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Chronic kidney disease

Morbus renalis chronicus · Chronické onemocnění ledvin

What it is

Kidney function fades over years, usually from diabetes or high blood pressure.

Symptoms & signs

  • Silent early on
  • fatigue
  • swelling
  • itching
  • nausea
  • poor appetite
  • foamy urine
  • breathlessness

🚩 Get help if…

  • call 112 / 911 now Breathless when lying flat or sudden swelling of legs and face
  • call 112 / 911 now Palpitations, muscle weakness or chest pain (high potassium)
  • see a doctor soon Passing much less urine than usual
  • see a doctor soon Confusion, itching, vomiting or loss of appetite getting worse

Where it strikes

Medical treatment

  • ACE inhibitor or ARB
  • SGLT2 inhibitors (dapagliflozin, empagliflozin) — about 5 fewer serious kidney events or deaths per 100 over 2.4 years in DAPA-CKD; genital thrush, rare ketoacidosis
  • finerenone
  • phosphate binders
  • EPO
  • dialysis or transplant at end stage

Natural & lifestyle

  • Blood-pressure and glucose control
  • salt under 5 g
  • moderate protein
  • avoid NSAIDs
  • smoking cessation
  • weight loss

Emerging & experimental

  • Xenotransplantation (pig kidneys)
  • bioartificial kidney implants
  • anti-fibrotic agents
  • stem-cell therapy

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Sodium bicarbonate when the blood is acidic — trials slow the decline mixed evidence
  • Ketoanalogues with a very-low-protein diet — trials slow progression mixed evidence
  • Astragalus — Chinese herbal trials of lower protein loss early / small studies
  • Herbal 'kidney detox' teas — some Chinese herbs (aristolochic acid) have caused kidney failure and cancer not confirmed in trials

ICD codes