Kidney disease can begin with few obvious symptoms. There are many things that can be done to slow or even stop the progression of the disease. Kidneys are essential to normal body functioning. They work around the clock to filter out waste and regulate fluid and chemical levels in the body. Kidneys also contribute to other functions, such as blood pressure, calcium absorption and hemoglobin levels. Chronic kidney disease CKD is defined as the presence of kidney damage or decreased kidney function for a period of three months or more.
An estimatedpeople in British Columbia have some level of chronic kidney disease. Kidney disease is progressive, meaning that it usually gets worse over time. However, with early diagnosis, the progression of the disease can often be slowed and sometimes even stopped through lifestyle, diet and medication changes. Kidney disease can worsen to the point that the kidneys have very little function. This is called kidney failure, or end-stage kidney disease. Kidney failure is fatal unless a patient undergoes lifelong dialysis or receives a new donor kidney through transplant.
Every effort should be made to prevent or delay end-stage kidney disease because the outcomes for patients on dialysis are poor and the wait for transplant can be long. Because the symptoms of early stage kidney disease are easily misunderstood or ignored, many people with the disease are unaware of it.
This is why early diagnosis and early treatment are so important. Many people show no symptoms in the early stage of kidney disease. However, early symptoms may include:. Thinking about donating your kidney to someone in need? Our world-class Renal Program offers services to travellers who need dialysis while they are in Vancouver. Help us further patient care innovations and kidney research through a designated gift to the Renal Program.
Research Professionals Sitemap. Jump to Navigation.In addition their patient care role, our specialists lead research into the prevention and treatment of kidney disease.
The Division of Nephrology has a strong and internationally-recognized research program with a particular emphasis in chronic kidney disease and associated conditions, and kidney transplant outcomes. Its researchers also investigate issues such drug effectiveness, access to transplantation services, patient quality of life and renal program management.
The Nephrology Research Unit operates as an integrated part of the Division to provide centralized resources for renal research in Vancouver and across the province. With support from the BC Renal Agency and other research grants, the unit serves to:. Researchers collaborate locally, provincially, nationally and internationally with scientists from many organizations, including:.
Thinking about donating your kidney to someone in need? Our world-class Renal Program offers services to travellers who need dialysis while they are in Vancouver.
Help us further patient care innovations and kidney research through a designated gift to the Renal Program. Research Professionals Sitemap.
Jump to Navigation. Renal Program. Studies Get Involved.Because early stage kidney disease is asymptomatic and is associated with both, morbidity and mortality, laboratory measurements are required for its detection.
To summarize evidence supporting the use of laboratory tests for glomerular filtration rate GFR and albuminuria to detect and stage acute kidney injury AKIacute kidney diseases and disorders AKDand chronic kidney disease CKD in adults.
We reviewed recent guidelines from various professional groups and systematically searched for other sources of evidence for selected topics.
If confirmation of GFR is required because of conditions that affect serum creatinine independent of GFR, such as extremes of muscle mass or diet, or interference with the assay, cystatin C should be measured and estimated GFR should be calculated and reported using both serum creatinine and cystatin C eGFRcys and eGFRcr-cys or GFR should be measured directly using a clearance procedure.
If confirmation of albuminuria is required because of diurnal variation or conditions that affect creatinine excretion, such as extremes of muscle mass or diet, the albumin excretion rate AER should be measured from a timed urine collection.
Detection and staging of acute and chronic kidney diseases can be relatively simple. Because of the morbidity and mortality associated with kidney disease, early diagnosis is important and should be pursued in at-risk populations. Acute and chronic kidney diseases are common in adults, and are associated with increased risk for kidney failure, complications and mortality Table 1 1 - 3.
Kidney failure is the end-stage of acute and chronic kidney disease, and may require treatment by dialysis or transplantation. Earlier stages of kidney disease are times more common in the population than kidney failure, depending on age and the clinical setting, and are associated with electrolyte and acid-base disorders, fluid overload, metabolic and endocrine complications, toxicity of drugs excreted by the kidneys, and cardiovascular disease.
Early detection facilitates the appropriate diagnosis and treatment of acute and chronic kidney diseases, but early stage kidney disease is usually asymptomatic requiring laboratory tests for detection. Measurement of serum creatinine and urine protein are frequently performed in the general medical evaluation of adults with acute and chronic illness. Serum creatinine is routinely measured in the basic metabolic panel and proteinuria is ascertained along with routine urinalyses.
However, until recently, uncertainty and controversy existed regarding the definitions for acute and chronic kidney diseases, which tests should be obtained to diagnose these conditions and how the tests should be reported and interpreted Box 1.
The international organization Kidney Disease Improving Global Outcomes KDIGO attempted to resolve these controversies by updating prior evidence based consensus definitions and staging systems for acute and chronic kidney diseases and for the proper laboratory evaluation of these diseases 12.
