The Missing Million: Let's clear up the facts about kidney disease

LET’S CLEAR UP THE FACTS ABOUT KIDNEY DISEASE

Nobody wants another life to go to waste

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YOUR KIDNEYS SAVEYOUR LIFE EVERY DAY

What do your kidneys do?

Very simply, your kidneys take away the rubbish fromyour body and keep the good stu� like amino acids andhormones in. They also play a vital role in maintaining agood balance of � uid and salts. If we take on too much,they take the excess away. If we need to retain mineralsand salts, they make sure we do.

Importantly they secrete a hormone involved incontrolling high blood pressure, and another whichprevents anaemia by stimulating the production ofred blood cells. Finally, they play an important role inactivating Vitamin D and making sure our bodies canabsorb calcium and keep bones strong and healthy.

They work away quietly in the background. It’s easy notto notice them and they are often taken for granted, butthey perform an essential service – keeping our bodiesclean and healthy.

What is kidney disease?

Kidneys become less e� cient in a slow, steady way after we reach middle age. Because the kidneys are so e� cient, it is usually a long time before there are obvious signs of something wrong. Doctors describe any long-term, progressive damage or abnormality in the kidneys, as chronic kidney disease, or CKD.

The trouble with your kidneys is that they are very complex and delicate organs made up of millions of tiny parts called nephrons. When some nephrons fail, the others have to work even harder to compensate and so they begin to fail too. A chain-reaction begins, which can be very di� cult to stop.

Depending on the problem, early diagnosis and treatment can help slow down any damage to the kidneys. Left unchecked, however, it can lead to renal failure, which is fatal without treatment by dialysis or a kidney transplant.

Where would we be without someone to take away the rubbish? Everything that comes in must go out somewhere. If waste hangs around, it infects us, poisons us and threatens our health.

So it’s a good job our bodies have their very own pair of dustmen to keep us clean and healthy. They’re called our kidneys and they are well worth looking after.

Learn more and take our kidney health check at

The kidneys are a pair of organs found in the small of the back on either side of the spine, roughly the size of your � st or a computer mouse.

Blood, waste and water enter here through the renal artery.

Blood without waste or excess water leaves here through the renal vein.

Excess water and toxic waste in the form of urine leaves here via the ureter.

Blood, waste and water enter here through the renal artery












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What are the causes of kidney disease?

The condition sometimes gets missedbecause it is quite hard to detect. There arefew obvious and unique symptoms that caneasily pin it down. More often it sneaks upon us, under the guise of other conditionssuch as:

■ Diabetes■ High blood pressure■ Vascular disease (e.g. heart attack,

poor circulation or stroke)

If you have any of these conditions youshould be particularly concerned, becauseonce kidneys become damaged a viciousspiral begins. The kidney damage actuallymakes your high blood pressure or heartcondition even worse, which in turngoes on to compound the kidney damage.And so it goes on until one or other of theorgans fail.

Kidney disease is even more common ifthe blood pressure or the diabetes hasn’tbeen controlled as well as it could be. If youcontinue to smoke, drink too much alcohol orhave a poor diet while su� ering from theseconditions, you are at greater risk.

Other less common causes includein� ammation (glomerulonephritis) orinfection (pyelonephritis). Sometimes kidneydisease is inherited (polycystic disease) or theresult of a longstanding blockage (such asenlarged prostate or kidney stones).

Some drugs can cause CKD, especially certainpain-killing and anti-in� ammatory drugs iftaken over a long time. Often it isn’t possibleto say what has caused the problem.

Unfortunately, your risk of having kidneyfailure is also increased if you are froman African-Caribbean or South Asianbackground, or have a family history ofkidney disease.

If you already have one or more of theseconditions, you should get your kidneyhealth tested regularly by your GP.

Research suggests that over three million people in the UK are at risk of chronic kidney disease. The illness is extremely common in older people and is expected to rise over the next ten years.

Worryingly, up to one million of these are undiagnosed and these are the missing million Kidney Research UK is urgently trying to fi nd.


MILLIONS ARE AT RISKFROM A SILENT KILLER


These symptoms can include:

■ High blood pressure■ Extreme tiredness or lethargy ■ Di� culty concentrating■ Persistent headaches■ Poor appetite and weight loss■ Feeling sick■ Itchy skin■ Swelling in the face and ankles■ Fluid retention and/or lower back pain

While these signs can indicate other problems besides kidney disease, it’s best to get any worries you have checked out by your GP. In most cases, CKD does not cause any symptoms and is detected because tests are abnormal.

In most people, mild to moderate CKD does not display any obvious symptoms. Sometimes there areno obvious signs at all until just before your kidneys start to fail.

When the kidneys are not working properly, harmful toxins andexcess fl uids build up in the body, which may cause the symptoms of kidney failure.


IT’S DANGEROUS TOIGNORE SIGNS LIKE THESE

How can my doctor test for kidney disease?

