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Kidney Disease

Chronic kidney disease (CKD) impacts an estimated 26 million Americans. It is often undetected until it has progressed to being potentially morbid condition. Learn more about CKD from Cleveland Clinic experts.

What is Chronic Kidney Disease?

Learn more about Cleveland Clinic’s nationally top-ranked nephrology program.

Chronic kidney disease is the irreversible, progressive decline in kidney function. Doctors assess how effective a patients kidneys are at filtering waste from the blood stream. You have kidney disease if the amount of blood that passes through the glomeruli (tiny filters in the kidney) falls to less than 60 mL/min/1.73 m2 for at least 3 months. Doctors test this glomerular filtration rate (GFR) to also determine what stage of chronic kidney disease a patient has reached.

According to the National Kidney Foundation, 26 million Americans have kidney disease and millions more are at an increased risk. 

If kidney disease worsens, wastes build to high levels in the blood; complications such as high blood pressure, anemia (low blood count), weak bones, and nerve damage can occur and increase the risk of heart and blood vessel disease. Chronic kidney disease (CKD) may be caused by diabetes, high blood pressure and other disorders. When kidney disease progresses, it may eventually lead to kidney failure, requiring dialysis or kidney transplant. Early detection and treatment can often help keep CKD from getting worse.

Nephrologists in Cleveland Clinic’s Glickman Urological & Kidney Institute are the experts in treating chronic kidney disease (CKD). Our innovative model of health management focuses on educating and involving patients in their care. We work to slow the progression of CKD, identify risk for cardiovascular disease, and evaluate CKD patients to decrease risk for complications from surgery.

Stages of Chronic Kidney Disease

Physicians track the progress of chronic kidney disease in 5 stages:

Stage Description GFR (mL/min/1.73m2)
1 Kidney damage with near normal or elevated GFR ≥90
2 Kidney damage with mildly decreased GFR 60-89
3 Moderately decreased GFR 30-59
4 Severely decreased GFR 15-29
5 Kidney Failure (End Stage Renal Disease) <15

While physicians design treatment plans, nurse practitioners, physician assistants, nutritionists, and educators round out the health management team. By learning about CKD from the health management team and carefully following its treatment plan, patients may be able to slow the progression of their CKD. A recent CKD Clinic analysis documents the powerful positive impact that our team care approach has had on the effective management of the medical and educational issues relating to CKD.

What Causes Chronic Kidney Disease?

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.

Diseases and conditions that commonly cause chronic kidney disease include:

  • Type 1 or type 2 diabetes
  • High blood pressure
  • Glomerulonephritis (gloe-mer-u-lo-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli)
  • Interstitial nephritis, an inflammation of the kidney's tubules and surrounding structures
  • Polycystic kidney disease
  • Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
  • Vesicoureteral (ves-ih-koe-yoo-REE-ter-ul) reflux, a condition that causes urine to back up into your kidneys
  • Recurrent kidney infection, also called pyelonephritis (pie-uh-lo-nuh-FRY-tis)

How is Chronic Kidney Disease Diagnosed?

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To determine whether you have chronic kidney disease, you may need tests and procedures such as:

Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.

Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.

Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure and size. Other imaging tests may be used in some cases.

Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem.

What are the Symptoms of Chronic Kidney Disease?

Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Signs and symptoms of kidney disease may include:

  • Fatigue and weakness
  • Sleep problems
  • Changes in urine output
  • Swelling of feet and ankles
  • Persistent itching
  • Muscle cramps
  • Shortness of breath, if fluid builds up in the lungs
  • High blood pressure
  • Vomiting
  • Nausea

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. And because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

How is Chronic Kidney Disease Treated?

The CKD Clinic Program

At their initial visit, patients undergo physical examination and glomerular filtration rate (GFR) testing, along with a comprehensive cardiovascular evaluation that includes an ECG,lipid profile, and a serum cholesterol level check. The GFR, calculated from the results of a blood creatinine test along with age, race, gender and other factors,is the best way to measure kidney function and determine the stage of kidney disease.

Depending on the patient’s results and stage of disease, a nephrologist will outline an individual treatment plan and arrange for the patient to meet with the CKD Clinic health management team charged with his or her care. A nurse practitioner follows the patient’s treatment progress.

At subsequent visits, a registered dietitian will provide nutritional and dietary interventions for renal disease, cardiovascular disease and diabetes as needed. Patients needing future dialysis are assessed on a regular basis for an access specialist.

Who Can Benefit from the CKD Clinic?

Patients with a GFR of <45 ml/min would benefit from the CKD Clinic. (The GFR must be determined because the serum creatinine is not a thorough marker for kidney disease.) The clinic accepts referrals for disease evaluation. If you do not know your GFR, please set up an evaluation. People with a family history of kidney disease or uncontrolled hypertension are at an increased risk for developing kidney disease.

Can I Prevent Chronic Kidney Disease?

Chronic kidney disease may sometimes be prevented by controlling the other diseases or factors that can contribute to kidney disease. People who have already developed kidney failure also need to focus on these things to prevent the complications of kidney failure.

Keep your blood pressure below 130/80. Learn to check your blood pressure at home.

If you have diabetes, keep your blood sugar within a target range. Talk with your doctor how often to check your blood sugar.

Stay at a healthy weight. This can help you prevent other diseases, such as diabetes, high blood pressure, and heart disease. For more information, see the topic Weight Management.

Control your cholesterol levels. For more information, see the topic High Cholesterol.

Don't smoke or use other tobacco products. Smoking can lead to atherosclerosis, which reduces blood flow to the kidneys and increases blood pressure.

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Urology Appointments: 800.223.2273 ext. 4-5600
Nephrology Appointments: 800.223.2273 ext. 4-6771

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Do you have a question about our services? Ask the nurse in the Glickman Urological & Kidney Institute.