Chronic Kidney Disease
Chronic kidney disease, or CKD, is common, silent and deadly.
One of every 11 Australians have signs of chronic kidney disease. Most people with CKD don’t realise they have it as you can lose up to 90% of your kidney function before you start developing symptoms. Any disease that affects the kidney can cause CKD, but the commonest causes are diabetes, hypertension, glomerulonephritis and inherited kidney conditions.
Screening for CKD is easy using a Kidney Health Check:
- Blood pressure
- Blood test (creatinine and eGFR)
- Urine test (urine albumin-to-creatinine ratio or ACR)
eGFR stands for estimate of glomerular filtration rate and you can think of it in simple terms as a percentage of normal kidney function. It is used to monitor for kidney disease progression over time.
If signs of CKD are detected your work-up will include further tests to look for a specific cause of kidney disease and will usually include an ultrasound or other imaging test.
Early detection is the key because there are simple things you can do to slow the rate of progression and reduce the chance of complications. Even at an early stage, CKD is associated with an increased risk of cardiovascular disease.
If you have CKD it needs to be monitored and managed.
Download Home Blood Pressure Monitoring Diary
Hypertension is a disease of chronic high blood pressure that affects one in every 3 Australian adults. It becomes more common with age and although silent in the early stages, can lead to serious consequences including heart disease, heart failure, stroke and kidney failure. Hypertension is commonly uncontrolled or inadequately controlled.
Diagnosing hypertension is important but not as straight-forward as just getting your blood pressure checked with a GP. Blood pressure goes up and down all the time and is affected by exercise, stress, stimulants like caffeine, even talking. And quite a few people are affected by ‘white-coat’ hypertension – a short-term rise in blood pressure when you are seeing the doctor!
The diagnosis usually involves repeated measurements of blood pressure with a doctor and confirmed by home blood pressure readings or ambulatory blood pressure monitoring in which a BP monitor is worn for a 24h period. Once confirmed, additional tests may be required to rule out underlying conditions that can cause high blood pressure and to look for signs of damage to the kidneys and other internal organs.
Most patients will need treatment using a combination of lifestyle measures and blood pressure medications. Reducing dietary salt intake, which contributes to more than 20% of high blood pressure in Australia, is an important first step. Medications that lower blood pressure are effective but often two or 3 different drugs will need to be used in combination to get control. These medications must be continued for years to maintain good control and to prevent complications.
Inside the kidneys there are millions of tiny filters called glomeruli, which sieve the blood to start the process of making urine. Glomerulonephritis, which means inflammation of the glomeruli, is a condition in which these filters are damaged. There are many different diseases that can cause glomerulonephritis and the damage can occur quickly (acute) or slowly (chronic).
Glomerulonephritis, or “GN”, is suspected when blood or protein is detected in the urine and may be associated with kidney failure. Further tests are required to find the cause and many people with GN will require a kidney biopsy to confirm the diagnosis.
Glomerulonephritis can make you very sick, but for many people it gets picked up incidentally when undergoing tests for another reason and this is why it can come as a shock.
The most important thing is to work out the diagnosis and get the most appropriate treatment. Because many of these conditions are rare, you may be asked if you want to participate in clinical trials to help find better treatments.
Vasculitis is a rare condition that causes inflammation of blood vessels and can affect almost any part of the body. The kidney, which has a rich supply of blood vessels, is commonly affected. Because it is rare and can present in myriad ways, it can be hard to diagnose. Numerous diseases can cause renal vasculitis but the commonest is called ANCA-associated vasculitis.
Signs of vasculitis in the kidney include the presence of blood or protein in the urine, a persistent cough, coughing up blood or unexplained kidney failure.
Suspected kidney vasculitis requires urgent assessment. Your work-up will include urine and blood tests, including testing for special antibodies (anti-neutrophilic cytoplasmic antibodies, or ANCA). A kidney biopsy is usually required to confirm the diagnosis.
Nephrotic syndrome is a form of glomerulonephritis in which the kidneys are leaking large amounts of protein into the urine. People with this condition usually complain of leg swelling and frothy urine. Other features include low levels of the blood protein albumin, high cholesterol levels, kidney failure and an increased risk of blood clots.
It is important to identify what type of glomerulonephritis is causing nephrotic syndrome and whether it is associated with any other diseases. A kidney biopsy is commonly required.
Because diseases causing nephrotic syndrome are rare, you may be asked if you want to participate in clinical trials to help find better treatments.
Download Kidney Biopsy Information Sheet
Despite the improvements in diagnostic testing in modern medicine, it may still be necessary to collect a sample of tissue from the kidney to make a specific diagnosis for kidney diseases.
A kidney biopsy is a day-procedure in which a needle is placed into one kidney to collect a small sample under local anaesthetic. Typically, two samples are collected from one kidney because these diseases affect both kidneys equally and to ensure there is enough tissue to make a diagnosis. Ultrasound may be used to assist with the procedure and after a kidney biopsy one needs to lie flat on a bed for several hours.
The biopsy undergoes extensive testing using a variety of methods to determine a specific diagnosis.