Kidney Problems

Care & Treatment

Once your kidney disorder has been identified and its severity assessed, your healthcare provider can order the treatment most appropriate for you. Your primary care provider or kidney specialist (nephrologist) can help you control your kidney disease by determining the best medical and lifestyle approaches for your individual condition.

The goal of treatment is to reduce kidney damage by fixing the causes of your kidney disease, which usually means:

  • reducing blood pressure
  • improving cholesterol levels
  • controlling diabetes (blood sugar)
  • balancing electrolytes
  • reducing protein in urine
  • controlling phosphorus levels

Click on the topics below to read about things to consider when receiving treatment for kidney disease.

 

Medications

Many medications should have their dosages reduced or be avoided entirely if you have 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

Your healthcare provider may also prescribe:

  • iron pills (if you are anemic)
  • vitamin D supplements (must be strictly monitored because of the increased risk of kidney stones)
  • medications to lower phosphate levels

Diet

For many patients with chronic kidney disease (CKD), strict limits must be placed on protein, phosphorus, and potassium consumption. If you are one of these patients, a nutritionist or dietitian who specializes in kidney diseases can help you come up with a healthy diet that tastes good to fit your individual needs.

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.

Some kidney conditions are dangerous. If symptoms are severe, urgent attention in the emergency department may be needed. Others are milder. Prompt attention and sticking to your healthcare provider’s recommendations will often delay or prevent kidney failure. 

Electrolyte or fluid imbalances such as low or high sodium or potassium levels may be corrected by simply supplying the missing electrolyte or adjusting your intake of water. Electrolytes can be administered either in an intravenous solution in the hospital, or in pill form.  In other cases, a small change in your diet or medications may be enough. If fluid retention (swelling) is a problem, you may be given a diuretic pill, such as furosemide, torsemide, or hydrochlorothiazide, and be told to restrict your fluid intake for a while.  Dehydration may need to be treated in the hospital with intravenous (IV) fluids delivered directly into your vein. 

Kidney stones may result from dehydration, infection, or other stress to your kidneys. Treatment may not be needed if the kidney stones are small since they often pass out through your urine on their own. If they are too large to pass this way, your nephrologist may suggest extra-corporeal shock wave lithotripsy (ESWL). In this non-surgical approach, you rest in a type of water bath while a particular frequency of sound waves targets the kidney stones, which then disintegrate and pass out of your body through the urinary pathway. Kidney stones that are too large for ESWL must be removed surgically. 

Nephrotic syndrome, a condition where proteins leak out of your kidneys, can often be treated effectively in older patients with the use of steroid medicines such as prednisone and other drugs that are taken in pill form (cytotoxic agents). If the nephrotic syndrome resulted from taking certain medicines – such as an NSAID painkiller – then another medication should be substituted. 

Kidney conditions called glomerulonephritis or glomerulosclerosis sometimes occur with certain illnesses (for example, autoimmune diseases, hypertension, or diabetes) or infections. Treatment or improved control of the underlying disorders is likely to improve these types of kidney problems. 

Renovascular disease (kidney damage from bad circulation) is usually a result of conditions common to older people such as blood clots, high blood pressure, high cholesterol, smoking, and atherosclerosis (hardening of the arteries). Aggressive treatment of these underlying conditions will often delay more serious illness. 

Acute kidney failure can follow a variety of kidney stresses, including infection, urinary blockage (common in older men with enlarged prostate glands), surgery, dehydration, heart rhythm problems, heart failure, or exposure to certain medicines or toxins, including narcotic pain medication, antihistamines, and antidepressants. Quick treatment of the cause of your acute kidney failure is often enough to restore kidney function. 

To avoid severe complications, you may need dialysis treatment until your kidneys recover. 

End-stage kidney disease or kidney failure cannot be cured or reversed. It requires dialysis or a kidney transplant to prolong life, if that is your healthcare goal. Your nephrologist will guide you in choosing the best renal replacement therapy – dialysis or kidney transplant – for your needs. 

Dialysis

Dialysis is a treatment that performs the work that healthy kidneys would do. 

There are two commonly used forms of dialysis:

  1. In hemodialysis, you sit in a chair for several hours one or more times per week, while your blood is siphoned into a machine. The machine filters the waste products and then returns the clean blood back into your body.
  2. In continuous ambulatory peritoneal dialysis, solutions are pumped into your abdomen through a special dialysis 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 in 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. 

Most patients undergo hemodialysis to remove waste products from their blood. This procedure usually adds years to a patient’s life, even for people over 80 years of age, providing a good quality-of-life during which normal activities can be enjoyed. Often, minor surgery will be performed to create an access port for the dialysis treatment. 

Patients who are suffering from dementia may be given a trial of dialysis if it is possible that the declining cognitive symptoms are actually a result of kidney failure. If no improvement has occurred after four to six weeks, dialysis treatment is usually stopped, particularly if the patient is unable to tolerate the dialysis treatments well. 

Kidney transplantation: Many relatively healthy older patients, well into their 70s, are good candidates for a new kidney, especially since rejection rates are lower in older people. However, infection and blood vessel problems are more common in older transplant recipients. A nephrologist will carefully assess the risk factors and discuss the pros and cons of a kidney transplant with you. 

If you are an older kidney failure patient, your likelihood of a significant increase in life expectancy from a kidney transplant is very high. Getting a new kidney often doubles your remaining years, compared to remaining on dialysis. Unfortunately, the wait for a donated kidney is now about five years in the United States. For this reason, it is important to explore the possibility of a transplant as soon as you begin to consider renal replacement therapy. Living donor kidney transplantation remains an excellent option because there is no waiting time once the donor and recipient are cleared for surgery. Patients who have kidney transplants must be careful to take medication for the rest of their lives to avoid their body rejecting the transplanted kidney. 

Monitoring

If you have been diagnosed with kidney disease, your healthcare provider will probably be doing blood tests to check your electrolyte levels on a regular basis. Monitoring is especially important:

  • during hospitalizations or long-term care
  • if you are having surgery
  • if you take diuretic medicines (water pills)
  • in hot weather (diuretic doses may have to be reduced)
  • if your salt intake is restricted

Do not miss any follow-up appointments or lab tests, since kidney damage can occur very quickly if a risk is not identified and controlled.

Complications

Chronic kidney disease is an important risk factor for cardiovascular diseases such as heart attacks, heart failure, heart rhythm disturbances, and strokes. Controlling your kidney disease will lower your risk for these serious cardiovascular events. 

Malfunctioning kidneys also put you at higher risk of:

  • malnutrition
  • osteoporosis
  • anemia (not enough red blood cells to carry oxygen through your body)
  • high blood pressure
  • depression (very low doses of short-acting antidepressants may be helpful)
  • reduced ability to carry out daily functions
  • numbness in feet and hands (neuropathy)
  • lower general quality of life

Nonaggressive Care and Hospice

About 20% of patients withdraw from dialysis in any given year. Once a chronic dialysis patient stops dialysis, death usually occurs within 7–14 days.  Patients receiving hospice care are far more likely to die at home.

 

Last Updated April 2017