CKD is the abbreviation for Chronic Kidney Disease which is a gradual and progressive decline in kidney function over an extended period of time. As we become older and our body ages, our kidneys start to lose function. This is a slow and gradual process. However, some conditions in patients, especially those like Diabetes and High Blood pressure, can cause damage to the internal structure of the kidney, leading to decease of function.

While kidneys have many functions, one of the most important is processing and filtering waste products from the blood.  When CKD progresses, the kidneys do not work as well and waste products and toxins, normally filtered out by the kidney, start to accumulate in the body.

The following list includes some of the signs and symptoms of decreased kidney function or CKD:

> Weight loss or excessive weight gain

> Fatigue

> Decrease in appetite

> Swelling of the body (especially of the feet and legs)

> Increased tendency to bruise or bleed

> Paleness

> Seizures

When you are diagnosed with CKD it is managed and treated by a Nephrologist or kidney doctor. The Nephrologist will work with you to help preserve your kidney function and to prepare you for kidney dialysis or kidney transplant, if indicated.

Please consider calling our office for a nephrology (kidney) consultation if you or your patient has any of the following conditions.

> Elevated Creatinine Level in Lab work (Creatinine >1.5mg/dL or GFR< 45 ml/min)

> Hypertensive Urgency

> Proteinuria (Protein found in your Urine ) or Hematuria ( Blood found in your Urine)

> Severe edema (swelling) or volume overload

> Recurrent Kidney Stones

Dialysis is a form of renal replacement therapy.  Many patients with CKD will lose their kidney function and may need to start dialysis, to rid the body of waste products.  Dialysis can be done two ways.

1. Hemodialysis – blood is taken from the patient’s body and transferred to a machine that will act as an artificial kidney. The machine can remove excess fluid, correct the balance of electrolytes, remove the waste products from the blood and buffer acid production. It then returns the clean blood to the patient’s body.

2. Peritoneal Dialysis – fluid enters into the abdominal cavity of a patient, where the abdominal cavity acts as a natural filter and helps remove all of the same elements and waste products that Hemodialysis does, but through the abdomen vs blood.

Hemodialysis is often done in a dialysis unit, where the patient will go to 3-4 times a week.  Peritoneal dialysis, however, can be done comfortably in the home by the patient.

Home Dialysis, whether hemodialysis or peritoneal dialysis, focuses on training patients to perform these tasks independently in the comfort of your own home and at your own convenience.

If you need to go on dialysis your Nephrologist will work with you to determine which option is best for you and your life style.

For patients with advanced CKD, a kidney transplant is often the best option. A kidney transplant is from a donor and is placed alongside existing kidneys and will take over the functions of your own kidney. A kidney transplant can provide an improved quality of life over dialysis.

Patients who receive a kidney transplant typically have more energy, more freedom and a less strict diet.

Our physicians are experienced and trained to help guide patients through the kidney transplant process.

Hypertension is the medical term for High Blood pressure.

High Blood Pressure is a condition in which the force of the blood against the artery walls is too high.

Types of Hypertension

Essential Hypertension – The cause of this type of hypertension is unknown. Some factors that contribute are genetics, race, diet and obesity. This is by far the most common etiology of HTN (typically 95-98% of cases)

Secondary Hypertension – High Blood pressure that may have a specific underlying cause that is different from essential hypertension (typically in 1-5% of cases).

Causes of Secondary Hypertension:

> Chronic Kidney Disease (CKD)

> Adrenal gland disorders

> Endocrine Disorders

> Narrowing of the kidney arteries

> Medications

> Sleep Apnea

> Genetic Disorders

> Resistant Hypertension – High blood pressure that is not changing towards the goal of a lower blood pressure reading despite being treated with three medications - one of them being a diuretic.

Anemia is a common condition in patients with CKD. Anemia occurs when there are not enough red blood cells in your body. Red blood cells carry oxygen through the blood stream, helping your bones, muscles and organs work properly. Your kidneys help with this production of red blood cells by producing a hormone called erythropoietin (EPO).

