Basic information about the disease and diagnosis
PChN - basic
information
The kidneys filter the blood, remove toxins, abnormal metabolic products, excess salt and water. PChN means that the kidneys do not function properly and gradually lose their ability to filter the blood. Over time, they may stop working altogether. That's why it's so important to control the progression of the disease as best as possible and prevent it from getting worse.
Definition of PChN: is a long-term disorder of kidney function or structure that persists for more than 3 months and affects health. PChN develops gradually, and its progress can be determined by testing glomerular filtration rate (GFR) and urine protein (albumin) levels.
The most common causes of PChN are:
- diabetes,
- hypertension,
- glomerular diseases,
- Drug-induced kidney damage,
- chronic nephritis,
- Hereditary kidney diseases, such as polycystic kidney disease.
Certain factors can accelerate the progression of PChN, including:
- high blood pressure,
- Excess protein in the urine (proteinuria),
- uncontrolled diabetes,
- high cholesterol,
- smoking cigarettes,
- Certain medications that can harm the kidneys.
The symptoms of PChN depend on the severity of the disease. In the early stages, there may be no characteristic symptoms, but over time they may appear:
- fatigue,
- weakening,
- hypertension,
- leg swelling,
- More frequent urination,
- concentration problems.
PChN is diagnosed based on the results of tests that assess kidney function. The most common tests are:
- GFR (glomerular filtration rate), which assesses how efficiently the kidneys filter blood,
- protein concentration in the urine (albuminuria), which may indicate kidney damage.
Yes, proper treatment and lifestyle changes can slow the progression of the disease. It is important to control blood pressure, blood glucose, cholesterol and avoid medications that can damage the kidneys.
PChN can lead to many complications, such as:
- hypertension,
- anemia,
- electrolyte disorders,
- bone problems,
- Increased risk of heart disease.
Visits to the doctor will be made at least once a year. Regular blood and urine tests will also be ordered. If your PChN worsens, you will probably need to visit a "nephrologist," a doctor who specializes in kidney disease.
You can influence the stabilization of the disease if:
- You take all prescribed medications daily and follow your doctor's instructions for their use.
- You maintain normal blood glucose levels if you have diabetes.
- You will correct your diet if recommended by your doctor or nurse. They may suggest working with a nutritionist.
- You quit smoking if you smoke.
- You will lose weight if you are overweight.
- Regularly measure blood pressure and properly treat hypertension.
- Avoid medications that can damage your kidneys - examples include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Consult your doctor, nurse or nephrologist before starting any new medications or supplements, even over-the-counter ones.
Early stages of PChN can be treated with medications to slow the progression of the disease, your doctor will tell you.
In advanced stages of PChN, the kidneys can stop functioning properly, leading to a buildup of toxins in the body. If the kidneys can no longer filter the blood properly, you have three choices for "renal replacement" treatment
- Kidney transplant: a new kidney will take over the function of your own kidneys. After the transplant, you will need to take medication daily to prevent transplant rejection.
- Hemodialysis: is a procedure in which a dialysis machine takes over the function of the kidneys. The machine takes a portion of the blood from the body, purifies it and puts it back into the body. If you choose hemodialysis, you will need to use the machine at a dialysis station at least three times a week for several hours. You will also need to have surgery to prepare the vascular access for connection to the machine before starting.
- Peritoneal dialysis: involves inserting a special fluid into the abdominal cavity each day. If you choose peritoneal dialysis, you will have to undergo surgery to implant a dialysis catheter in your abdomen. You will then have to learn how to insert and remove the fluid through this catheter.
You and your doctor will work together to choose the optimal treatment. Kidney transplantation is usually the best option for most patients, but it is not always possible. Ask your doctor for detailed information about all treatment options and how they might work in your case. Talk frankly about your preferences. You may also decide that you do not want any treatment at all.
