Patients with impaired kidney function--also called renal function--are treated symptomatically. This means that instead of treating the disease with the expectation of cure, the symptoms of the disease are managed. Given that the symptoms of renal disease get progressively worse as renal function declines, treatment gets more complex over time. Maintaining a good partnership with a nephrologist is key to feeling better and slowing disease progression.
Blood Pressure Medication
Almost all kidney patients have some degree of hypertension. As function continues to dwindle, this problem gets worse. It is not uncommon for kidney patients to be on four of five different blood pressure medications.
ACE inhibitors are usually the first drug of choice because they have a reno-protective benefit. As noted by the National Institute of Diabetes, Digestive and Kidney Disease, "these drugs have been found to protect kidney function even more than other drugs that provide the same level of blood pressure control."
Immunosuppression
Most kidney patients have some degree of proteinuria or protein in the urine. Patients who spill more than three grams of protein a day into their urine are said to be nephrotic. While low levels are urine protein are usually not treated, nephrologists try to control high levels of protein because they have a deleterious effect on renal function when continuing for months and years.
Frequently, proteinuria is caused by inflammation of the kidneys. Oral of IV prednisone may be extremely beneficial. In some instances, other immunosuppressants such as mycophenolate mofetil, cyclosporine and others may be useful in the event the patient does not respond to prednisone.
EPO
The National Institute of Diabetes, Digestive and Kidney Disease explains that anemia may begin to develop when patients still have 20 percent to 50 percent of normal kidney function. They go on to state that nearly all patients who reach end stage disease are anemic. This anemia relates to a hormone called erythropoietin--abbreviated EPO--which is secreted by the kidneys. EPO is responsible for transforming the immature red blood cells called reticulocytes into mature red blood cells that are capable of bearing hemoglobin. As kidneys get progressively scarred, they loose their ability to make EPO and anemia results.
Synthetic EPO can be administered via injection every two weeks. It replaces the EPO that the kidney can no longer make. Patients who take EPO are no longer fatigued and breathless.
Diet
Patients with low renal function also begin to have problems maintaining normal levels of potassium and phosphorus. This can cause serious problems. For example, high levels of potassium can cause cardiac arrhythmias and high levels of phosphorus can cause calcium to be released from the bones. These problems can be prevented by regular monitoring. When these electrolyte levels begin to creep up, a consultation with a dietician can be very helpful because controlling potassium and phosphorus intake become the only way to control serum levels of these electrolytes.
References
- National Institute of Diabetes, Digestive and Kidney Disease: Proteinuria
- National Kidney Foundation: Nephrotic Syndrome
- Pub Meds: Effect of Mycophenolate Mofetil (Cell Cept) in the Treatment of Immune Glomerulopathies.
- Lupus: Effect of Low-Dose Cyclosporine A in the Treatment of Refractory Proteinuria in Childhood-Onset Lupus Nephritis
