Chronic Kidney Failure

Chronic kidney failure

Chronic kidney failure (renal insufficiency, renal insufficiency) leads to a deterioration in kidney function. This increases the concentration of urinary substances in the blood (substances that have to be excreted via the kidneys), e.g. creatinine and urea. The regulation of the water, electrolyte and acid-base balance is impaired. After the kidneys also produce hormones or activate vitamins, blood formation disorders and changes in bone metabolism can occur.

The kidneys can be damaged by inflammatory processes, vascular changes and various other diseases (high blood pressure, diabetes mellitus, genetic factors). Chronic kidney disease develops over months or years, usually affecting both kidneys.

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• What are the causes of chronic kidney failure?
• What are the symptoms?
• How is the diagnosis made?
• How is chronic kidney failure treated?
• What can I do myself?
• Whom can I ask?
• How are the costs going to be covered?

Noticeable signs of illness (due to high blood pressure, anemia or urinary poisoning) often only appear when the kidney function has decreased significantly. Common triggers are various diseases such as diabetes, high blood pressure, kidney infections, or genetic defects. The aim of treatment is to stabilize kidney function or at least to slow the progression of the disease. If this does not succeed, dialysis initiation or a kidney transplant is often necessary in the later stages.

What are the causes of chronic kidney failure?

Various diseases can be considered as triggers for chronic kidney failure, for example:

• Diabetes mellitus: This is responsible for 40 percent of all cases of chronic kidney failure (diabetic nephropathy). A long-term increased blood sugar level damages the walls of the blood vessels and the other filter structures in the kidneys and makes them more permeable for small protein particles (especially albumin). These are increasingly excreted in the urine. In addition, the sinking of filter particles (glomeruli) leads to a progressive reduction in detoxification performance.
• Inflammation of the filter particles in the kidney corpuscles (glomerulonephritis, but also systemic diseases such as lupus erythematosus): this is the cause of about every fourth chronic kidney failure and is caused by immune and autoimmune reactions, infectious diseases or tumors.
• Cystic kidneys and other genetic diseases: This congenital malformation causes about eight percent of all cases of chronic kidney failure. The kidney function is restricted, for example, by fluid-filled cavities (cysts).
• High blood pressure: Over time, high blood pressure damages the glomeruli and blood vessels in the kidney. Paradoxically, in kidney disease, more blood pressure-increasing hormones are formed and less fluid is excreted. Disturbed kidney function and high blood pressure cause and reinforce each other.
• Blood vessel diseases, eg arteriosclerosis: can lead to reduced blood flow to the kidneys.
• Medicines: The kidneys filter medicines and their breakdown products from the blood. Some substances can damage the kidney tissue, e.g. certain antibiotics, pain relievers and cytostatics.

What are the symptoms?

Chronic kidney disease is often insidious and causes very different symptoms depending on the stage of the disease. In the beginning there are usually no or only slight symptoms. Only in the case of a rapid deterioration in kidney function can the first signs of illness appear, for example:

• increased excretion of pale urine,
• High blood pressure,
• Edema in the legs, but also other parts of the body (e.g. eyelids),
• red colored urine (due to blood), foaming urine (due to the addition of protein).

With more severe impairment of kidney function, the following symptoms may occur:

• Symptoms of anemia, such as pale skin, feeling cold, tired, weak,
• Concentration and memory disorders
• decreasing physical resilience,
• Nausea,
• Vomit,
• Diarrhea,
• Itching and burning in the legs,
• Muscle and bone pain.

In the advanced stage, almost all organ systems are impaired by the kidneys' lack of detoxification function. Typical symptoms in the end stage (terminal kidney failure) include:

• Non-adjustable high blood pressure,
• Decrease in urine volume,
• Water retention (edema),
• Shortness of breath,
• Nausea,
• Vomit,
• Loss of appetite,
• irregular heartbeat,
• Drowsiness, drowsiness,
• Cramps,
• Coma.

How is the diagnosis made?

As part of the anamnesis, the doctor informs himself about pre-existing kidney damage, chronic diseases and drug therapies as well as known kidney diseases in the family. This is followed by a physical examination including measurement of blood pressure and EKG. Further examinations include:

• Blood laboratory: especially creatinine, urea, glomerular filtration rate (GFR), C-reactive protein (CRP) and other signs of inflammation, blood count, liver and fat values, potassium, calcium, phosphate, vitamins, parathyroid hormone;
• Urinary laboratory: rapid urine test (protein, blood), creatinine clearance, urine sediment;
• Ultrasound;
• Possibly kidney puncture to remove tissue.

Classification of chronic renal failure

Chronic kidney failure is divided into five stages based on the glomerular filtration rate (GFR). The GFR shows how well the kidneys excrete substances that are urinary (especially creatinine and urea). Their normal value is 95 to 120 ml per minute / 1.73 square meters of body surface. This means that a healthy kidney cleans at least 95 ml of blood of creatinine and other small-molecule poisonous substances per minute and excretes them in the urine.

