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ALL ABOUT CHRONIC KIDNEY DISEASE

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WHY DO KIDNEYS FAIL?


Insideeachkidneythereareaboutonemilliontinyunitscallednephrons.Thenephrons arethepartofthekidney,whichfiltertheblood.Eachnephronismadeupofaverysmall filtercalledaglomerulus.Asbloodpassesthroughthenephron,waterandwaste productsareremoved.Mostofthewaterreturnstothebloodandthewasteproducts collectinthebladderthenleavethebodyasurine(wee).Mostkidneydiseasesattack thenephrons.

Sometimeskidneyfailurecanhappenquickly.Forexample,kidneyfailurecanbecaused byasuddenlossoflargeamountsofbloodorbyanaccident.Asuddendropinkidney functioniscalledAcuteKidneyFailureandisoftenshortlivedbutcanoccasionallyleadto lastingkidneydamage

Moreoftenkidneyfunctionworsensoveranumberofyears.Thisisgoodnewsbecauseif kidneydiseaseisfoundearly,medication,dietaryandlifestylechangescanincreasethelife ofyourkidneysandkeepyoufeelingyourbestforaslongaspossible.

SometimeskidneydiseaseleadstoKidneyFailure,whichrequiresdialysisorakidney transplanttokeepyoualive.

LocationoftheKidneysandBladder

InsideaNephron

WHAT ARE THE SIGNS OF CHRONIC KIDNEY DISEASE?


Kidneydiseaseiscalledasilentdiseaseasthereareoftennowarnings.Itisnotuncommon forpeopletoloseupto90%oftheirkidneyfunctionbeforegettinganysymptoms.Thefirst signsmaybegeneralandinclude: Highbloodpressure Changesintheamountandnumberoftimesurineispassed,e.g.atnight Changesintheappearanceofurine Bloodintheurine Puffinesse.g.legsandankles Paininthekidneyarea Tiredness

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Lossofappetite Difficultysleeping Headaches Lackofconcentration Itching Shortnessofbreath Nauseaandvomiting Badbreathandametallictasteinthemouth

HOW IS CHRONIC KIDNEY DISEASE DIAGNOSED?


Ifkidneydiseaseissuspected,youwillhavesomekidney functionteststomeasurehowwellyourkidneysareworking andhelpplanyourtreatment,including:

Testsforalbumin/proteinand/orbloodinyoururine. Abloodtesttofindoutthelevelofwasteproductsin thebloodandcalculateyourglomerularfiltrationrate (GFRseebelow). Abloodpressuretestaskidneydiseasecauseshigh bloodpressure,whichcandamagethesmallblood vesselsinthekidneys.Highbloodpressurecanalso causekidneydisease. AnultrasoundorComputedTomographyscan(CTscan)totakeapictureofyourkidneys andurinarytract.Thesetestsshowthesizeofyourkidneys,locatekidneystonesor tumoursandfindanyproblemsinthestructureofyourkidneysandurinarytract.

Youmayalsovisitakidneyspecialist(calledanephrologist)tohelpmanageyourcareand decideifakidneybiopsyisneeded.Duringakidneybiopsyasmallpieceofkidneytissueis removedandlookedatunderamicroscopetofindoutthetypeofkidneydiseaseandcheck ifthekidneysaredamaged.

WHAT DO KIDNEY TEST RESULTS MEAN?


Thefollowingbloodandurinetestsarecommonlyperformedtoassesskidneyfunction.

Glomerularfiltrationrate(GFR)isthebestmeasureofyourkidneyfunctionandhelpsdecide thestageofkidneydisease.Itshowshowwellyourkidneysarecleaningtheblood.YourGFR isusuallyestimated(eGFR)fromtheresultsofthecreatininebloodtest.eGFRisreportedin millilitresperminuteper1.73m2(mL/min/1.73m2).

YoureGFRcanalsobeusedtoworkoutyourpercentof kidneyfunction.Thisisanestimateofthelevelthateach kidneyisworking.AGFRof100mL/min/1.73m2isinthe normalrangesoitisusefultosaythat100mL/min/1.73m2 isaboutequalto100%kidneyfunction.AGFRof50 mL/min/1.73m2couldbecalled50%kidneyfunctionand aGFRof30mL/min/1.73m2couldbecalled30%kidney function.SeetheeGFRfactsheetformoreinformation.

