Chronic Kidney Disease: Causes, Symptoms, and Treatment

“How long can a damaged kidney last?” is a common question among those facing kidney problems. Most of the time, the answer depends on the stage at which the disease is discovered and how it is managed.

Chronic kidney failure (CKD), also known as chronic kidney disease (CKD), occurs when the kidneys can no longer properly filter waste and fluids from the blood. It is a progressive condition that worsens over time and can lead to the accumulation of toxins in the body.

Kidney function is evaluated by an indicator called glomerular filtration rate (GFR). If it drops below 60 ml/min/1.73 m² and remains so for at least 3 months, we are talking about a chronic form. Over time, the kidneys lose their ability to produce essential hormones, maintain mineral balance, and control blood pressure.

Next, you will learn about the causes that can lead to the onset of the disease, what symptoms indicate poor kidney function, how the diagnosis is established, and what treatment options exist to slow the progression of the disease and prevent complications.

What does chronic kidney failure mean?

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The kidneys are two fist-sized, bean-shaped organs located in the lower back, on either side of the spine. Their main role is to filter blood, removing toxic substances and excess fluids through urine. Additionally, they regulate electrolyte balance (such as sodium, potassium, and calcium), control blood pressure, and produce hormones essential for red blood cell formation and maintaining bone health.

Each day, the kidneys filter about 200 liters of blood and produce around 2 liters of urine. When this vital function is progressively and irreversibly impaired, we speak of chronic kidney failure or chronic kidney disease.

This condition is characterized by:

• slow and continuous deterioration of kidney function;
• a drop in glomerular filtration rate below 60 ml/min/1.73 m² for at least 3 months;
• the kidneys’ inability to efficiently remove waste and maintain water and mineral balance.

As the disease progresses, electrolyte imbalances, hypertension, anemia, and bone fragility can occur. Many people have no symptoms in the early stages, which is why early diagnosis is essential to prevent severe complications and slow the progression of the disease.

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Causes of chronic kidney failure

Chronic kidney failure is a progressive and irreversible condition that occurs when the kidneys are gradually affected by factors that compromise their filtering function. The most common causes include:

• Diabetes mellitus (type 1 and type 2) – over the long term, it can lead to diabetic nephropathy.
• High blood pressure – untreated or uncontrolled, it affects the blood vessels in the kidneys.
• Polycystic kidney disease – a genetic disease that causes multiple cysts to form in the kidneys.
• Chronic glomerulonephritis – inflammation affecting the kidney’s filtering units.
• Recurrent urinary tract infections – especially chronic pyelonephritis, can cause gradual damage to kidney tissue.
• Urinary tract obstructions – such as kidney stones or prostate enlargement, which block urine flow.
• Prolonged exposure to toxins or nephrotoxic drugs – such as anti-inflammatories or certain antibiotics.

In addition to these direct causes, there are also risk factors that promote the onset of chronic kidney disease:

• advanced age;
• obesity;
• smoking;
• cardiovascular diseases;
• certain autoimmune conditions (e.g., systemic lupus erythematosus);
• family history of kidney disease.

In most cases, the disease has a slow progression and can remain asymptomatic for a long time. Therefore, monitoring kidney function is essential, especially in individuals with risk factors.

Signs of chronic kidney disease, obstruction, and impaired kidney function

Chronic kidney failure progresses slowly and can remain asymptomatic for a long time. In the early stages, the signs are subtle or absent, but as the disease advances, obvious manifestations appear:

• Changes in urine – dark color, cloudy, reduced amount, or presence of blood.
• Edema – swelling of the hands, feet, or eyelids due to fluid retention.
• High blood pressure – common in kidney diseases.
• Significant fatigue – due to anemia, often associated with kidney disease.
• Nausea and loss of appetite – signs of toxin accumulation in the blood.
• Pruritus (itching) – persistent, especially at night.
• Muscle cramps – particularly in the calf area.
• Frequent headaches – can occur with metabolic imbalances.

In more advanced stages, the following may occur:

• Difficulty breathing – due to fluid accumulation in the lungs.
• Chest pain – caused by inflammation of the pericardium (pericarditis).
• Confusion and memory problems – signs of uremic poisoning.
• Seizures – in severe, untreated cases.

