Chronic illness has been described as a journey made by an unwilling traveler.  For those living with chronic kidney disease (CKD), it's a journey of strong emotions, uncertainty, shifting roles, changing relationships, compromise, complex choices, and often a more profound awareness of yourself and the people who are important to you.  It's not a trip you can take alone.  When CKD progresses toward kidney failure, it will also impact the day-to-day lives of your family and loved ones.   

Before you can understand what kidney disease is, you need to understand what your kidneys do. 

Most people are born with two kidneys – nature's way of giving you a back-up system in case one is damaged.  Each kidney contains over a million tiny nephrons that contain small blood vessels that filter the blood to remove waste products and excess water.  Much of this waste is produced by the body as it metabolizes the food you eat.  Your entire blood volume gets filtered approximately 20-25 times each day and more than 2 quarts of waste are filtered out and sent to the bladder to be excreted as urine. The kidneys also help regulate levels of various salts and minerals in the blood, such as calcium, sodium, phosphate and potassium; which regulate the body's acid-alkaline balance; and secrete hormones that help your body regulate blood pressure, make red blood cells and promote strong bones.  

Kidney disease occurs when the kidneys become damaged and the nephrons lose their ability to filter the blood.  Small declines in kidney function pose no health problems. The body only requires the presence of one fully functioning kidney to do its job successfully.  When renal function drops to 25 percent or below (less than half of one kidney functioning properly), serious health problems begin to emerge.   

There are three main types of kidney disease:

• Hereditary kidney disease is part of your genetic make-up, though it may not present itself in every generation.  One of the most common forms of inherited kidney disease is Polycystic Kidney Disease (PKD). 
  
  
• Congenital (present at birth) kidney disease involves malformations in the kidney, bladder and surrounding organs, causing pressure on the kidneys or disabling them.
  
  
• Acquired (not present at birth) kidney disease is the most common form of kidney disease and is most frequently of the chronic variety. 

The causes of kidney disease are not always known.  Doctors call this generic kidney disease or failure.

There are 3 degrees of kidney disease:

• Acute renal failure (ARF), now also referred to as acute kidney injury (AKI), is an abrupt drop in the blood cleaning ability of the kidneys over a period of hours or days, and generally happens as a result of severe illness, injury or poisoning.  ARF can lead to the permanent loss of kidney function if not treated immediately.  However, if the kidneys are not severely damaged, renal failure may be reversed.
  
  
• Chronic kidney disease (CKD) is the gradual loss of kidney function and the most common form of kidney disease.  It usually occurs over a period of months to years. CKD is considered a "silent killer" because there are few symptoms in early stages.  Too often, by the time a person realizes they have a problem, significant damage has already been done.  In fact, people may not know they have kidney disease until they're facing kidney failure. Even with an early diagnosis of CKD, the condition is often irreversible. While there's no cure for CKD, with early diagnosis it may be possible to stop its progress or at least slow down the damage. The two most common causes of CKD are diabetes and high blood pressure (hypertension). Among other causes are obstruction of urine flow, arteriosclerosis, kidney infection and inflammation, and overexposure to toxins and to some medications. 
  
  
• End-stage renal disease (ESRD) occurs in the late stages of chronic kidney disease (CKD). It's the total or near-total loss of kidney function, meaning your kidneys are unable to perform well enough to keep you alive.  Individuals with ESRD will need to undergo dialysis or have a kidney transplant to survive.  The amount of time between when an individual is first diagnosed with CKD and when he or she requires dialysis or a transplant is different for each person. It could be a few months or it could be many years depending on when the kidney failure is first detected, the extent of the damage, and how quickly kidney function declines.  

Chronic kidney disease is classified into five stages of increasing severity using a test called a glomerular filtration rate (GFR) – a measurement of how many milliliters (ml) of waste products your kidneys can filter in a minute: 

• Stage 1:  Slight kidney damage with normal or increased filtration.  There are usually no symptoms to indicate the kidneys are damaged.  (GFR >90)
  
  
• Stage 2:  Mild decrease in kidney function.  There are usually no symptoms to indicate the kidneys are damaged. (GFR 60 – 89)
  
  
• Stage 3:  Moderate decrease in kidney function.  Most patients continue to have no symptoms related to their kidney disease.  Symptoms may start to appear including fatigue due to the anemia that can develop at this level of kidney disease.  Some patients may develop swelling in the lower legs, hand or face around the eyes or shortness of breath but the majority of patients do not develop problems with fluid retention until stage 5.
  
  
• Stage 4:  Severe decrease in kidney function.  Despite the low level of kidney function, many patients continue to have no symptoms.  Some will develop fatigue, mainly related to anemia. Itching (pruritis) may develop at this stage due to high phosphorus levels in the blood.  Patients may be more prone to fluid retention (see Stage 3) with more swelling in their legs.  Bloodwork may start to reveal an inability to excrete adequate amounts of potassium from the blood and extra medications may be required to do so.  Vitamin D levels are often low and require supplementation at this level.  (GFR 15 – 29)
  
  
• Stage 5:  Kidney failure (or end-stage renal failure) is the total or near-total loss of kidney function.  Uremic (i.e. "urine in the blood") symptoms usually develop at this stage.  Most patients begin to note fatigue, weakness, no appetite or a "metallic" taste to food.  As the kidney function gets even lower, nausea and vomiting and confusion or difficulty concentrating may develop.  Other symptoms may include itching, restless legs syndrome and numbness or tingling in the toes or fingers.   The amount of urine formed may decrease, causing some swelling of the legs and around the eyes, or shortness of breath due to fluid collecting in the lungs, but many people continue to make adequate amounts of urine even after starting dialysis.  (GFR < 15)

Many of the symptoms of kidney disease may be indicative of other illnesses.  If you have one or more of them, the only way to get an accurate diagnosis is to see your doctor.

Chronic kidney failure can affect almost every part of your body.  It can cause anemia, hypertension, acidosis, disorders of cholesterol and fatty acids, impotence, damage to the central nervous system, decreased immune response and degenerative bone disease.  People with kidney disease are at increased risk of heart attack or stroke. 

If you have high blood pressure, diabetes or a family history of kidney problems, have your kidney function evaluated. Your doctor can perform tests to determine if your kidneys are functioning properly. An early diagnosis can mean a longer, healthier and more independent life. 
           

Learn more about Kidney Disease: 

Key Point 1: In management of a chronic disease, the burden on the caregiver is great, and there are physical and emotional costs to the caregiver.  The patient is not the only one who needs to be watched and taken care of.

Key Point 2:  When dealing with end-stage chronic disease, the decisions for and against interventions can be agonizing to make and to live with.  It is important that open communication results in all options getting weighed.