PChN - stage G1-G5
In the first stage of chronic kidney disease (CKD), the kidneys function in relatively good condition. Values of the glomerular filtration rate (GFR) are normal, meaning that the kidneys filter blood efficiently. However, there may be abnormalities associated with underlying diseases such as diabetes and hypertension.
Symptoms and observations:
- Clinical symptoms usually relate to the underlying disease, not to PChN itself.
- Possible albuminuria (urine protein concentration) and abnormal urine sediment.
- The increase in blood pressure may be noticeable.
Recommendations:
- Determining the cause of PChN and eliminating risk factors is key, which can help prevent further progression of the disease.
- Annual determination of serum creatinine is recommended.
In stage G2, kidney function remains fairly stable, but there are signs that may indicate problems. GFR is lowered, but still within normal limits.
Symptoms and observations:
- Serum creatinine and urea levels are usually normal.
- The kidneys' ability to concentrate urine is limited, increasing the risk of dehydration.
- Phosphate retention and the onset of secondary hyperparathyroidism may occur.
- Some people with diabetic kidney disease may develop anemia due to reduced erythropoietin production.
Recommendations:
- Monitoring kidney health and controlling sugar levels and blood pressure are crucial at this stage.
- Annual determination of serum creatinine and GFR is recommended.
In the third stage of PChN, kidney function declines significantly. GFR indicates moderate impairment of renal function.
Symptoms and observations:
- Symptoms such as isostenuria (inability to concentrate urine), polyuria and nycturia (frequent urination at night) may occur.
- An increase in blood pressure occurs in more than 50% of people.
- An increase in the concentration of phosphate and products of protein metabolism (urea, creatinine) in the blood.
- Possible symptoms include anemia, bad taste in the mouth, loss of appetite and nausea.
Recommendations:
- The focus should be on controlling symptoms and preventing complications, including constant monitoring of diet and fluid levels.
- It is recommended to determine serum creatinine levels every 6 months.
At stage G4, there is advanced renal impairment, and symptoms are markedly worse.
Symptoms and observations:
- Weakness, nausea, vomiting and loss of appetite are becoming common.
- Hypertension occurs in more than 80% of people; left ventricular hypertrophy is often noted.
- Significant anemia affects exercise tolerance, which limits daily activities.
Recommendations:
- It is important to intensively monitor the condition and implement treatment to control symptoms and prevent further complications.
- It is recommended to determine serum creatinine levels every 6 months.
In the fifth stage of PChN, there is extreme renal impairment, leading to kidney failure.
Symptoms and observations:
- There are symptoms from all organs, including uremia, which manifests as high blood urea and creatinine levels and uncompensated non-respiratory acidosis.
- Neurological, cardiovascular and metabolic symptoms appear, including circulatory disorders and respiratory problems.
Recommendations:
- Preparing for renal replacement therapy, which may include dialysis or a kidney transplant, is crucial.
- Regular monitoring of the condition is needed to manage symptoms and complications, which may include determination of serum creatinine levels every 1-3 months.
Proteinuria
Proteinuria is a condition in which there is an excessive loss of protein in the urine. Under normal conditions, the kidneys filter the blood, removing metabolic products, but retain substances such as protein. Damage to the glomeruli can lead to the appearance of protein in the urine.
Proteinuria can occur for a variety of reasons, including kidney damage, diabetes, hypertension or in response to external factors such as fever, stress or intense exercise.
- Transient proteinuria: Short-lived and often triggered by stressful conditions such as infection, fever or exercise. Usually resolves spontaneously.
- Orthostatic proteinuria: Occurs while standing, but resolves when lying down. It is common in young adults and usually does not require treatment.
- Chronic proteinuria: Occurs as a result of chronic kidney disease, diabetes or hypertension. Requires monitoring and treatment.
In most cases, proteinuria is asymptomatic, especially when protein loss is small. In more severe cases, swelling of the face, legs or abdomen may occur.
- Urinalysis: Most often, proteinuria is detected during a routine urine test, such as a strip test.
