Chronic kidney disease (CKD) is a global health concern that often goes undetected until its later stages. The intricate web of kidney functions plays a vital role in maintaining our overall well-being, and when this web starts to unravel, it manifests through a range of symptoms that warrant our attention. In this comprehensive article, we will delve into the nuances of kidney disease symptoms, shedding light on the hidden indicators that can be crucial for early detection and effective management.
Understanding the Silent Menace
The Stealthy Onset
Kidneys, those unassuming bean-shaped organs, perform a myriad of critical functions that support our body’s equilibrium. From filtering waste and excess fluids to regulating blood pressure and producing essential hormones, their role is extensive.
- Most human beings are born with 2 kidneys. However, if one of the kidneys is taken out, the body only loses 25% of kidney function. Due to hypertrophy, the remaining kidney continues to sustain the body. For children born with renal agenesis (i.e. one kidney), the lone kidney grows till it has the combined weight of two.
- The average kidney is as big as a cellphone and weighs 4-6 ounces. Even though the kidney only accounts for 0.5% of the body’s weight on average, it receives more blood than all other organs except the liver.
- Nephrons are the functional unit of kidneys that filter the blood ensuring resorption of essential micronutrients and excretion of the body’s waste products within the blood. The portion of the nephron mainly in charge of filtering the blood is called the glomerulus. The proper secretion, resorption and excretion of molecules takes place in the other sections of the nephron that are termed overall as renal tubules. Each kidney has between 1 to 2 million nephrons. If the nephrons in the 2 kidneys are removed and laid end-to-end, they would cover a distance of ~10 miles. Amazing !
- Vitamin D production occurs in the skin with the help of UVB sunlight. The vitamin D produced by the skin needs to be further metabolized in the liver (25OHD) and in the kidneys in order to become its active hormonal form (1,25(OH)2D; most potent metabolite of vitamin D and accounts for most of its biologic actions) which act directly on the skin, the immune system, parathyroid gland, intestinal epithelium, prostate, and breast.
However, kidney disease often remains asymptomatic during its early stages, earning it the moniker of the “silent menace.” This lack of outward signs can be deceiving, lulling individuals into a false sense of well-being while the disease silently progresses. Chronic Kidney Disease is becoming a silent epidemic worldwide. 10% of the population worldwide is affected by chronic kidney disease (CKD), and millions die each year because they do not have access to affordable treatment (ex. Dialysis).
Unveiling the Subtle Clues
Fatigue: More Than Just Tiredness
Fatigue is a common symptom, but in the context of kidney disease, it takes on a distinct character. As many as 70% to 97% of individuals with chronic kidney disease (CKD) report fatigue. As the kidneys falter, toxins and waste accumulate in the body, sapping energy levels. The result is an overwhelming sense of fatigue that can persist even after ample rest. Understanding the underlying cause of fatigue is crucial, as it can often be mistaken for everyday tiredness. Studies of the causes of muscular fatigue have also investigated potential causative factors, such as impaired oxygen delivery, altered cardiovascular response to exertion, and metabolic acidosis etc. 2
Swelling: When Fluids Collect
Edema, or swelling, is another telltale sign of kidney dysfunction. As the kidneys struggle to eliminate excess fluids, the body retains sodium and water, leading to swelling in the legs, ankles, and feet. While occasional swelling might not immediately ring alarm bells, persistent edema could be an indicator of an underlying issue.
Changes in Urination: The Subtle Shifts
Kidneys play a pivotal role in regulating the body’s fluid balance. Therefore, changes in urination patterns can provide valuable insights into their health. Frequent urination, especially during the night, or conversely, decreased urination, could signal kidney concerns. Paying attention to these changes and discussing them with a healthcare professional can aid in early diagnosis.
Connecting the Dots: The Systemic Impact
High Blood Pressure: A Dual Relationship
Kidneys and blood pressure share an intricate relationship. While kidney disease can contribute to hypertension, the reverse is also true. Uncontrolled high blood pressure can damage the delicate blood vessels within the kidneys, impairing their function. This bidirectional connection underscores the importance of monitoring blood pressure as a preventive measure.
Anemia: Beyond Blood Counts
Anemia, characterized by a deficiency of red blood cells, is a common companion of kidney disease. As kidneys falter, they produce less of the hormone erythropoietin, which stimulates red blood cell production. This deficiency leads to anemia, contributing to fatigue, weakness, and cognitive impairment. Addressing anemia alongside kidney disease is essential for comprehensive management.
Navigating the Diagnostic Landscape
Seeking Medical Guidance
Navigating the complex terrain of kidney disease symptoms requires professional expertise. Physicians employ a combination of medical history, physical examination, and diagnostic tests to assess kidney function. Blood tests, including serum creatinine and glomerular filtration rate (GFR) measurements, offer valuable insights. Urinalysis can also detect abnormalities, shedding light on potential kidney damage.
Biomarkers to Test
- eGFR & albumin
- Cytokine Panel: esp. IL-1β, IL-1RA, IL-6, TNF-α, hs-CRP. https://www.mayocliniclabs.com/test-catalog/Overview/75139
- Kidney Injury Molecule-1 (KIM-1): a type 1 transmem- brane protein, has been shown to be upregulated in dediffer- entiated proximal tubule epithelial cells upon ischemic or toxic injury but is undetectable in healthy kidneys or urine. Urinary KIM-1 has been shown to predict renal injury before changes in eGFR were detectable
- Cystatin C
- Ferritin and Iron metabolism
- FGF23, PTH, and Serum Klotho (hard to find a lab for this)
The Road to Wellness: Management and Lifestyle
Dietary Considerations: A Balancing Act
Adopting a kidney-friendly diet is integral to managing kidney disease. Reducing sodium intake helps manage fluid retention and blood pressure. Monitoring protein consumption eases the kidneys’ filtration burden. Incorporating fresh fruits, vegetables, and whole grains provides essential nutrients while promoting overall health.
Medication and Treatment
Depending on the severity of kidney disease, physicians might prescribe medications to address specific symptoms or underlying causes. Blood pressure medications, erythropoietin supplements, and phosphate binders are common interventions. In advanced stages, dialysis or kidney transplantation might become necessary.
The subtlety of kidney disease symptoms makes early detection a challenge, but not an impossibility. By recognizing the hidden clues that our bodies provide, we can take proactive steps toward safeguarding our kidney health. Regular medical check-ups, a mindful approach to diet and lifestyle, and open communication with healthcare professionals form the pillars of effective kidney disease management. As we unveil the unseen symptoms, we equip ourselves with the knowledge needed to navigate the path to kidney wellness.
- Joshwa, B., & Campbell, M. L. (2017). Fatigue in Patients with Chronic Kidney Disease: Evidence and Measures. Nephrology nursing journal : journal of the American Nephrology Nurses’ Association, 44(4), 337–343.
- Gregg, L. P., Bossola, M., Ostrosky-Frid, M., & Hedayati, S. S. (2021). Fatigue in CKD: Epidemiology, Pathophysiology, and Treatment. Clinical journal of the American Society of Nephrology : CJASN, 16(9), 1445–1455. https://doi.org/10.2215/CJN.19891220