Simple blood and urine tests can lead to an early diagnosis of potential kidney problems. The blood test in particular uses a measure called eGFR (estimated glomerular � ltration rate) to tell roughly how well the kidneys are working, compared to normal.

The results are broken down as follows. Any declines in kidney function up to stage 3 can be much reduced or even halted with a combination of a diet, lifestyle and medication.

Making these changes is even more important when you bear in mind that even relatively mild kidney damage like this puts you at a much greater risk of heart disease.

Beyond stage 3, the situation becomes more serious. Your GP will recommend a consultation with a kidney specialist and dialysis or transplantation may come into the equation depending on how far gone your kidney damage might be.

Stage Description eGFR Level Action

Normal kidney function

Healthy kidneys 90% or more Discuss your health and lifestyle with your doctor

Stage 1 Kidney damage with normal or high GFR

90% or more Discuss your health and lifestyle with your doctor

Stage 2 Kidney damage and mild decrease in GFR

60 to 89% Make lifestyle changes on the advice of your doctor

Stage 3 Moderate decrease in GFR 30 to 59% As above and check kidney function every 6 months – 1 year.

Stage 4 Severe decrease in GFR 15 to 29% Referral to a kidney specialist

Stage 5 Established renal failure (ERF)

Less than 15% Active treatment such as dialysis or transplant


Control of high blood pressure and cholesterol

Avoiding high blood pressure is particularly important because it puts strain on the small blood vessels in the kidneys, preventing the � ltering process from working properly. Have your blood pressure checked regularly and note down your numbers.

Most people with kidney damage should have a blood pressure below 140 (top number) and below 90 (bottom number). If you have kidney damage and diabetes, the numbers should be below 130 (top number) and below 80 (bottom number).

Good management of diabetes

Diabetes is the most common cause of end-stage renal failure in the UK. The condition is becoming more common and it is estimated that numbers will double in the UK over the next few years.

High blood sugar levels can damage the � lters in the kidneys, causing them to fail. 30-40 per cent of people with diabetes may eventually develop kidney complications. So if you have diabetes, it is vital you manage it well, in line with the advice from your GP.

Stop smoking

Smoking is thought to have a number of e� ects on the kidney, particularly by raising blood pressure. If you smoke, seek advice on how to give up. Your GP or nurse can advise you on ways to make this easier for you.

Eat well

It is important that you try to eat a healthy, well-balanced diet and try to maintain a healthy weight. We’re all di� erent so ask your GP or nurse what they recommend for you.

Keep fi t

There are no special exercises for people with kidney problems, but like anybody, you should try to be active several times a week. Ask your GP or nurse what they recommend for you. This is particularly important if you have existing medical conditions.

If kidney damage is identifi ed early enough, the good news is that there are things you can do to stop the kidney function getting worse.


SO IT’S VITALTO CATCH IT EARLY

These include:


Treatment for early stage kidney disease

Increasingly, stages one to three of kidneydisease are managed by your local GP’ssurgery. As we’ve described, the treatmentsare generally simple steps you can taketo protect your kidneys through goodmanagement of blood pressure, diabetes (if it exists) and lifestyle issues such as stopping smoking, healthy eating and exercise.

Your doctor will measure your blood pressureand take the necessary urine and blood teststo make sure your condition has stabilised.

Treatment for later stage kidney disease

If your kidney disease looks as though itis going to progress beyond stage 3, yourGP will refer you to a kidney specialist (nephrologist or renal physician) at your nearest renal unit.

Renal units have teams of specialist sta� to help with all forms of treatment forkidney disease, including dialysis andtransplantation. The teams consist of doctors,surgeons, renal nurses, laboratory scientists,transplant co-ordinators, dieticians, renaltechnicians and others as required.

They will all work together to providetreatment, advice, training and support,be it physical, psychological or � nancial –even arranging transport requirements toand from treatments (if appropriate). Theirobjective is to give you the most up-to-date treatment and support available, so you can return to as independent a lifestyle as possible.

If you recognise yourself in Dusty, or in any of the information we’ve talked about today, there’s no harm in contacting your GP to discuss any concerns you may have. They should be able to give you any reassurance, checks or tests you might need.

We hope everything is fi ne and there’s no need to worry, but if you do have a kidney problem it’s worth knowing what to expect from any treatment you might need.


IF YOU’RE WORRIEDSEE YOUR DOCTOR


Kidney Research UK o� ers a health information service for kidney patients, their families and carers, as well as medical professionals and researchers.

It provides general information only and is not intended to provide personal medical advice, or act as a substitute for the advice of your doctor. If you have any questions or concerns about kidney health matters please consult a medical health professional. Users should seek such advice before taking, or deciding not to take, any action as a result of this information.

So far as is permissible by law, Kidney Research UK accepts no liability to any person relating to the use of the information contained herein.

Registered Charity No. 252892 Scottish Charity No. SC039245.

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The Missing Million: Let's clear up the facts about kidney disease

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