Signs and symptoms of anemia include:

> Chronic fatigue and tiredness

> Paleness of skin

> Decreased appetite

> Shortness of breath (due to decreased available oxygen)

If you have CKD your body will not make enough of this hormone which causes a decrease in the creation of red blood cells. Your Nephrologist and healthcare team can work with you to help manage your anemia with medication

Electrolytes are particles that carry an electric charge when they are dissolved in blood. The kidneys help to maintain electrolyte concentrations by regulating its concentrations in the body. Any disturbance in this process often leads to an electrolyte imbalance.

The different electrolytes are:

> Sodium -  Sodium plays a major role in the body by maintaining fluid balance. Its major function is in nerve and muscle function. The body obtains sodium from food and drink and loses it in sweat and urine. Kidneys, when functioning normally, maintain a consistent level of sodium by adjusting the amount excreted from the body. When sodium intake and excretion are not in balance, it may lead to either high sodium (Hypernatremia) or low sodium (Hyponatremia).

> Potassium -  Potassium is necessary for the normal functioning of cells, nerves and muscles. Potassium is obtained from food and drinks and lost primarily in urine, but also through the digestive tract and in sweat. Imbalances in potassium can lead to high potassium (Hyperkalemia) or low potassium (Hypokalemia).

> Phosphorus - In the body, almost all phosphorus is combined with oxygen to form phosphate. Phosphate is used as a building block for many substances such as DNA, cell membranes, etc. The body obtains phosphate from food and excretes it in urine and sometimes stool. Foods that are phosphate rich are milk, egg yolks, chocolate and soft drinks. Imbalances in phosphate may be too high (Hyperphosphatemia) or too low (Hypophosphatemia).

> Calcium -  Calcium has many functions which include – formation of bone and teeth, muscle contraction, normal functioning of enzymes, blood clotting and maintenance of normal heart rhythm. The level of calcium in the blood is maintained by 2 hormones – Parathyroid Hormone (PTH) and Calcitonin. The body moves calcium out of bones into the blood to maintain calcium levels. PTH increases the calcium level in blood whereas calcitonin is responsible for lowering calcium level in the blood. Too much calcium is Hypercalcemia and too little calcium is Hypocalcemia.

> Magnesium -  Magnesium is required for the formation of bone and teeth and for normal functioning of nerves and muscles. Too much magnesium is Hypermagnesemia and too low magnesium is hypomagnesemia.

Acid–base imbalance is an abnormality of the human body's normal balance of acids and bases that causes the plasma pH to deviate out of the normal range (7.35 to 7.45).  These disorders are pathologic changes in carbon dioxide partial pressure (Pco2) or serum bicarbonate (HCO3−) that typically produce abnormal arterial pH values.

> Acidemia is serum pH < 7.35.

> Alkalemia is serum pH > 7.45.

> Acidosis refers to physiologic processes that cause acid accumulation or alkali loss.

> Alkalosis refers to physiologic processes that cause alkali accumulation or acid loss.

> Actual changes in pH depend on the degree of physiologic compensation and whether multiple processes are present.

Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone secreted by the parathyroid glands that regulates the serum calcium concentration through its effects on bone, kidney, and intestine.

PTH influences bone remodeling, which is an ongoing process in which bone tissue is alternately resorbed and rebuilt over time. PTH is secreted primarily by the chief cells of the parathyroid glands. The gene for PTH is located on chromosome 11. Its action is opposed by the hormone calcitonin.

Disorders that yield too little or too much PTH, such as hypoparathyroidism, hyperparathyroidism, and paraneoplastic syndromes can cause bone disease, hypocalcemia, and hypercalcemia.

Secondary hyperparathyroidism is the medical condition of excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels), with resultant hyperplasia of these glands. This disorder is primarily seen in patients with chronic kidney failure. It is sometimes abbreviated "SHPT" in medical literature.