including those in your kidney filters and if severe, can
lead to kidney failure.
Diabetes also affects your kidneys in other ways. As an
example, it changes the level of sugar in the blood or urine
and can lead to bacterial growth in the bladder increasing the
risk of kidney infections. Nerve damage can also affect your
bladder making it more difficult to pass urine. Urine build
up in the bladder can create a back flow into your kidneys
resulting in scarring.
If you have diabetes, your chance of kidney damage greatly
increases if you smoke and/or have high blood pressure, high
cholesterol or proteinuria. It is also affected by:
– Duration of diabetes. Although kidney damage may
be present when diabetes is first diagnosed, the longer
diabetes is present, the greater the chance of developing
kidney damage.
– Family history and genetic factors. Some studies suggest
that if there is a family history of high blood pressure or
cardiovascular disease, your risk of diabetic nephropathy
increases. Currently the genes for diabetic nephropathy
have not been identified, but if your parent(s) have this
condition then you are more likely to have it.
page 22 Kidney disease

– Hyperglycaemia
Hyperglycaemia or high blood sugar is a strong risk factor
for developing diabetic nephropathy. It damages the small
blood vessels in the kidneys, particularly to the capillaries
in the kidney filters. Control of blood sugar levels may
slow down the development of diabetic nephropathy.

If you have diabetic nephropathy, regular monitoring

of your blood sugar levels is very important. You may need
adjustments to your diabetic medication as insulin is excreted
via the kidneys. Good control of blood sugar levels and blood
pressure can reduce or in some cases prevent further
kidney damage.

ACTS
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page 23 Kidney disease

Nephritis
Nephritis is a general term used to describe a group of
diseases that cause swelling or inflammation of the glomeruli
or kidney filters in the nephrons. Nephritis is often used
as an abbreviation for glomerulonephritis or ‘GN’.
It is a common cause of chronic kidney disease in
Australia and is more common in males. For reasons that
are not always understood, the body’s immune system attacks
the glomeruli causing swelling and scarring. This reduces
the kidney’s ability to filter waste from the blood.
There are many different types of nephritis. It can vary
from a mild, non-damaging condition to a serious problem
causing kidney failure. The acute form develops suddenly,
sometimes after a throat or skin infection. These infections
often need treatment, such as antibiotics, to prevent them
from causing kidney damage. Chronic nephritis develops
silently over several years and can lead to kidney failure
Sometimes an acute attack can cause chronic nephritis
years later.
Factors such as your age and the characteristics of your
urine are used to help diagnose different types of nephritis,
such as:
– Nephritic syndrome. Damage and inflammation of the
filters/glomeruli can cause loss of blood and protein into
the urine, accumulation of wastes in the blood and high
blood pressure. If untreated, some diseases causing the
nephritic syndrome can cause kidney failure.
– Nephrotic syndrome. Damage to the filters/glomeruli
causes them to leak large amounts of protein into the
urine. It is harder to diagnose this syndrome because the
symptoms and signs can also be caused by other conditions.
Swelling due to retention of fluid and high cholesterol can
also be a sign of nephrotic syndrome. Nephrotic syndrome
can make the blood sticky, leading to blood clots. These can
occur in the veins of the leg and cause swelling. Blood clots
can go into the lungs, and cause chest pain, breathlessness
or coughing up blood.
page 24 Kidney disease

As each form of nephritis acts differently, the best course of

treatment can only be determined after the type of nephritis
is identified – proper identification often requires a kidney
biopsy. Some types need observation and no treatment as
they rarely lead to long-term kidney damage. Some people
will need blood pressure treatment. Severe forms may
need rapid treatment and if treated early enough, may
respond well to medication. Occasionally nephritis leads
to kidney failure.

IgA nephropathy
IgA nephropathy is the most common, serious form of
nephritis. IgA refers to the antibody IgA (Immunoglobulin A),
which helps to fight infection and is made in your throat, air
passages, intestine and bone marrow. Nephropathy simply
means kidney disease.
In IgA nephropathy, two protein molecules join up
and make longer chains. These chains travel in the blood
and are deposited in the material between the kidney filters,
called the mesangium. The build up of IgA protein triggers
inflammation as well as damaging the filters, allowing
protein and blood to leak into the urine.
IgA nephropathy is found more often in males than
females and is usually diagnosed before the age of thirty.
In most cases the disease is not thought to be hereditary
but in some families there may be a genetic link. There is
a less common form of IgA called Henoch-Schonlein purpura.
This form also affects other parts of the body as well as the
kidneys, such as skin, joints and bowel.
page 25 Kidney disease

High blood pressure

Blood pressure is the pressure of the blood against the
walls of the arteries as the heart pumps the blood around
your body. High blood pressure damages the small vessels
that take blood to the kidney filters and can also damage
the filters themselves. If left unchecked, it tends to thicken
the blood vessel walls causing blood vessels to narrow.
High blood pressure can also lead to kidney disease, heart
attack, strokes and loss of vision.
It is possible to get into a vicious cycle – high blood
pressure causes kidney damage leading to higher blood
pressure and more kidney damage. High blood pressure
has almost disappeared as a cause of kidney failure in
young people but it is a common cause in older people.