Albuminuriacanmeanthatyourkidneysaredamagedsoalbumin,akindofprotein,leaksinto theurine.Asmallormicroamountofalbuminintheurineiscalledmicroalbuminuria,anda largermacroamountiscalledmacroalbuminuria.Albuminuriaisoftenanearlywarningof kidneydiseasebutcanalsobepresentforotherreasons.Albuminuriacanbedetectedbya

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specialurinetestcalledaurine:creatinineratio(ACR).AnACRisperformedonasinglesample ofurine.SeetheAlbuminuria/Proteinuriafactsheetformoreinformation.

Haematuriaorbloodintheurineoccurswhenredbloodcellsleakintotheurine.Itcanturnurine aredordarkcolacolour.Sometimesthebloodintheurineisnotvisibletotheeye,butmaybe foundonaurinetest.Thisiscalledmicroscopichaematuria.Bloodintheurineisacommonsign ofurinarytractinfectionsbutcanalsobethefirstsignofaproblemwiththekidneysorthebladder.

Creatinineisawasteproductmadebythemuscles.Itisusuallyremovedfromthebloodbythe kidneysandpassesoutintheurine.Whenthekidneysarentworkingwell,creatininestaysinthe blood.Abloodtesthelpstoworkouthowquicklyyourkidneysremoveorclearcreatininefrom theblood.Creatinineisagoodmeasureofkidneyfunctionasitdoesnotchangewithdiet. Howeveritdoesvarywithage,genderandbodyweightsoisnotanaccuratewayofmeasuring overallkidneyfunction.

Ureaisawasteproductmadebythebodyasitusesproteinfromthefoodyoueat.Ifyouhave lostsomekidneyfunction,yourkidneysmaynotbeabletoremovealltheureafromyourblood.

Potassiumisamineralfoundinmanyfoods.Ifyourkidneysarehealthy,theyremoveextra potassiumfromtheblood.Ifyourkidneysaredamaged,thepotassiumlevelcanriseandaffect yourheart.Aloworhighpotassiumlevelcancauseanirregularheartbeat.

WHAT IS THE DEFINITION OF CHRONIC KIDNEY DISEASE?


TobediagnosedwithchronickidneydiseaseyoumusthaveaGFRlessthan60mL/min/1.73m2 formorethanthreemonths OR Evidenceofkidneydamageformorethanthreemonths,regardlessofyourGFR.

Kidneydamagecanbeanyofthefollowing: albuminuria haematuria pathologicalabnormalities(suchasanabnormalkidneybiopsyresult) structuralabnormalities(suchasanabnormalkidneyultrasoundresult)

WHAT ARE THE STAGES OF CHRONIC KIDNEY DISEASE?


KidneyfunctioncanbeclassifiedintostagesdependingonyoureGFR.

Stage1: Stage2: Stage3a: Stage3b: Stage4: Stage5:

AnormalGFRgreaterthanorequalto90mL/min/1.73m2 SlightlydecreasedGFRbetween6089mL/min/1.73m2

Ifyourkidneyfunctionisatstage1or2,youonlyhaveCKDifyouhavealbuminuria,haematuria,apathological abnormalityorastructuralabnormality.

MildmoderatedecreaseinGFRbetween4559mL/min/1.73m2 ModerateseveredecreaseinGFRbetween3044mL/min/1.73m2 SeveredecreaseinGFRbetween1529mL/min/1.73m2 KidneyfailureasGFRdecreasestolessthan15mL/min/1.73m2ordialysisisstarted

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YoureGFRandalbuminuriaresultsarecombinedtoprovideanoverallpictureofhowwellyour kidneysareworking.Yourdoctorusesthisinformationtodecidewhichtreatmentisbestfor you.Treatmentalsodependsonthecauseofyourkidneydamage.Controllingdiabetesand highbloodpressurecanhelptosloworpreventfurtherkidneydamage.Italsoreducestherisk ofotherhealthproblems,suchasheartattacksandstrokes.

