by Kimberly Allen, RN
In the past chronic kidney disease, or CK,D went by other names like chronic renal failure and chronic renal disease. Today, CKD is used as an umbrella term to cover a variety of structural and functional conditions that lead to kidney damage and their inability to function properly.
As many as 26 million Americans suffer from CKD and of those over 570,000 have progressed to end stage renal disease or ESRD. African-Americans develop CKD related to hypertension six times more often than Caucasians and they also progress to ESRD four times more often than Caucasians. American Indians as well as Hispanics are also at least twice as likely to progress to ESRD than Caucasians. Adults develop CKD approximately 20 times more often than children. However, most experts believe that many adults, especially young adults, developed kidney disease in childhood or adolescence but were not diagnosed. Boys are also twice as likely to develop CKD from birth defects, like polycystic kidney disease than girls.
The cause of CKD is different in adults and children. In adults approximately 90% is related to diabetes and is glomerular based. The glomerulus is the structure at the beginning of the nephron tubes and are responsible for beginning the filtration process. On the other hand, approximately 70% of CKD in children is caused by structural abnormalities like dysplastic or hypoplastic kidneys, or genetic conditions like polycystic kidney disease.
Not only is the cause different in adults CKD from CKD in children but the symptomology differs as well. Another serious issue with CKD is that the symptoms are so subtle early on in the disease that they are rarely noticed. For example a mild puffiness in your face, especially around the eyes, or foamy urine. As the disease progresses you will start to notice swelling in your hands and feet, lose your appetite and experience increase fatigue as well as nausea and vomiting. many also notice blood in their urine, however, in many cases it’s microscopic and found when your urine is tested for protein. In CKD, instead of utilizing the protein, the kidneys excrete it. Left untreated, CKD can lead multiple complications including anemia, hypertension, and nerve damage.
In children the symptoms aren’t so obvious, in fact it’s considered the ‘silent’ disease in children. What happens frequently is children will manifest symptoms of diabetes like frequent thirst and frequent urination. So they are tested for diabetes and when it turns out negative frequently the search is dropped and there is no further testing. In today’s world of high health care costs many Dr’s are discouraged from ordering tests to find something wrong, especially if there are no obvious symptoms. For years, pediatric nephrologists have seen children that come in during adolescence that have had CKD without any symptoms for years that has progressed to ESRD. Most of these children have irreversible kidney damage. This type of situation is particularly devastating to the family because this is the first time they learn that their child has been suffering from CKD for years and they didn’t ‘see’ it. This is why well baby check and regular pediatric checks are so important. What can’t be seen on the outside can usually be seen on the inside.
Treatment of CKD depends on the cause and the extent of kidney damage. There are medications available that can slow the progression of CKD as well as prevent further damage to the kidneys. Your blood pressure will be closely monitored and regardless of whether or not hypertension is the cause of your CKD or was caused by it your blood pressure will need to be managed and controlled. While CKD in the past meant long term dialysis and death today there’s hope through transplants. There has been a significant increase in research in the last 20 years on CKD, though it has been in adults, which has lead to significantly improved detection and treatment effectiveness. Also, there are several parallel studies of pediatric CKD that have already been done in adults currently in progress, however, they are in their beginning phases.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.