Usually high blood pressure does not give any warning

signs and is often detected accidentally. Some people with
high blood pressure experience:
– Headaches
– Dizziness
– Nosebleeds
– Vision changes

ACTS
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page 26 Kidney disease

Polycystic Kidney Disease (PKD)

PKD is the most common, inherited cystic kidney disease.
It is caused by genetic defects, which lead to the growth
of thousands of cysts in the kidneys.
Both kidneys are affected but one kidney may develop
the cysts earlier than the other.
As the cysts grow larger, the kidneys become blocked, swell
and can eventually fail. Cysts can be painful and become
infected and bleed. You may still pass urine in normal
amounts but the waste products remain in your body.
Kidney failure caused by PKD usually develops slowly;
only around 50% of people with this condition have developed
kidney failure by the age of sixty.
There are two types of inherited PKD:
– Autosomal Dominant PKD. This is the most common,
inherited form. If one parent has this type of PKD, there
is a 50 per cent chance of passing the faulty gene in each
pregnancy to their child. If a person does not inherit the
gene, they have no chance of passing it on to their children
because it never ‘skips’ a generation. Special blood tests
can help to find the abnormal chromosomes linked to PKD
and genetic counselling is available for affected couples.
Occasionally, a person develops this condition when
there is no family history. The affected person’s children
also have a 50–50 chance of inheriting it.
– Autosomal Recessive PKD. This is a rare, inherited
form of PKD. Both parents have to carry this gene fault
for a child to inherit this disease. If both parents are
affected, they have a 25% chance of passing it on
to their child. Symptoms begin in the early months
of life or even before birth.
page 27 Kidney disease

Medullary Cystic Kidney Disease (MCKD)

This is another inherited kidney disease, which is transmitted
in an autosomal dominant pattern. It often causes kidney
failure between 20 and 50 years of age. In a few cases there is
no family history, which may indicate a new genetic mutation.
The childhood disease, juvenile nephronophthisis, is very
similar but usually occurs in young children and is due to
autosomal recessive inheritance. It can also be linked to non-
kidney complications often affecting the eyes while MCKD
is limited to the kidneys.
In both diseases cysts develop in the inner part of the
kidney (medulla), the kidneys shrink as the cortex (outer
section) thins and kidney failure develops. The kidneys can’t
concentrate urine properly, leading to an over production of
urine, loss of sodium and dehydration. Other health problems
usually follow, including anaemia, kidney bone disease,
gout and high blood pressure.

Medullary Sponge Kidney

Medullary Sponge Kidney is a condition where cysts develop
in the kidney’s urine collecting ducts and tubules. The exact
cause of Medullary Sponge Kidney is not known. One or both
kidneys may be affected. Complications include blood in the
urine (haematuria), calcium deposits in the kidneys, kidney
stones or infections. Kidney failure is rare but can develop
as a result of repeated infections or kidney stones.

Analgesic Nephropathy
In the past some pain relieving drugs were shown to cause
kidney damage. This condition became known as analgesic
nephropathy. The best-recognised drugs to have this effect
were the old APC headache powders - a combination of
aspirin, phenacetin and codeine. Kidney Health Australia
successfully campaigned the Australian Government to
have these preparations removed from the marketplace.
As a result, the rate of analgesic nephropathy has fallen
steadily. However, there are some drugs which can have
this effect on some people. You should consult your doctor
if you are concerned that the medications you are taking
may be causing kidney damage.
page 28 Kidney disease

Vascular conditions
Many older people can have a type of vascular disease where
blood vessels become completely or partly blocked. The word
vascular relates to your blood vessels such as arteries, veins
and capillaries. Fatty deposits, cholesterol, calcium and other
substances build up in the inner lining of the arteries. This
affects the kidney’s filters and reduces the blood supply to the
kidney, resulting in high blood pressure and reduced kidney
function. This problem can cause heart attacks and strokes
as well as kidney failure.

Reflux Nephropathy
Nephropathy describes any type of non-inflammatory kidney
condition. Reflux nephropathy is a form of chronic kidney
disease, linked to problems in the kidneys and urinary tract
that block the flow of urine, and is often present at birth.
Causes can include:
– Problems with the ureters location when entering the
bladder.
– Repeated urine infections.
– A blockage in the bladder outlet causing backpressure
to build up in the kidneys.
– Problems with the ureter valves. When the bladder is being
emptied these valves stop the urine moving from the
ureters into the kidney. One or both of these valves may
not work properly.

Reflux Nephropathy is often found in young children with

frequent urine infections. Reflux usually fixes itself, although
sometimes an operation is needed. Some doctors give daily
antibiotics to try to prevent infections and scarring. Usually
the damage is only minor but long-term problems like high
blood pressure can occur much later in life. However, the
damage caused by infection can sometimes be permanent.
page 29 Kidney disease

FAST F
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The main
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sti
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nephro ropath
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