- Measuring the amount of protein: The amount of protein in urine is assessed using a random urine sample or 24-hour urine collection.
- Blood tests: Tests are performed to assess kidney function, such as creatinine levels and glomerular filtration rate (eGFR).
- Kidney biopsy: In advanced or atypical cases, a sample of kidney tissue is taken for further analysis.
- Transient and orthostatic proteinuria: Usually do not require treatment, but regular monitoring of renal function is recommended.
- Chronic proteinuria: May require pharmacotherapy, especially in people with kidney disease. Medications such as ACE inhibitors or ARBs are used to help reduce the amount of protein excreted in the urine.
Those with transient or orthostatic proteinuria usually do not experience long-term complications. Those who have chronic proteinuria, especially with associated kidney disease, may require more intensive treatment and monitoring to prevent further kidney damage.
- Proteinuria is the presence of protein in the urine, which can be the result of kidney damage or other conditions.
- Most cases of proteinuria are asymptomatic and are detected incidentally during urinalysis.
- There are three main types of proteinuria: transient, orthostatic and chronic.
- Proper diagnosis requires urine and blood tests and, in some cases, a kidney biopsy.
- Treatment of proteinuria depends on the cause, and regular monitoring is key to preventing complications.
Glomerulonephritis
Glomerulonephritis is a condition that affects the part of the kidney responsible for blood filtration. It leads to substances that should not normally be in the urine, such as protein and blood, infiltrating the urine. The disease can have a sudden onset or develop gradually and lead to serious complications such as acute or chronic kidney failure.
Symptoms depend on the type and cause of the inflammation. Some people experience no symptoms and find out about the disease during routine urine tests. However, when inflammation causes symptoms, they can include:
- Bloody, red, pink or brown urine
- Foamy urine
- Swelling (hands, face, feet, abdomen)
- Fatigue
- Less frequent urination
Yes, glomerulonephritis can be diagnosed by blood and urine tests. These tests can show the presence of blood or protein in the urine and assess kidney function. Additional tests may include:
- Blood tests to detect causes of inflammation
- Renal ultrasound
- Kidney biopsy, which is the collection of a tissue sample for analysis under a microscope
Treatment depends on the symptoms, cause and rate of progression of the disease. In mild cases, your doctor can only monitor your condition through regular examinations. Some forms of inflammation may resolve on their own, especially those that occur after an infection in another part of the body.
- For more advanced inflammation, treatment may include:
- Plasmapheresis - filtration of blood to remove harmful substances.
- Steroid drugs - reduce inflammation in the kidneys.
- Immunosuppressive drugs - weaken the response of the immune system.
- Hypertension drugs - help control blood pressure.
- Diuretics - increase the excretion of urine.
If the kidneys stop working, replacement therapy will be needed. The available methods are:
- Hemodialysis - blood purification using a machine, performed at least 3 times a week.
- Peritoneal dialysis - a procedure performed at home, which involves the introduction of fluid into the abdominal cavity to remove blood waste.
- Kidney transplantation - an operation in which a diseased kidney is replaced by a healthy one transplanted from a donor.
Prognosis depends on the cause and type of glomerulonephritis. Some forms of the condition resolve spontaneously or respond well to treatment. Others can lead to chronic kidney failure, requiring ongoing treatment or a kidney transplant. Early recognition and appropriate treatment are key to preventing complications.
ADPKD - Autosomal dominant polycystic kidney degeneration
Autosomal dominant polycystic kidney degeneration (ADPKD) is a condition in which abnormal, fluid-filled cysts appear in various organs, including the kidneys. These cysts cause the kidneys to become larger and function abnormally. ADPKD can lead to problems such as high blood pressure, kidney infections and kidney failure. Kidney failure is a condition in which the kidneys stop working completely. ADPKD can also cause problems in other organs and parts of the body. ADPKD is usually inherited.
Some patients with ADPKD have no symptoms. When symptoms do appear, however, they may include:
- Pain in the lower back or side - can occur with or without fever.