• Stage 1: GFR greater than 90 ml / min, but other signs of kidney disease.

  Mostly it is an incidental finding. The detoxification function of the kidneys is still normal, the patient has no complaints from this point of view. The blood levels of the urinary substances are in the normal range, but it is possible that blood or protein is already excreted in the urine. If this happens in large quantities, it can lead to symptoms.

• Stage 2: GFR between 60 to 89 ml / min.

  There are still no symptoms, but a more detailed diagnosis reveals a restriction in the detoxification function of the kidneys and the first other laboratory changes (increase in parathyroid hormone).

• Stage 3: GFR between 30 to 59 ml / min.

  The kidney damage has progressed to such an extent that mostly increased creatinine and urea values also occur in the blood. Those affected complain of high blood pressure (hypertension), reduced performance and rapid fatigue due to secondary complications such as anemia.

• Stage 4: GFR between 15 to 29 ml / min.

  Those affected suffer from symptoms such as loss of appetite, vomiting, nausea, nerve pain, itching and bone pain or edema. So many filter particles are already defective that the inadequate excretion of the urinary substances affects the entire organism. However, it does not “only” result in poisoning, but also in a lack of certain vital substances. Erythropoietin is no longer sufficiently produced in the kidneys, which increases renal anemia (anemia). An overactive parathyroid disrupts the vitamin D and bone metabolism.

• Stage 5: GFR below 15 ml / min.

  If the kidneys fail completely, one speaks of terminal kidney failure. The organism must be cleaned of toxins by kidney replacement procedures.

How is chronic kidney failure treated?

The aim of treatment is to slow down or prevent the progression of the disease. Complete healing is rarely possible. In the case of many diseases (eg autoimmune diseases, but also diabetes mellitus), the therapeutic options and successes have improved dramatically in recent years. There are now promising therapeutic approaches for various genetic kidney diseases.

On the one hand, the therapy is directed against underlying diseases. On the other hand, drugs (e.g. diuretics, phosphate binders, erythropoietin) are used to alleviate the effects of kidney weakness. In advanced stages of the disease, there are two different options to choose from: artificial blood washing (dialysis) or kidney transplantation.

dialysis

If the kidney is no longer able to cleanse the blood adequately, artificial procedures have to take over this task.

• Hemodialysis: This is the most common method. The blood is conducted outside the body through an "artificial kidney" past a semi-permeable membrane. The urinary substances are diverted into a sterile liquid. This outpatient therapy is usually carried out three times a week and each takes several hours.
• Peritoneal dialysis (peritoneal dialysis): Here the well-perfused peritoneum, which lines the entire abdominal cavity, is used as the body's own filter membrane. A dialysis solution is passed into the abdominal cavity several times a day, which absorbs the toxic metabolic products. The advantage of this method is that it can be carried out at home by the patient himself after appropriate training. Due to the catheter lying permanently in the abdominal cavity, however, there is an increased risk of infection.

Kidney transplant

In the case of a kidney transplant, a patient with terminal kidney disease receives a healthy kidney from a living or deceased donor. The better the tissue characteristics between donor and recipient match, the better the immune system accepts the kidney. For more information, see Transplantation.

What can I do myself?

Every patient can make a significant contribution to positively influencing the progression of chronic kidney failure.

• Kidney-friendly diet: The diet should be low in: table salt, protein (maximum 0.6-0.8 grams of protein per kilogram of body weight), fat, phosphate, potassium;
• Do not smoke;
• Low alcohol consumption;
• Regular exercise (no strenuous exercise that increases blood pressure);
• Avoidance of drugs that could potentially damage the kidneys;
• Regular check-ups;
• Compliance with treatment recommendations;
• Consult a doctor in the event of deterioration.

Whom can I ask?

The following are responsible for the treatment of chronic kidney failure:

• Specialist in internal medicine,
• Specialist in internal medicine and nephrology.

Hospitalization is often necessary, especially for clarification and when initiating renal replacement therapy.

Note Patients with existing kidney disease have a particularly high risk of acute kidney failure. You should inform every treating doctor accordingly so that drugs that could potentially damage the kidneys are avoided as far as possible. In the case of other illnesses that have occurred in the meantime (e.g. high fever or diarrhea), it may be necessary to change the therapy at short notice. In these cases, it is advisable to contact the treating doctor as soon as possible.

How are the costs going to be covered?

The costs for diagnosis and therapy are covered by the social security agencies. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

Only if a doctor of choice is used (ie doctor without a health insurance contract) the costs will not be charged directly. For more information, see Costs and Deductibles.

If hospitalization is necessary because of chronic kidney failure, the hospital costs will be invoiced. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

For more information, see What does a hospital stay cost?