Manyfactorsaffecttheprogressofkidneyfailureandthesearenotcompletelyunderstood. Ifyouhavekidneydisease,itisimportanttoworkwithyourhealthcareteamandfollowtheir advicetoslowdownitsprogress.

EARLY STAGES
Intheearlystagesofkidneydisease,thereisonlyasmallamountofdamagetothekidneys.The earlystagesofkidneydiseasecancausescarringandblockagesthatchangebloodflowtoparts ofthekidneyssotheyarenotworkingaswellastheyshould.Evenintheearlystagesofchronic kidneydiseasetheriskofcardiovasculardisease(suchasaheartattackorstroke)hasbeenshown toincrease,someasurestoreducethisriskareessential.

Intheearlystagesyoumayhavenosymptomsandbloodtestscanbenormal.Howeveryoucan beatmoreriskofdehydrationandhaveahighersensitivitytomedications.Itisveryimportant totalktoyourdoctorbeforestartinganynewmedications.Maintainingagoodbloodpressure andfollowinganysuggesteddietarychanges,maydelayorpreventprogresstothenextstage.

MIDDLE STAGES
Inthemiddlestagesofkidneydiseasesymptomsmaybeginto appearasthelevelofwasteproductsinthebloodrises.Youmay begintofeelunwellandnoticechangesinthenumberoftimesyou wee.Asthekidneysslowdown,bloodpressurerises.Highblood pressurecanincreasetheriskofcardiovasculardisease.Earlysigns ofbonediseasemayalsobepresent.Itisveryimportanttowork withyourhealthcareteamtotreattheseconditionsandprevent otherproblemsdevelopinglateron.

Anaemiacanalsoappearduringthesestages.Anaemiaiscausedwhentherearenotenoughred bloodcellsintheblood.Redbloodcellscarryoxygensoanaemiamakesyoufeelweak,tiredand shortofbreath.Anaemiacanbetreatedwitherythropoietin(EPO)whichisabodychemical (hormone)mainlymadebythekidneysthattellsthebonemarrowtomakeredbloodcells.See theAnaemiafactsheetformoreinformation.

LATER STAGES
InthelaterstagesofCKDyouwillstarttonoticechangesintheamountofurineyoupassand highbloodpressurealmostalwaysoccurs.Theamountofalbuminintheurineincreases,asdo thelevelsofcreatinineandureaintheblood.Youmayneedtomakedietarychangesincluding limitingyouruseofsaltorreducingtheamountofpotassiumorphosphorusinyourdiet.

EndstagekidneydiseaseisthelaststageofCKD.Thekidneysareonlyfunctioningat1015% andareunabletoproperlyfilterwasteproducts,removeextrawaterfromthebodyandhelp tomaintainthebloodschemicalbalance.Nowit'stimetobeginpreparingfordialysisora kidneytransplant.

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WHO IS MORE AT RISK OF CHRONIC KIDNEY DISEASE?


Youareatincreasedriskofchronickidneydiseaseifyou: are60yearsorolder areofAboriginalorTorresStraitIslanderorigin havediabetes haveafamilyhistoryofkidneydisease haveestablishedheartproblems(heartfailureorpastheartattack)and/or hadastroke havehighbloodpressure areobese(Bodymassindex30) areasmoker
Formoreinformationaboutkidneyshealthorthistopic,pleasecontactKidneyHealthAustralia:Kidney InformationLine(freecall)on18004KIDNEY(18004543639)orvisitwebsitewww.kidney.org.au

Thisisintendedasageneralintroductiontothistopicandisnotmeanttosubstituteforyourdoctor'sorHealth Professional'sadvice.Allcareistakentoensurethattheinformationisrelevanttothereaderandapplicableto eachstateinAustralia.ItshouldbenotedthatKidneyHealthAustraliarecognisesthateachperson'sexperience isindividualandthatvariationsdooccurintreatmentandmanagementduetopersonalcircumstances,thehealth professionalandthestateonelivesin.Shouldyourequirefurtherinformationalwaysconsultyourdoctororhealth professional.

RevisedMarch2012
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