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DEAR MAYO CLINIC: My wife was diagnosed with "moderate" chronic kidney disease about three months ago. What does this mean? Are there things she can do to stop the progression of the disease?
ANSWER: Your kidneys are two bean-shaped organs, each the size of a fist. They're located in the back of your abdomen, one on each side of your spine. Your kidneys' main job is filtering waste and excess fluid from blood to make urine. They also do other tasks, including adjusting the balance of minerals and acids in the blood and regulating blood pressure.
Kidney disease occurs when the kidneys have been damaged and no longer work the way they should. Early on, kidney disease may not cause symptoms. As it worsens, symptoms may appear. But they're often vague and can include fatigue, poor appetite, nausea and swollen ankles, legs or hands.
Chronic kidney disease, or CKD, is usually diagnosed with a blood test that measures creatinine. Creatinine is produced by muscles and removed from the body by the kidneys. As kidney function decreases, the level of creatinine in the blood increases. This level is used to calculate the estimated glomerular filtration rate, or eGFR, which is a better indicator of kidney function than creatinine alone. Abnormal amounts of protein or other markers of kidney damage in the urine may indicate CKD, as well.
Chronic kidney disease is often broken down into five stages. In stage three, or "moderate" CKD, eGFR is between 30-59 ml/min/1.73m2. Stage three CKD is usually progressive. That means it can get worse as time goes on. It is unlikely that it can be completely cured, but in many cases, lifestyle changes and medications help slow its progress. Slowing the progress depends, in part, on the cause. Although many diseases and conditions can damage the kidneys, the two main causes of CKD are diabetes and high blood pressure.
In most cases, controlling blood pressure is the most important step a person with CKD can take. Keeping blood pressure at a healthy level may involve taking medication, eating less sodium, staying at a healthy weight and increasing physical activity.
If your wife has diabetes, following her doctor's directions for controlling blood sugar can help slow kidney disease. Over time, both high blood pressure and high blood sugar can damage small blood vessels and cause scarring in the kidneys, making it difficult for them to work properly.
Avoiding medications that can harm the kidneys and getting treatment for other medical conditions that lead to CKD also can help. Some of those conditions include inherited disorders such as polycystic kidney disease, immune system disorders, infections, kidney stones and damage from medications. Even medications available without a prescription (including ibuprofen, naproxen and omeprazole) can hurt the kidneys. She should check with her doctor before taking new medications.
Some people with CKD may need to limit liquids or follow a special diet. The kidneys may not be able to remove excess fluid or adjust levels of minerals in the blood, such as sodium, potassium and phosphorus. Medications may be needed to control these functions. Taking medication to regulate acids in the blood might slow the progression of CKD. Your wife also may need to limit the amount of protein she eats. She might find it useful to meet with a dietician to make sure she's eating a balanced diet while limiting certain foods.
People with CKD are at increased risk for heart disease. Other complications also can occur as kidney disease gets worse. They include anemia, bone disease, nerve damage and depression. In time, kidney function may decrease so much that a kidney transplant or dialysis is recommended.
With CKD in the moderate range, your wife should see a nephrologist -- a doctor who specializes in kidney care. Such a specialist can work with her to identify specific steps to take that may help slow her kidney disease now, as well as plan treatment to manage the disease in the future. -- Suzanne Norby, M.D., Nephrology, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. To submit a question, write to: firstname.lastname@example.org. For health information, visit www.mayoclinic.com.)