- Abdominal pain
- Blood in the urine
- Kidney stones - These are small, hard structures that form in the kidneys and can cause abdominal or flank pain and the presence of blood in the urine.
ADPKD can also lead to problems in other parts of the body, such as:
- Brain aneurysm - if the aneurysm ruptures there is a sudden, severe headache, nausea, vomiting and eventually brain damage and even death.
- Cysts in the liver - can cause abdominal pain.
- Hernia - a weakened area in the abdominal muscles that causes a bulge.
- Heart problems - usually do not give symptoms.
Yes. To diagnose ADPKD, your doctor may order:
- Imaging studies, such as ultrasound, computed tomography (CT) or magnetic resonance imaging(MRI). These tests provide images of the inside of the body.
Genetic testing, which checks for the presence of abnormal genes responsible for the disease.
If ADPKD causes high blood pressure, the doctor will first focus on controlling it, which can help preserve kidney health longer. Treatment usually includes lifestyle changes, dietary changes and medication.
For other symptoms or problems, your doctor may recommend additional treatment. Examples include:
- Treatment of kidney infection with antibiotics
- Treatment of pain with painkillers
- Operative treatment of brain aneurysm
- Operative treatment of hernia
In some cases, a drug called tolvaptan can slow the development of ADPKD and relieve pain. However, this drug is not recommended for everyone, as it can cause side effects. Your doctor will discuss possible treatment options with you.
If your kidneys completely stop working, you will need treatment to replace their function. The kidneys normally remove unnecessary metabolic products, excess salt and water from the blood to form urine.
Two types of treatment are available for total renal failure:
- Dialysis - Many patients with ADPKD benefit from hemodialysis. During hemodialysis, a machine removes unnecessary metabolic products, salt and water from the blood. The procedure takes about four hours and is performed at least three times a week. Hemodialysis is necessary for the rest of life or until a kidney transplant.
- Kidney transplantation - During this operation, the diseased kidney is replaced by a healthy one. The new kidney takes over the function of removing unnecessary blood products. One healthy kidney is sufficient for life.
If you have questions about these options, talk to your doctor or nurse.
If you have ADPKD, adult family members should talk to their doctor about the possibility of being tested. There are both benefits and risks associated with undergoing such testing.
Doctors do not usually recommend testing in children unless they have symptoms of the disease. However, children should have their blood pressure checked by a doctor regularly, every year.
Nephrolithiasis
Nephrolithiasis is the presence of deposits in the urinary tract, which are formed by the precipitation of chemicals in the urine. This happens when their concentration exceeds the solubility threshold.
The main factors are:
- High concentration of lithogenic substances in the urine, such as oxalate, calcium, phosphate, uric acid and cystine.
- Urinary stasis.
- Urinary tract infection (UTI).
- Presence of organic nuclei of crystallization.
Most often, the deposits consist of calcium oxalate, but can also include calcium phosphates, urate, struvite and cystine.
The deposits most often form in the renal calyxes or pelvis, and then move into the ureter and bladder.
A typical symptom is renal colic, which manifests itself as severe pain in the lumbar region, radiating to the pubic conjunctiva, genitals and the inner surface of the thighs. You may also experience nausea, vomiting, urinary urgency and frequent urination in small amounts.
The diagnosis is established on the basis of clinical symptoms, such as an attack of renal colic, and the results of imaging studies and a general urinalysis. In some cases, lithiasis is diagnosed incidentally during examinations performed for other reasons.
Supporting studies include:
- Imaging studies, such as spiral computed tomography (CT) or ultrasonography (ultrasound), which help visualize the deposits.
- General urine examination, which often shows hematuria.
- Blood tests to assess inflammation.
You should consult a urologist if you experience symptoms such as:
- Severe pain that does not go away despite treatment.
- Fever and urinary tract infection symptoms.
- Scanty or urineless.
