Chronic Kidney Disease (CKD)

People are normally born with two kidneys, which filter waste and excess liquid from the blood. The kidneys also produce hormones that help strengthen bones, control blood pressure and direct the production of red blood cells.

Chronic kidney disease (CKD) is the term for progressive and permanent damage to the kidneys that occurs over time.

CKD is distinguished from acute kidney injury (AKI), the sudden loss of kidney function, by the gradual decline in kidney function and by the permanence of that damage. When kidney disease persists for at least three months and does not get better, CKD is diagnosed. While kidney function is often recovered in treatment for acute kidney injury, the goal of treatment for chronic kidney disease is to prevent further damage, and typically does not result in restored kidney function.

Chronic kidney disease can be caused by any disease or condition that damages the kidneys, including:

• Anomalies of the kidneys or urinary tract at birth
• Glomerulonephritis
• Recurring infections

• Inherited kidney conditions such as polycystic kidney disease
• Type 1 or type 2 diabetes
• High blood pressure (hypertension)

In addition to the risks from diabetes and high blood pressure, people are at greater risk of chronic kidney disease if they are obese or have a family history of kidney disease.

While high blood pressure can be a cause of chronic kidney disease, the relationship can also go in the other direction, with kidney disease causing high blood pressure.

In its early stages, there may be no physical symptoms of chronic kidney disease.

As kidney function declines, symptoms may include:

• Swelling of the hands or feet or in the face around the eyes
• Nausea and vomiting
• Loss of appetite
• Feeling tired
• Trouble concentrating
• More frequent need to urinate, especially at night
• Muscle cramps, especially at night
• Trouble sleeping
• Shortness of breath
• Dry, itchy skin

Because physical symptoms of kidney disease don’t appear until significant damage to the kidneys has occurred, children and adolescents who are at risk of developing CKD because of family history, diabetes, high blood pressure or obesity should have periodic screening tests. These screening tests may include:

• Blood pressure measurement
• Urine test to check for the presence of protein
• Blood test to estimate the kidneys’ function (glomerular filtration rate or GRF)

When physical symptoms or the patient’s history suggest chronic kidney disease, the screening tests listed above and additional tests are done to make a diagnosis. These additional tests may include:

• Ultrasound, CT scan or MRI of the kidneys and urinary tract
• Kidney biopsy

Once a diagnosis is made, further tests may be done to identify the cause of the kidney problem or to look for complications from the condition.

Treatment of CKD focuses on addressing the causes of the kidney problems and stopping the progression of the kidney damage.

If diabetes or high blood pressure are causing or contributing to kidney problems, the goal of treatment will be to get these conditions under control to prevent further kidney damage. Treatment may include:

• Lifestyle changes to improve diet, increase healthy exercise, adopt healthy sleep habits or lose weight
• Medications (insulin for diabetes, ACE inhibitors or ARBs for hypertension)

When CKD is caused by anomalies of the urinary tract, such as an obstruction to the flow of urine from the bladder or a backflow of urine from the bladder to the kidneys (vesicoureteral reflux), treatment may include:

• Antibiotics to prevent kidney infections
• Surgery to remove the obstruction or stop the backflow of urine

When CKD is not detected early or when treatment is unable to prevent serious damage to the kidneys, kidney failure may require treatment with:

• Dialysis
• Kidney transplantation

Damage to kidneys from CKD is usually permanent, but treatment can slow or prevent further damage.

People can live healthy lives with a single kidney or with partial function in the kidneys.

When kidney function falls to levels that cause serious health problems, dialysis and kidney transplantation may be needed.

People with chronic kidney disease typically require long-term medical monitoring and care. They may need periodic tests of kidney function. They may also need ongoing treatment for the condition that caused the CKD (diabetes or high blood pressure, for example).

The frequency of that ongoing care and monitoring will vary greatly case by case.

The Chronick Kidney Disease (CKD) Clinic within the Division of Nephrology at Children's Hospital of Philadelphia (CHOP) provides your child with world-class care for and treatment of kidney diseases. Our division is consistently ranked as one of the top programs in the nation by U.S. News & World Report. Our physicians and staff are known for their ability to diagnose, treat and care for children with all forms of kidney disease, including chronic kidney disease. Here, you'll find superb clinical care and an equal measure of understanding and compassion.

Our multidisciplinary team — including nephrologists, clinical nurse specialists, social workers, a pharmacist, psychologist, and nutritionist — provides comprehensive medical consultations and evaluations for children with renal diseases, electrolyte disorders and hypertension. We have extensive experience managing children with all stages of CKD, including those needing dialysis or a kidney transplant.