The National Kidney Foundation reports that one in nine Americans is afflicted with some form of kidney disease. Since chronic kidney disease is incurable, doctors focus upon treating symptoms such as high urine protein, hypertension and anemia. When kidney function declines to the point that it is no longer possible to sustain life, dialysis and transplant are life-saving treatments.
Hypertension
Hypertension is the bane of almost all kidney patients. As kidney function decreases, the kidneys sense less blood flowing over them and secrete a hormone that constricts blood vessels. This causes a vicious cycle because the resulting high blood pressure whittles away at the remaining kidney function.
Consequently, kidney patients often end up on multiple hypertension medications to control this. Doctors prescribe different classes of drugs such as angiotensin converting enzyme inhibitors, commonly called ACE inhibitors, angiotensin receptor blockers or ARBs, calcium channel blockers, diuretics and beta blockers to treat this symptom of kidney failure. Patients often spend much time adjusting medications and doses to arrive at the optimal solution.
Urine protein
Patients with decreased kidney function also commonly have elevated urine protein. Just as hypertension erodes kidney function, high urine protein does as well.
Since ACE inhibitors have relatively few side effects, they are often the first treatment for excess urine protein. If this is not sufficient, doctors try immunosuppressant drugs such as prednisone, mycophenolate mofetil and cyclophosphamide.
While prednisone and cyclophosphamide have been used for decades, mycophenolate mofetil, also known as Cellcept, is a relative newcomer and has been shown to be very helpful in treating high urine protein with fewer side effects than its predecessors. The May 2010 issue of "Clinical Nephrology" reports that mycophenolate mofetil can be combined with prednisone.
Anemia
Anemia is a problem for many patients with decreased kidney function because the kidneys also secrete a hormone called erythropoitin that aids the maturation of red blood cells. According to the National Kidney Foundation, not having enough erythropoitin is the leading cause of anemia in kidney patients.
Synthetic erythropoitin is one of the most recent miracle drugs in the treatment of anemia in patients with declining function. Patient inject themselves with this drug every two weeks. After several weeks, the change is often astounding as patients go from being profoundly fatigued and breathless to feeling energetic and productive again.
Phosphate binders
As kidney function decreases, kidneys lose the ability to filter phosphates, causing itchy skin. The National Kidney Foundation recommends treating this with phosphate binders if reducing dietary potassium is not sufficient.
Potassium binders include calcium carbonate preparations such as TUMS and PhosLo, as well as sevelamer and others.
References
- National Kidney Foundation: Clinical Practice Guidelines
- National Kidney Foundation: Anemia and Chronic Kidney Disease
- National Kidney Foundation: Kidney Disease
- "Clinical Nephrology"; Combination therapy with mycophenolate mofetil and prednisone; M. Yuan, et. al.; May 2010
- "Therapeutische Umschau"; Immunosuppressive therapy of glomerulonephritis; P. Ferrari, et. al.; February 1993
