What Causes Chronic Kidney Disease?

Chronic kidney disease is a serious, progressive illness that results from a wide range of causes. A kidney specialist shares what you need to know.

According to the Centers for Disease Control and Prevention, chronic kidney disease impacts about 35.5 million people in the United States alone. It can happen at any age, and it’s often a secondary condition, meaning it’s caused by another disease in the body.

The kidney is a complex organ, and chronic kidney disease can come in different forms. “Chronic kidney disease is a general term, and it can be caused by many different kidney conditions,” says Hui Yi Shan, MD, a nephrologist with Keck Medicine of USC. “The most common causes are linked to diabetes and hypertension, especially if they’re not well controlled.”

When people think of kidney disease, dialysis and transplant often come to mind, but other interventions can slow the disease’s progression early on. Dr. Shan explains how chronic kidney disease is treated at every stage.

How each stage of kidney disease affects treatment

“Chronic kidney disease treatment largely depends on the cause and how advanced the disease is,” Dr. Shan says.

The condition has five stages. Patients don’t typically feel sick early on, though some may experience high blood pressure or swelling in the lower extremities. By stage 4 or 5, there may be symptoms of fatigue and lethargy, followed by nausea, vomiting, decreased appetite and persistent itching.

According to the nonprofit American Kidney Fund, doctors approach stages 1 and 2 of kidney disease by treating the underlying illness, such as high blood pressure, diabetes or kidney inflammation. In addition, you may be referred to a nephrologist to manage specific kidney conditions and be prescribed medications to help support the kidneys.

At stages 3 and 4 of kidney disease, besides treating the underlying kidney disease cause, the dosage of kidney-protective medications may be increased in order to slow down the progression of chronic kidney disease. Other drugs may be prescribed to help reduce fluid accumulation in the body.

At stage 5 of kidney disease, the kidneys are so badly damaged that they can no longer do their job. Doctors may continue prescribing medications, but at this point it is crucial for the patient to go on dialysis until they can get a kidney transplant.

What is dialysis like?

“There are two main types of dialysis, and they both impact quality of life,” Dr. Shan says.

The first is hemodialysis. Three times a week, a patient goes to a dialysis unit for three to four hours to have a machine filter their blood to correct their body’s electrolytes and remove excess fluid.

“It often leaves people very tired, and it can take about a day for them to recover,” Dr. Shan says.

Peritoneal dialysis is another form of dialysis, a gentle approach to the process that can be done daily at home by the patients themselves.

“Patients can receive peritoneal dialysis during their sleep at night,” Dr. Shan says. “This way, patients can maintain a more normal lifestyle like continuing to work or going to school during the day, but the treatment needs to be done nightly.”

What happens to a stage 5 patient after a kidney transplant?

“Once the kidney transplant recipients recover from the surgery, their quality of life dramatically improves,” Dr. Shan says. “They have to make sure to manage their primary conditions and be compliant with taking immunosuppressive medications so the new kidney can stay healthy.”

While kidney transplants tend to have a better outcome than dialysis, there is a major shortage of deceased donor kidneys in the United States. Some patients are not able to survive the long wait for a donated kidney to become available. Some patients who do survive are too sick by the time a kidney becomes available.

The good news is that living donor kidney transplant, in which a living person donates one of their kidneys to a loved one or a stranger, is making an impact. When a match is made between a living donor and a recipient, not only is the recipient saved, but everyone behind them on the list gets a better shot at getting a transplant sooner. Programs such as the USC Living-Donor Kidney Transplant Program, part of the USC Transplant Institute and Keck Medicine, can help.

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