Treatment may include:
- Conservative treatment: use of analgesics such as NSAIDs (e.g., ketoprofen) and opioids (e.g., morphine).
- Invasive treatment: procedures such as extracorporeal lithotripsy (ESWL), percutaneous nephrolithotripsy (PCNL) or ureterorenoscopy (URSL).
The probability of developing symptoms of nephrolithiasis after incidental detection of deposits is about 50% within five years. Without prophylaxis, the risk of recurrence of renal colic after a first episode is about 15% within a year, and up to 50% within 10 years.
Early recognition of the cause and appropriate treatment can significantly improve the prognosis, especially for recurrent episodes. Diet should also be monitored and the body properly hydrated to minimize the risk of deposits.
Hypertension
Blood pressure is the force that blood exerts on the inner walls of the arteries. Arteries transport blood from the heart to other organs and parts of the body. "Hypertension" is the medical term for high blood pressure.
Hypertension is a condition that increases the risk of heart attack, stroke and kidney disease. It usually does not produce obvious symptoms, but can lead to serious health consequences. When you measure your blood pressure, your doctor or nurse will tell you two values. For example, they may inform you that your blood pressure is "130 over 80." The first value (top) reflects the pressure in the arteries when the heart is contracting, and the second value (bottom) is the pressure in the arteries when the heart is diastolic.
The term "elevated blood pressure" is used by doctors and nurses to warn people. People with elevated blood pressure do not yet have hypertension, but their blood pressure values are higher than optimal for health. Experts define blood pressure values as follows:
- Normal blood pressure: Upper value of 119 or lower and lower value of 79 or lower.
- Hypertension: Upper value of 130 or more and/or lower value of 80 or more.
- Elevated blood pressure: An upper value between 120 and 129 and a lower value of 79 or lower.
If your doctor or nurse has prescribed you hypertension medication, the most important thing is to take it regularly. If you experience side effects, don't stop treatment on your own. Instead, it's a good idea to consult your doctor or nurse to discuss possible changes in treatment, such as reducing the dose or choosing a different drug. If the cost of treatment is an issue, be sure to mention it, as there are cheaper drug alternatives. Taking high blood pressure medication regularly can prevent a heart attack, stroke or even save a life.
You have a lot of influence in controlling your blood pressure. To lower it, it is recommended:
- Quitting smoking.
- Weight reduction (if you are overweight).
- Dietary adjustment: choose low-fat products, rich in fruits, vegetables and low-fat dairy products.
- Limit salt intake.
- Physical activity for at least 30 minutes a day, most days of the week.
- Limit your alcohol intake (if you consume more than 2 drinks a day).
Buying a blood pressure monitor for home use is also a good idea. People who regularly measure their blood pressure at home tend to monitor their blood pressure levels more effectively and can sometimes reduce the dosage of their medications.
Untreated high blood pressure increases the strain on the heart and arteries, which can eventually lead to organ damage. Hypertension increases the risk of heart failure, heart attack (myocardial infarction), stroke and kidney failure. Most adults with hypertension have primary hypertension, meaning that the cause of high blood pressure is unknown. A small proportion of adults have secondary hypertension, meaning there is a primary and potentially correctable cause, usually related to kidney disease or endocrine disorders.
Hypertension is a common health problem. In the United States, about 46% of adults have hypertension. With age, the risk of hypertension increases; in the US, for example, it affects 76% of adults aged 65-74 and 82% of adults aged 75 or older. Unfortunately, many people's blood pressure is not well treated and controlled. Studies show that hypertension is well controlled in only 47% of adults.
Although the exact cause of primary hypertension remains unclear, several risk factors have been identified. Your risk is higher if:
- You are older (risk increases with age).
- You have obesity.
- There is a history of hypertension in your family (that is, relatives who had or have high blood pressure).
- You are a black person.
- You consume a large amount of sodium (salt) in your diet.
- You drink a lot of alcohol.
- You don't do enough physical activity.