Therefore, the possible signs of kidney obstruction are:

• intense pain in the lower back or abdominal area;
• fever, chills;
• severe nausea and vomiting;
• inability to urinate (anuria).

Diagnosing chronic kidney failure

To identify chronic kidney disease, blood and urine tests are primarily used, along with imaging studies. The most important test is the blood creatinine level – a substance normally eliminated by the kidneys. If it is elevated, it means the kidneys are not filtering properly, which may indicate a kidney blockage or a more advanced degree of impairment.

Other useful tests to confirm the diagnosis include:

• Complete blood count – can show anemia, frequently seen in kidney disease.
• Urinalysis – reveals protein, blood, or other abnormalities.
• Urine volume determination – important to see how much urine the kidneys produce daily.

Imaging studies also play an essential role:

• Renal ultrasound – provides information about the shape and size of the kidneys.
• MRI or CT scans – useful for detailed visualization of the kidneys and urinary tract, especially if an obstructive cause is suspected.
• Kidney biopsy – involves taking a tissue sample from the kidney for microscopic examination and is indicated in selected cases.

Based on these tests, the doctor determines the severity of the disease (stage) and the appropriate treatment. Early diagnosis is essential to slow the progression of the condition and prevent complications. If you have diabetes, high blood pressure, or a family history of kidney disease, it is recommended to check your kidney function regularly.

Stages of acute kidney failure

Acute kidney failure (AKF) is a condition with a sudden onset, occurring within hours to days. Depending on the severity, its progression can be divided into three distinct stages:

Stage 1 – Risk

In this early stage, kidney damage is minimal and often asymptomatic:

• Glomerular filtration rate (GFR) begins to decrease slightly.
• Blood creatinine levels rise slightly compared to previous values.
• Urine volume is generally normal or slightly reduced.
• Subtle signs may appear, but the patient usually does not experience clear symptoms.

Stage 2 – Injury

This is the intermediate stage, where kidney damage becomes more evident:

• Serum creatinine and urea continue to rise.
• Urine production significantly decreases (oliguria).
• Edema, fatigue, nausea, and electrolyte disturbances may occur.
• Electrolyte imbalances (hyperkalemia, acidosis) begin to develop.

Stage 3 – Failure

This represents the most severe form of acute kidney failure:

• The kidneys can no longer adequately filter blood.
• Anuria (absence of urination) may occur.
• Metabolic derangements become severe.
• Extracorporeal purification methods (hemodialysis) may be necessary.

Difference from chronic kidney disease

Unlike AKF, chronic kidney disease (CKD) has a slow progression and is divided into 5 stages based on glomerular filtration rate. For example, in stage 2, kidney function is slightly reduced but with good control potential, while in stage 3, the impairment is moderate, increasing the risk of complications. Careful monitoring and early intervention are essential to avoid progression to severe stages in both forms of the disease.

Chronic kidney failure: treatment, decrease in glomerular filtration rate, and prohibited medications

Treatment for chronic kidney disease aims to slow the progression of the disease and prevent complications. It is established based on the stage of the disease and associated causes.

In the early and moderate stages, the therapeutic approach focuses on:

• blood pressure and blood sugar control;
• reducing salt and protein intake;
• treatment of dyslipidemia and hyperparathyroidism;
• avoiding drugs with nephrotoxic effects.

In some cases, medications from the class of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are administered to protect kidney function.

As the glomerular filtration rate (GFR) drops below 30 ml/min/1.73 m², electrolyte imbalances, anemia, and bone disorders may occur, requiring specific treatments.

In advanced stages, when kidney function is severely compromised, renal replacement therapies are necessary:

• hemodialysis – blood filtration through an external machine;
• peritoneal dialysis – using the peritoneal membrane as an internal filter;
• kidney transplant – an option recommended for eligible patients with immunological compatibility.

