Chronic Kidney Disease

What happens when the kidneys stop functioning properly?

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Chronic kidney disease (CKD) is a gradual loss of the kidneys’ filtering ability, usually due to high blood pressure or diabetes. When kidney function is seriously impaired, dangerously high levels of fluid and wastes can accumulate in the body. 

In the early stages of CKD, there may be few signs or symptoms. In fact, many people with CKD do not realise they have a problem until their kidney function has decreased to less than 15 percent of normal, at which point symptoms may appear. 

The main goal of CKD treatment is to halt or delay progression of the disease, usually by controlling the underlying cause. CKD can progress to end-stage kidney disease, which can be fatal if not treated with artificial filtering (dialysis) or a kidney transplant.

Chronic Kidney Disease Symptoms

Signs and symptoms may include any of the following:
High blood pressure
Decreased urine output or no urine output
Darkly coloured urine
Anaemia
Nausea or vomiting
Loss of appetite
Sudden weight change
A general sense of discomfort and unease (malaise)
Fatigue and weakness
Muscle twitches and cramps
Swelling of the feet and ankles 
Yellowish-brown cast to your skin
Persistent itching

CKD can be difficult for you or your doctor to detect initially. Signs and symptoms are often non-specific, meaning they can also be attributed to other illnesses. In addition, because the kidneys are highly adaptable and able to compensate for lost function, signs and symptoms of chronic kidney failure may not appear until irreversible damage has occurred.

When to Seek Medical Advice 

If you have a chronic medical condition that puts you at increased risk of CKD, your doctor is likely to monitor your blood pressure and kidney function with urine and blood tests during regularly scheduled office/clinic visits.

Call your doctor if you experience any of the signs and symptoms of CKD between visits. These may include a change in urination patterns or quantity, dark or cola-coloured urine, unexplained weight loss, nausea or vomiting, fatigue, or a yellowish-brown cast to your skin. Even if you have no risk factors for kidney failure, see your doctor immediately if you notice that you are urinating much more or much less than usual, or if you see any blood in your urine.

Chronic Kidney Disease Treatment 

The following is the treatment you could expect as a patient of the National University Hospital (NUH):

General Nephrology 
Staff will test for the various diseases of the kidney and urinary tract. These conditions include haematuria (blood in the urine), proteinuria (protein in the urine), other urine abnormalities, high blood pressure, diabetic nephropathy (kidney involvement due to diabetes), glomerulonephritis (like IgA, lupus-related renal diseases) electrolyte disorders, kidney stones, cysts and urinary tract infections. Patients with kidney failure at various stages can also be evaluated for the cause of kidney failure and the prognosis in order to provide holistic management of the disease. 

Patients are evaluated through the use of laboratory tests, radiographic and ultrasound scans and, where appropriate, real time ultrasound-guided kidney biopsy. Patients are also provided with medical and dietary therapy to slow progression of the disease. Those with worsening kidney function are counselled on the treatment options. Treatment for all CKD stages uses various types of renal replacement therapy, including acute dialysis, haemodialysis, peritoneal dialysis and kidney transplantation.

Chronic Haemodialysis 

In haemodialysis, blood is pumped out of the body to the kidney machine, and returned via tubes that connect the patient to the machine. Patients with end-stage kidney failure who opt for long-term haemodialysis will receive comprehensive treatment including dietary counselling, hypertension control, evaluation and management of cardiac risk factors, anaemia and renal bone disease. The hospital also operates a chronic haemodialysis centre for stable patients (the NUH Dialysis Centre at the Singapore Labour Foundation Building on Thomson Road). Furthermore, the hospital provides selective high-dependency haemodialysis for patients with high cardiovascular risk, who are often deemed unsuitable for haemodialysis in Singapore. 

Peritoneal Dialysis

Other options are peritoneal dialysis (PD), continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD), which uses the inside lining of the patient’s own stomach as a natural filter. Training is offered on an outpatient basis to both patients and their relatives or helpers. A disease management care team consisting of nephrologists, renal dietitians and specialist nurses provides dietary counselling and holistic care to PD patients to minimise complications of kidney failure.

Kidney Transplant 

Kidney transplantation is an important form of treatment for kidney failure and can be performed for suitable patients even without embarking on dialysis (pre-emptive transplant). Patients will be evaluated for suitability for a transplant, and the hospital coordinates the pre- and post-transplant care of patients and donors in addition to the long-term care of transplant patients. 

A number of milestone transplants have been done at NUH: the first Asian combined bone-marrow and kidney transplant and the second ABO (blood group) incompatible transplant in Singapore, as well a number of high-risk complicated cases.



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Chronic Kidney Disease

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