Chronic kidney disease is a description of having not normal kidney function or having
abnormal structure to your kidneys, and it can be detected by a blood test, by an ultrasound
of your kidneys or by finding something abnormal in your urine when it’s dipped either
blood and/or protein. It’s a descriptive term and it doesn't give you the diagnosis
of why your kidney function may be abnormal.
So chronic kidney disease is more common in
people who have high blood pressure and in people who have diabetes, but many people who
have chronic kidney disease have no idea they have it. You may have no symptoms at all until
your kidney function is only about 10% of normal. Some people, if they’re leaking
a lot of protein in their urine, can notice that their ankles are swelling, even their
legs are swelling, and sometimes they wake up with a puffy face. Sometimes, if your kidney
function is not very good, that can cause anaemia and you might feel tired and under
the weather. But actually, most patients with chronic kidney disease do not know they have
a problem with their kidneys and they need to have a blood test and they need to have
their urine dipped and their blood pressure checked.
There are some more general diseases that can cause kidney disease and you might have
symptoms from them such as a condition called vasculitis, where you may get a rash and pains
in your joints and fevers and there’s also quite a common condition affecting young women
called lupus, which can also affect your kidneys and again different type of rash, also swelling,
fatigue, you might notice some hair loss. So there are lots of symptoms you can get
that may be nothing to do with your kidneys. But actual chronic disease needs tests to
make the diagnosis.
There are two aspects to treating chronic
kidney disease. But first, in my view, one of the most important is actually to make
the diagnosis because it’s often assumed to be due to certain things and it’s not
always the case. Sometimes, you need specific blood tests and sometimes you might even need
a sample of your kidney tissue taken, a kidney biopsy, to look under a microscope and make
a specific diagnosis that would need treatment for that condition such as lupus or vasculitis.
Other times, we know. We know if you’ve had diabetes for many years that it might
be the likely cause. The other aspect to treatment is not just
to treating the specific underlying disease, controlling your blood pressure very well,
and treating your diabetes, but also to look after your kidneys in the long term. The key
ways you look after your kidneys in the long term and to prevent a chronic kidney disease
getting worse, a tight control of blood pressure. And we tend to use specific blood pressure
tablets that not only reduce the blood pressure but reduce any protein leak you might have
from your kidneys and we know they’re kidney protective, but above all, we want your blood
pressure very well controlled. The next most important thing is avoid tablets
that might upset your kidneys, and the biggest group we always warn you about are not to
take anti-inflammatories like ibuprofen, Nurofen, Voltarol. All those sort of drugs can be really
damaging to kidneys if you already have chronic kidney disease. You should stick to paracetamol
or other types of codeine-based treatments for treating pain rather than anti-inflammatories.
Something you can do quite easily is to think about the amount of salt in your diet. Reducing
salt definitely reduces blood pressure and the recommended total daily intake of salt
now is only 6 grams a day and there’s an enormous amount of hidden salt especially
in processed foods. So reducing that would help treat your blood pressure.
And the other important general factor is to stop smoking. Of course, that’s terribly
important for your lungs and heart, but kidneys don't like smoking either and people who smoke
tend to have their kidney disease progress more rapidly.
If you have chronic kidney disease, you can almost certainly have a baby, but the art
is to think about planning and to discuss it with your doctor. The first thing to say is
until you’re going to try and get pregnant, you need to use a safe form of contraception
and for most women, that would be a progesterone-only pill or progesterone-only based form of contraception,
not an oestrogen containing pill. But when you want to think about having a baby, it’s
very important to discuss it with your doctor who’s looking after you. There are things
to take into consideration. In general, it’s better to have your baby when your kidney
function is better, not worse. So if you have a condition that we know is going to progress
and your kidney function get worse, then you should do it sooner rather than later.
But you do need to think about the medications you’re on and whether they’re safe for
a baby and sometimes certain medications need to be stopped before you get pregnant and
change to baby-safe ones. All of this needs discussion about the best
timing. If you have a disease like lupus, your disease needs to be quiet for about six
months before you try and get pregnant. And you should be discussing this with an expert
who understands both kidney disease and pregnancy. But it’s definitely possible and in general,
the better your function and the better controlled your blood pressure, the safer the pregnancy
is going to be.