Medications that require caution or dose adjustment include:

• non-steroidal anti-inflammatory drugs (NSAIDs);
• nephrotoxic antibiotics (e.g., aminoglycosides, vancomycin);
• metformin (contraindicated in GFR <30 ml/min);
• digoxin and lithium – strict monitoring required;
• gadolinium-containing contrast agents in MRI.

Attention! It is important that any new treatment, including supplements, is discussed with your treating physician. Kidney function monitoring is essential throughout the course of the disease.

Dietary recommendations and restrictions in chronic kidney failure + What foods are forbidden?

The goal of the diet in chronic kidney disease is to reduce the workload on the kidneys, thereby slowing the progression of the disease and preventing complications. At the same time, monitoring sodium, potassium, phosphorus, and protein intake is recommended.

Proteins

In mild and moderate stages, protein intake should be reduced to limit the accumulation of waste products. However, in advanced stages, especially in patients on dialysis, protein requirements increase.

• Stages 1-3: 0.8-1 g/kg body weight/day.
• Stages 4-5: 0.6-0.8 g/kg body weight/day.

Sodium

Salt should be limited to a maximum of 2-3 g/day to prevent fluid retention and hypertension. Avoid:

• processed foods (cured meats, canned goods);
• salty snacks;
• instant soups and fast food.

Potassium

In advanced stages, high blood potassium levels can become dangerous. It is advisable to avoid or reduce:

• bananas, avocados, potatoes;
• dried fruits, legumes, seeds, and chocolate.

Phosphorus

To prevent bone imbalances, phosphorus should be limited to 800-1000 mg/day. Foods to avoid:

• full-fat dairy products;
• red meat, organ meats;
• carbonated beverages.

Fluids

Depending on residual diuresis, fluid intake restriction may be necessary to prevent water overload.

Here are some examples of foods to avoid:

• foods preserved with salt;
• potassium-rich fruits and vegetables (in certain stages);
• full-fat dairy products;
• fatty meat and organ meats;
• carbonated and alcoholic beverages;
• cocoa-based sweets, chocolate.

Adjuvant natural remedies (only with medical advice):

• Herbal supplements – based on diuretic and anti-inflammatory extracts (such as horsetail, nettle, birch, juniper), which can support urinary function.
• Medicinal teas – infusions of herbs with a mild diuretic and kidney-protective effect, such as smallflower hairy willowherb, corn silk, dandelion, or cranberry.
• Multivitamin and mineral supplements – specially formulated for patients with kidney conditions, with reduced potassium, phosphorus, and vitamin A content, but rich in B vitamins, vitamin D, and iron, depending on the patient’s needs.

How long can one live with end-stage kidney failure?

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The lifespan of patients with end-stage kidney failure varies depending on several factors, but generally:

• Patients on dialysis can live an average of 5-10 years, although many live for 20-30 years.
• Individuals who receive a kidney transplant can live approximately 15-20 years before needing another transplant.

Factors influencing lifespan depend on:

• Age at diagnosis – younger patients tend to have a longer life expectancy.
• Stage of the disease at diagnosis – early detection and treatment can prolong life.
• Effective disease management and adherence to treatment.
• Presence of other associated conditions, such as diabetes or cardiovascular disease.
• Quality of medical care and access to modern treatments.

Many patients with end-stage kidney disease can lead active and high-quality lives, despite treatment. Adopting a healthy lifestyle, following medical recommendations, and closely monitoring health status can significantly contribute to prolonging lifespan and improving quality of life.

In conclusion, chronic kidney failure is a serious condition, but it can be managed effectively when detected early and treated appropriately. If you have been diagnosed with this disease or have risk factors, it is essential to consult a specialist physician to establish a personalized treatment plan. A balanced lifestyle, proper nutrition, and regular monitoring of kidney function can make a difference in maintaining a stable state of health.

This article is for informational purposes only and does not replace medical consultation. If you have symptoms or concerns about your kidney health, consult a doctor as soon as possible for a thorough evaluation and appropriate advice!

References:

1. Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017;389(10075):1238-1252;
2. Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165-180;
3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3:1-150;
4. Kalantar-Zadeh K, Fouque D. Nutritional Management of Chronic Kidney Disease. N Engl J Med. 2017;377(18):1765-1776.