Kidney Problems

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Care & Treatment

If a person has a kidney disease, the primary care provider or kidney specialist (nephrologist) can help the person control their disease.

Referral to a nephrologist is important in the following situations.

  • Stage 3 of chronic kidney disease. A person reaches this stage when the rate at which their kidneys filter wastes is less than 60 milliliters per minute. People need help managing the complications at this stage of the disease.
  • High risk cases such as patients who lose a lot of protein in their urine, have unexplained blood in their urine, or quickly decreasing kidney function

Goal for Treatment of Kidney Disease

The goal of treatment is to reduce kidney damage by treating the causes of disease. This usually means:

  • Reducing blood pressure
  • Improving cholesterol levels
  • Controlling diabetes (blood sugar)
  • Balancing electrolytes (minerals in the body that have an electric charge)
  • Reducing protein in urine
  • Controlling phosphorus levels
  • Avoiding medications that cause kidney problems
  • Lifestyle changes (such as diet and exercise)
Some kidney conditions are dangerous. If symptoms are severe, urgent attention in the emergency department may be needed. Prompt attention and sticking to your healthcare providers recommendations will often delay or prevent kidney failure.

Treatments

Many kidney diseases can be treated. Treatments can involve diet changes or medications. Treatments also vary with the type of kidney disease. However, if these problems become too severe, dialysis may be necessary. Hemodialysis uses a machine to clean the blood to make up for the loss of kidney function.

Note that medication or their dosage levels (“renal dosing”) need changes if kidney function has decreased. The body can accumulate elevated drug levels if your kidneys cannot get rid of drugs efficiently.

Diet

Contact a trained renal dietitian for help in putting together a healthy diet for your special needs, especially if you have reached an advanced stage of kidney disease.

People with chronic kidney disease (CKD) generally need to limit protein (especially from animal sources), phosphorus, and potassium consumption. A nutritionist’s help may be necessary.

Some medications may also be prescribed specficially to lower phosphorus levels.

Medications

Many medications need to be avoided or used carefully if the person has kidney disease.  These include:

  • Non-steroidal anti-inflammatory pain medications (NSAIDs) such as ibuprofen or naproxen
  • Certain antihistamines such as ranitidine and cimetidine 
  • Many antibiotics
  • Many heart medicines, including some blood thinners

The person with kidney disease may need:

  • Iron pills (if they have a low blood count, which is known as anemia)
  • Vitamin D supplements (must be strictly monitored because of the increased risk of kidney stones)
  • Medications to lower levels of phosphate (an important electrolyte)

Treatment is different depending on the type of kidney disease. Click on the below topics to read more.

Dialysis

Dialysis is a treatment that performs the work that healthy kidneys would do. There are two common forms of dialysis.

  • Hemodialysis, where the person sits in a chair for several hours at least once a week. Their blood goes into a machine, which cleans out the waste products and returns the clean blood to the body.
  • Continuous ambulatory peritoneal dialysis involves pumping solutions into your abdomen through a tube that is inserted through the skin of your abdominal wall. This tube draws out the waste products from the blood. The excess solution and waste products are then removed from the abdomen. There is no need to sit in a clinic for several hours with this type of dialysis. 

The choice of hemodialysis or peritoneal dialysis depends on your wishes and overall condition, as well as available resources. Survival rates for both procedures are about the same. However, frail older adults are less able to benefit from dialysis than other people.

Most people get hemodialysis. It adds years to a person’s life. It also offers a good quality-of-life so that the person can enjoy normal activities. 

People who have dementia may get a trial of dialysis if their cognitive (thinking and memory) problems are a result of kidney failure. Dialysis will generally stop if the person’s cognition improve after four to six weeks. Also, people with dementia may not tolerate dialysis well.

Kidney Transplantation

Many otherwise healthy older adults with kidney disease can benefit from a new kidney. They may double their remaining years and the body’s rejection rate for new kidneys is lower in older people. A nephrologist will carefully assess the risk factors and discuss the pros and cons of a kidney transplant with the person who may need one. 

The wait for a donated kidney is about five years. So, a person needs to explore the possibility of a transplant as soon as possible. Living donor kidney transplantation is a good choice because there is no waiting time once the donor and recipient are cleared for surgery.

People who have kidney transplants must take medication for the rest of their lives to avoid their body rejecting the new kidney. 
 

Last Updated February 2023

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