These guidelines use glomerular filtration rate GFRgenerally accepted as the best index of kidney function in health and disease, and albuminuria, a marker of kidney damage, as the principal kidney measures to define and stage acute and chronic kidney diseases.
Chronic Kidney Disease
The guidelines also provide recommendations for the initial and confirmatory tests for these diseases Figure 1. The evaluation of GFR and albuminuria is reviewed here in the context of the KDIGO guidelines, the guidelines are compared to other recent guidelines and more recently published literature, and areas of uncertainty are addressed.
Figure illustrates stepwise use of initial and confirmatory tests for GFR and albuminuria for detection of acute and chronic kidney diseases and their association with complications. These were developed by an independent and global group of volunteers with expertise in kidney disease supported by a professional evidence review team. Guidelines and evidence reviews are submitted for open review by experts, stakeholders and the public.
Additional searches of the literature focused on the evaluation of kidney disease through December were performed. The National Guideline Clearance House was searched for kidney disease testing guidelines. The review was restricted to equations developed and evaluated using standardized assays for creatinine and cystatin C. Testing for CKD in high-risk populations was reviewed by Deo et al in 6. The National Guideline Clearance House was searched for guidelines appearing after this publication regarding this topic.Chronic kidney disease CKD is the progressive and irreversible destruction of the kidneys.
Your kidneys are essential parts of your body. They have several functions, including:. The most common causes of CKD are high blood pressure and diabetes. Each kidney contains about 1 million tiny filtering units, called nephrons.
Any disease that injures or scars the nephrons can cause kidney disease. Diabetes and high blood pressure can both damage your nephrons. High blood pressure can also damage the blood vessels of your kidneys, heart, and brain. The kidneys are highly vascularized, meaning they contain lots of blood vessels. So, blood vessel diseases are generally dangerous to your kidneys.
Autoimmune diseases such as lupus can damage blood vessels and can make antibodies against kidney tissue. There are various other causes of CKD. For example, polycystic kidney disease is a hereditary cause of CKD. Glomerulonephritis can be due to lupus. It can also appear after a streptococcal infection. The risk of CKD increases for people older than 65 years. The condition also runs in families.
Other risk factors for CKD include:. Once the kidney is severely damaged, the symptoms of CKD can include:. The diagnosis of CKD starts with a medical history. A family history of kidney failure, high blood pressure, or diabetes may alert your doctor. However, other tests are necessary to confirm that you have CKD, such as:.
A complete blood count can show anemia. Your kidneys make erythropoietin, which is a hormone. This hormone stimulates your bone marrow to make red blood cells. When your kidneys are severely damaged, your ability to make erythropoietin decreases. This causes a decline in red blood cells, or anemia. CKD can affect your electrolyte levels.
Potassium may be high and bicarbonate levels may be low if you have CKD. There may also be an increase of acid in the blood.With early chronic kidney disease, the goal is to keep the kidneys working. It is possible to slow or even stop the progression of disease using diet, lifestyle and medications.
Disease management approaches can also help patients on dialysis and transplant recipients improve how they feel. The BC Renal Agency provides a good overview of chronic kidney disease management. This clinic helps patients and their families manage their disease through nutrition counseling, social work support, teaching by nurse patient educators, and pharmacy review and advice.
Nutrition is a very important factor in kidney disease management. Making healthy food choices can reduce the workload on the kidneys, control the build-up of wastes, reduce symptoms and control the effects of high blood sugar for patients with diabetes. Appropriate food choices for a person with kidney disease may be different from what is normally seen as a healthy diet. Each person has different needs depending on their age, medical history and kidney function.
Nutritional issues also change over time and will depend on the stage of your disease. Your renal dietitian will work with you to design an individual daily eating plan that's right for you. People with chronic kidney disease may take a variety of medications to help manage their disease.
Your renal care team will determine the most appropriate medications for you. Your renal pharmacist will meet with you annually to review your medications for appropriateness, effectiveness and possible side effects or drug interactions.
You can also request an in-person or telephone consult at any time. The BC Renal Agency maintains a list of medications essential in the care and treatment of patients with kidney disease. This is called a formulary. The medications in the formulary are funded, meaning that the patient receives these drugs free of charge. There is a different formulary for dialysis patients and for kidney patients not on dialysis. In addition to prescribed medications, many people with kidney disease may use other products such as allergy medicine or herbal supplements.
Be sure to let your doctor or pharmacist know if you are taking non-prescription medications or health products. Here are some resources from the BC Renal Agency about medications:. Like anyone else, people with kidney disease can benefit from following a healthy lifestyle as much as possible. Making positive changes can help promote physical, mental and social well-being. Certain lifestyle habits can also help slow disease progression. The Renal Program can help you follow lifestyle recommendations and take care of your overall well-being.
