Once your kidney disorder has been identified and its severity assessed, your healthcare professional can order the treatment most appropriate for you. Some kidney conditions are dangerous. If symptoms are severe, urgent attention in the emergency department may be needed. Others are milder. Prompt attention and sticking to your healthcare provider’s recommendations will often delay or prevent kidney failure.
Electrolyte or fluid imbalances such as low or high sodium or potassium levels may be corrected by simply supplying the missing electrolyte or adjusting your intake of water. Electrolytes can be administered either in an intravenous solution in hospital or in pill form. In other cases, a small change in your diet or medications may be enough. If fluid retention (swelling) is a problem, you may be given a diuretic and be told to restrict your fluid intake for a while. Dehydration may need to be treated in hospital with special intravenous fluids delivered through a tube into your arm.
Kidney stones may result from dehydration, infection, or other stress to your kidneys. Treatment may not be needed if the kidney stones are small, since they often pass out in your urine on their own. If they are too large to pass this way, your nephrologist may suggest extra-corporeal shock wave lithotripsy (ESWL). In this non-surgical approach, you rest in a type of water bath while a particular frequency of sound waves target the kidney stones, which then disintegrate and pass out of your body through the urinary pathway. Kidney stones that are too large for ESWL must be removed surgically.
Nephrotic syndrome, a condition where proteins leak out of your kidneys, can often be treated effectively in older patients with the use of steroid medicines such as prednisone and other drugs that are taken in pill form (cytotoxic agents). If the nephrotic syndrome resulted from taking certain medicines – such as an NSAID painkiller – then another medication should be substituted.
Kidney conditions called glomerulonephritis or glomerulosclerosis sometimes occur with certain illnesses (for example, autoimmune diseases, hypertension or diabetes) or infections. Treatment or improved control of the underlying disorders is likely to improve these types of kidney problems.
Renovascular disease (kidney damage from bad circulation) is usually a result of conditions common to older people such as atherosclerosis (hardening of the arteries), blood clots, high blood pressure , high cholesterol , and smoking. Aggressive treatment of these underlying conditions will often delay more serious illness.
- Surgery: If unchecked, renal artery stenosis may occur, in which the arteries carrying blood to your kidneys get very narrow. Often there are no symptoms. But if the arteries become too narrow and medications can’t improve the problem you may need surgery to correct the blockage and prevent severe complications, including kidney failure.
Acute kidney failure can follow a variety of kidney stresses, including infection, urinary blockage (common in older men with enlarged prostate glands), surgery, dehydration, heart rhythm problems, heart failure, or exposure to certain medicines or toxins. Quick treatment of the cause of your acute kidney failure is often enough to restore kidney function.
To avoid severe complications, you may need dialysis treatment until your kidneys recover.
What is dialysis?
There are two commonly used forms of dialysis:
- In hemodialysis, you sit in a chair for several hours one or more times per week, while your blood is siphoned into a machine that filters the waste products and then returns the clean blood back into your body.
- In continuous ambulatory peritoneal dialysis, solutions are pumped into your abdomen through a special dialysis tube inserted through the skin of your abdominal wall to draw out the waste products from the blood. The excess solution and waste products are then removed from the abdomen. There is no need to sit in a clinic for several hours in this type of dialysis.
The choice of hemodialysis or peritoneal dialysis depends on your wishes and overall condition, as well as available resources. Survival rates for both procedures are about the same.
Chronic kidney disease refers to kidney damage that lasts for more than three months. It is classified into five stages based on how well your kidneys are able to filter your blood. In stage one, your kidneys retain much of their ability to filter out wastes, while in stage five, the filtration rate is inadequate and your kidneys are considered to have failed.
The goal of treatment is to reduce kidney damage by fixing the causes of your kidney disease, which usually means:
- reducing blood pressure
- improving cholesterol levels
- controlling diabetes (blood sugar)
- balancing electrolytes
- reducing protein in urine
- controlling phosphorus levels.
Medications: Almost all medications that you use will have to have their dosages reduced or must be avoided entirely if you have kidney disease, especially if you take:
- pain medicines (NSAIDs such as Advil or ibuprofen in particular)
- muscle relaxants
- many heart medicines.
Your healthcare provider may also prescribe:
- iron pills (if you are anemic)
- vitamin D supplements (must be strictly monitored)
- medications to lower phosphate levels.
Diet: For many chronic kidney disease patients, strict limits must be placed on protein, phosphorus and potassium consumption. If you are one of these patients, a nutritionist or dietitian who specializes in kidney diseases can help you devise a palatable, healthy diet to fit your individual needs.
Contact a trained renal dietitian for help in putting together a healthy diet for your special needs, especially if you have reached an advanced stage of kidney disease.
End-stage kidney disease or kidney failure cannot be cured or reversed. It requires dialysis or a kidney transplant for survival. Your nephrologist will guide you in choosing the best renal replacement therapy – dialysis or kidney transplant – for your needs.
Dialysis treatment: Most patients undergo hemodialysis to remove waste products from their blood. This procedure usually adds years to a patient’s life, even for people over 80 years of age, providing a good quality-of-life during which normal activities can be enjoyed. Often, minor surgery will be performed to construct an access for the dialysis treatment.
Patients who are suffering from dementia may be given a trial of dialysisif it is possible that the declining cognitive symptoms are actually a result of kidney failure. If no improvement has occurred after four to six weeks, dialysis treatment is usually stopped, particularly if the patient is unable to tolerate the dialysis treatments well.
Kidney transplantation: Many relatively healthy older patients, well into their 70s, are good candidates for a new kidney, especially since rejection rates are lower in older people. However, infection and blood vessel problems are more common in older transplant recipients. A nephrologist, or kidney expert, will carefully assess the risk factors and discuss the pros and cons of a kidney transplant with you.
If you are an older kidney failure patient, your likelihood of a significant increase in life expectancy from a kidney transplant is very high. Getting a new kidney often doubles your remaining years, compared to remaining on dialysis. Unfortunately, the wait for a donated kidney is now about five years in the United States. For this reason, it is important to explore the possibility of a transplant as soon as you begin to consider renal replacement therapy. Patients who have kidney transplants must adhere very closely to medication treatments for the rest of their lives to avoid their body rejecting the transplanted kidney.
If you have been diagnosed with a kidney disease, make sure that your electrolyte levels are checked on a regular basis. Monitoring is especially important:
- during hospitalizations or long-term care
- if you are having surgery
- if you take diuretic medicines (water pills)
- in hot weather (diuretic dose may have to be reduced)
- if your salt consumption is restricted.
Do not miss any follow-up appointments or lab tests, since kidney damage can occur very quickly if a risk is not identified and controlled.