- Decreases the amount of urine produced by the kidneys;
- Hypertension occurs or pre-existing hypertension can no longer be controlled with regular medication doses;
- Fluid is retained in the tissues: swelling of the legs, face, difficulty breathing, etc.;
- Fatigue occurs at low effort and the feeling of cold;
- You may lose your appetite;
- Toxins are retained in the blood, with consequences on your clinical condition;
- There is an imbalance of electrolytes and minerals in the body;
- Anaemia and bone disease may occur.
As the kidneys begin to deteriorate, their important functions diminish. Thus, residues in the body (toxins) can no longer be properly eliminated by the kidneys and accumulate. So, you will feel sick, by the appearance of nausea, vomiting, loss of appetite, difficulty concentrating.
In addition, the kidneys are no longer able to eliminate excess salt and water, which are retained in the body and cause swelling of the legs (oedema), increased blood pressure, difficulty breathing, etc. Sleeping at night can be difficult in these conditions and you will have to use an extra pillow to breathe better.
You may also notice dry skin and itching, which are caused by the accumulation of a mineral called phosphorus in your body.
When the function of your kidneys decreases, an electrolyte called potassium can also accumulate in your body, which can lead to arrhythmias (changes in heart rate), even life threatening.
Another function of the kidneys is to produce hormones, which help your body produce red blood cells and control bone health. Thus, in the advanced stages of CKD, your body can no longer produce enough red blood cells and anaemia occurs, and the bones can also become more fragile.
All these symptoms can appear very slowly, so you can overlook them and risk presenting to the doctor only when serious health problems occur, caused by BCR in advanced stages.
In the gradual evolution of CKD, all this leads, in one form or another, to cardiovascular damage (uncontrolled blood pressure, changes in heart structure, the occurrence of heart rhythm disorders, pericarditis, damage to blood vessels throughout the body), then when your condition is not closely monitored by your nephrologist.
Therefore, chronic kidney disease is a disease with multifactorial etiology (it has multiple causes). This requires a multidisciplinary approach, both in terms of etiology and complications of advanced disease, which involves the need for treatment of the patient by several medical specialties. The multidisciplinary team for integrated care of patients with chronic kidney disease should include family physicians, nephrologists, diabetologists, cardiologists and, depending on the situation, even other medical specialties.
The diagnosis of CKD in stages 1 and 2 largely depends on family doctors and doctors of other specialties (diabetologists, cardiologists, urologists, rheumatologists, internists, gastroenterologists). When they suspect CKD, they should refer you to a nephrologist for confirmation of the diagnosis, treatment and monitoring of the disease.
For the diagnosis of chronic kidney disease, two consultations are required at least every 3 months:
- determination of serum creatinine and RFG estimation (eRFG <60mL / min / 1.73 m²), which shows kidney function,
- determination of spontaneous (morning) urine albumin and creatinine and calculation of urinary albumin / creatinine ratio (RAC ≥30mg / g) or determination of the amount of albumin excreted by the kidneys in 24 hours (≥30mg / 24h).