We also offer physiotherapy services to help patients improve their physical function and feel better, stronger and more in control of their lives. To support patients in their day-to-day lives, the Renal Program offers a range of social work services. Social workers are available across our program to help you with emotional, personal and practical matters to help you cope better with your disease.
They can also connect you with helpful resources in the community. The following resources can help patients with kidney disease manage issues with finances, transportation, housing and food security.
Please contact our Social Work department for further assistance. Thinking about donating your kidney to someone in need?
Our world-class Renal Program offers services to travellers who need dialysis while they are in Vancouver. Help us further patient care innovations and kidney research through a designated gift to the Renal Program. Research Professionals Sitemap. Jump to Navigation. Renal Program. Disease Management.
Acute kidney injury AKI is defined as a rapid decline in renal function and is characterized by excessive renal inflammation and programmed death of resident cells. AKI shows high morbidity and mortality, and severe or repeated AKI can transition to chronic kidney disease CKD or even end-stage renal disease ESRD ; however, very few effective and specific therapies are available, except for supportive treatment.
In recent years, a series of studies have shown evidence that growth factors, receptors, and downstream effectors may be highly involved in the mechanism of AKI and may function in the early stage of AKI in response to stimuli by regulating inflammation and programmed cell death. Moreover, certain growth factors or correlated proteins act as biomarkers for AKI due to their sensitivity and specificity.
Furthermore, growth factors originating from mesenchymal stem cells MSCs via paracrine signaling or extracellular vesicles recruit leukocytes or repair intrinsic cells and may participate in AKI repair or the AKI-CKD transition. In addition, growth factor-modified MSCs show superior therapeutic potential compared to that of unmodified controls. In this review, we summarized the current therapeutic and diagnostic strategies targeting growth factors to treat AKI in clinical trials.
Acute kidney injury AKI is a clinical syndrome with acute renal dysfunction. The major causes of AKI include ischemic reperfusion, drug toxicity, and sepsis. In the last century, growth factors such as epidermal growth factor EGFinsulin-like growth factor IGFand fibroblast growth factor FGF have been widely investigated as an interesting research area since they are significantly dysregulated and dysfunctional in different AKI models 8 Table 1.
Evidence has shown that the administration of these growth factors promotes renal repair and restores renal function in animals; however, treatment with growth factors has not been used clinically. We also evaluated the current growth factor-targeted therapy or diagnosis in clinical trials and analyzed the limitations of growth factors in clinical treatment.
These precursor dimers are cleaved by an enzyme at R-X-X-R proteolytic processing sites, which release the biologically active domain. In the adult kidney, BMP-7 was detected specifically in the collecting tubule, the thick ascending limb, and podocytes 15 Fig. In renal tubules, growth factors are primarily expressed in fibroblasts and epithelial cells. Specifically, BMP-7 is only detected in thick ascending limb and collecting duct epithelial cells.
The first evidence regarding the protective role of BMP-7 in AKI was found in a study that indicated that OP-1 injection preserved kidney function and increased the survival rate after ischemic AKI through several mechanisms.
These mechanisms included reducing apoptosis and necrosis of tubular epithelial cells, suppressing inflammation by limiting neutrophil infiltration and the level of intercellular adhesive molecules, and maintaining the vascular smooth muscle cell phenotype in pericellular capillaries.Prev Chronic Dis ; Introduction The Chronic Care Model CCM uses a systematic approach to restructuring medical care to create partnerships between health systems and communities.
The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation.
We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices.
We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians PCPs were trained to deliver evidence-based care, and PCP office—based diabetes self-management education improved patient outcomes.
Only 7 studies described strategies for addressing community resources and policies.Patient's Story: Living with Chronic Kidney Disease
Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. Diabetes is a major cause of heart disease and stroke among adults in the United States and is the leading cause of nontraumatic lower-extremity amputations, new cases of blindness, and kidney failure 1—3.
Inthe Centers for Disease Control and Prevention reported that Comprehensive models of care, such as the original Chronic Care Model CCM 4,5advocate for evidence-based health care system changes that meet the needs of growing numbers of people who have chronic disease.
CCM was developed 4,5 to provide patients with self-management skills and tracking systems. The model represents a well-rounded approach to restructuring medical care through partnerships between health systems and communities.
CCM comprises 6 components that are hypothesized to affect functional and clinical outcomes associated with disease management. The 6 components 4,5 are 1 health system — organization of health care ie, providing leadership for securing resources and removing barriers to care2 self-management support ie, facilitating skills-based learning and patient empowerment3 decision support ie, providing guidance for implementing evidence-based care4 delivery system design ie, coordinating care processes5 clinical information systems ie, tracking progress through reporting outcomes to patients and providersand 6 community resources and policies ie, sustaining care by using community-based resources and public health policy.
The sum of these CCM component parts are purported to create more effective health care delivery systems that institute mechanisms for decision support, link health care systems to community resources and policies, deliver comprehensive self-management support services for patients, and operate and manage patient-centered clinical information systems.