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Kidney Disease

Living with Kidney Disease
As many of the signs and symptoms are non-specific and may be attributed to other causes, kidney disease is often discovered by chance.

Some of these symptoms include:

Someone with kidney disease may experience some or all of these symptoms, and sometimes advanced kidney failure can be present without the presence of any symptoms or warning signs. A doctor should always be consulted about any of the above symptoms.

After kidney disease is confirmed, different tests determine the type and extent of kidney damage and the subsequent treatments that would be effective.

Blood tests - assess levels of a range of waste products, salts, minerals and glucose in the blood.

Urine tests - look for substances in the urine such as blood, protein, glucose, red and white blood cells.

Imaging - taking pictures of the kidneys to discover more about the disease process, through ultrasounds, CT scans, xrays and other imaging techniques.

Kidney Biopsy - removing a small portion of the kidney tissue for examination with a needle to examine under a microscope.

Many different types of kidney disease can lead to kidney failure. Here are some brief descriptions of the more common diseases:

Diabetes
The most common cause of end stage renal failure in New Zealand. It damages the filtering membranes in the kidney directly, as well as damaging blood vessels throughout the body, increasing the risk of high blood pressure which can in itself cause renal failure. The presence of protein in the urine of diabetic patients can indicate the extent of damage to the kidney's filters.

Nephritis (also known as glomerulonephritis or Bright's disease)
Nephritis means the inflammation of the filtering units of the kidneys - the nephrons. In individuals with nephritis, the body's own immune system attacks the nephron and causes inflammation, damage and scarring. Some forms are treatable, but most are not. In its chronic form, nephritis affects both kidneys and causes slow, progressive damage. It can occur very rapidly or very slowly, and whilst some individuals recover without treatment, others progress to chronic renal failure. Rarely hereditary, most cases of nephritis occur at random. The little information available on causes of nephritis makes it an active area of medical research world wide.

Polycystic kidney disease (PCKD)
An inherited disorder which gradually replaces healthy kidney tissue with an ever increasing number of cysts. As these cysts grow, they cause the kidney to swell and eventually fail. PCKD is the most common genetic cause of end-stage renal disease, accounting for approximately 10% of all dialysis patients. There are two different types of polycystic kidney disease, dominant and recessive.
Dominant PCKD occurs in 90% of cases and usually affects adults. Recessive PCKD occurs in 10% of cases and usually affects children.
Recently the genes responsible for both forms of PCKD have been identified and mapped; if you are worried that other members of your family may be affected you should speak to your kidney specialist about family genetic studies.

Reflux nephropathy (RN)
RN is the term used by doctors to describe a form of kidney failure associated with the backflow of urine from the bladder into the kidneys. RN can also occur if the flow of urine is obstructed for any reason, for example, by a blockage to the bladder outlet. In this circumstance, back pressure builds up in the kidneys and damages them. Correcting the blockage and relieving the pressure on the kidneys can prevent this form of reflux nephropathy.
The reflux of urine from the bladder up to the kidneys is often diagnosed in younger children with reoccuring urine infections. In these cases, while operations are sometimes performed to correct it, the reflux is often resolved spontaneously.
People with damaged or scarred kidneys as a part of reflux nephropathy can develop high blood pressure which can in turn further damage the kidneys.

Living With Renal Failure
Kidney (Renal) failure will bring many changes to your life, affecting not only the diagnosed individual but their wider sphere of influence; family, friends, colleagues. Most people pass through several emotional stages, including denial and anger, before accepting the changes in their health. The time people take to reach a place of accepting these changes also varies. Many people feel sad or depressed when they find out they have kidney failure, but these feelings usually lessen and support is available for depression.

Living with symptoms
Some of the symptoms that an individual may think are related to depression may actually be a result of the kidney failure itself. The buildup of waste products in your blood can cause behavioural changes, affecting irritability, memory loss, confusion, problems with sleep patterns, fatigue, loss of energy, anger and depression, amongst other things.
Acceptance of living with renal failure does not always come quickly or without the help of others. Fortunately, most people do learn to live with kidney failure. With proper treatment, although life may not be able to return to exactly how it was, it can be just as good and even in different ways, better. It takes time and energy to adjust and reach acceptance but there are things that can be done to help

Who can you talk to?
Renal units in New Zealand, usually located in large teaching hospitals, offer specialised help for those adjusting to kidney failure. This professional guidance can be a great help to the patient and their family in coping through this process. Your renal physician, nurses, dialysis staff and social worker are available to assist you. Renal units also have access to psychiatrists, psychologists and chaplains should you desire them. Most renal units also have their own patient run organisations and support groups; information about these can be obtained from your renal unit social worker or staff, or from Kidney Health NZ's office.

Lifestyle Changes
Living with kidney failure means more than just staying alive. It is a real challenge to live life to the fullest despite the limitations imposed by kidney failure.
This means coping with the many changes that face most people with kidney failure; from self-image and relationship struggles, work and holidays, leisure and recreation as well as fitness and exercise, dietary changes, and the physical changes to your body which also affect sexual function, fertility and menstruation.

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