Hypertension is often identified during routine examinations. Experts recommend that people over 40 with no history of hypertension have their blood pressure checked regularly at least once a year; more frequent testing is recommended for those with risk factors such as obesity, family history or past elevated blood pressure. For younger people without risk factors, checking every few years may be a reasonable approach.
If elevated blood pressure is found during an examination at the office, it may be necessary to confirm the results by self-measurement at home. This is because in many cases a person's blood pressure temporarily rises when measured by a doctor, nurse or other medical professional. This is often called "white coat hypertension." Your doctor will use the results from your office blood pressure measurements and the results from your home measurements to determine if you have true hypertension.
This is a method of measuring blood pressure during normal daily activity, so to speak, in the natural environment of the test subject. It is a non-invasive, time-consuming test and represents a certain inconvenience, since it involves taking measurements multiple times a day (usually every 15 minutes during the day, every 30 minutes at night). Therefore, it is ordered in specific situations by a doctor, such as in cases of white coat hypertension or incomplete response to treatment. The device is put on in the morning on the day of the test, and should be returned to the ABPM Laboratory the next day after 24 hours. Respondents are usually asked to keep an activity diary during the study day (hours of rest and physical activity).
Pregnancy in PChN
If you have chronic kidney disease (CKD), especially at an advanced stage, you may be less likely to get pregnant and have a complication-free pregnancy compared to people with normal kidney function. Even mild PChN, especially if accompanied by proteinuria, hypertension or other comorbidities, increases the risk of complications for both you and the fetus. These risks include deterioration of kidney function, hypertension, premature birth and fetal growth restriction.
Chronic kidney disease is associated with a higher risk of adverse pregnancy outcomes, such as:
- Pre-eclampsia (preeclampsia)
- Premature birth
- Low birth weight and fetal growth restriction
- Necessity of cesarean section
- Pregnancy failures
This risk increases as your glomerular filtration rate (GFR) decreases, especially if you have proteinuria and hypertension.
Pregnancy can accelerate the progression of PChN. This risk depends on the level of glomerular filtration rate (GFR) before pregnancy, the presence of proteinuria and hypertension.
- Counseling - You should discuss your pregnancy plans at each visit. You should be informed that pregnancy in the context of PChN is considered a high-risk pregnancy and requires cooperation with your gynecologist and nephrologist.
- Baseline assessment - If you are considering pregnancy, a multidisciplinary health assessment is recommended, including consultation with a nephrologist and maternal-fetal medicine specialist.
- Medications - Medications such as ACE inhibitors, angiotensin receptor blockers (ARBs) and SGLT2 inhibitors should not be used during pregnancy because they can cause fetal defects. If you are planning a pregnancy, it will be necessary to discontinue them and switch to other blood pressure control drugs.
- Pregnancy diagnosis - Pregnancy is confirmed with a blood test for beta-hCG and an ultrasound to make sure the pregnancy is going well and to estimate the gestational age.
- Maternal and fetal monitoring - You will be monitored regularly during pregnancy: once a month in the first trimester, every two weeks in the second trimester, and weekly in the third trimester.
- Prevention of preeclampsia - PChN increases the risk of preeclampsia. Use of low-dose aspirin may reduce this risk.
- Delivery - Natural childbirth is preferred unless there are contraindications. If labor has not begun by the expected date, elective delivery is recommended.
- PChN care - You will continue to be under the care of a nephrologist during pregnancy to control any possible complications, such as hypertension or anemia. If your glomerular filtration rate (GFR) drops below 20 mL/min, you may need to consider dialysis.
- Maternal complications - Pregnant women with PChN are at risk for serious complications, such as preeclampsia and gestational diabetes.
After giving birth, your care will be similar to that of people without PChN. There are no contraindications to breastfeeding, as long as you are not taking medications that could affect lactation.
Because of the increased risk of pregnancy complications in women with PChN, contraceptive counseling is an important part of pre-pregnancy care. You should use effective contraception until you decide to actively pursue pregnancy.