Talk With Nephrologists: Acute vs. Chronic Kidney Disease

     While many are familiar with the kidneys as organs that excrete waste, few realize their crucial roles in regulating water, maintaining electrolyte balance, and producing essential hormones. Consequently, kidney dysfunction can profoundly impact various bodily systems. Therefore, our nephrologists at Ramkhamhaeng Hospital emphasize proactive kidney care to ensure smooth kidney function and prevent end-stage renal disease, which necessitates lifelong dialysis.

What Do Kidneys Do?

     The kidneys, shaped like soybeans, are located on either side of the mid-back. These two organs act as sophisticated filters vital for sustaining life. Beyond their well-known role in eliminating waste through urine, kidneys perform several other critical functions:

1.  Waste Excretion 

     Kidneys remove metabolic waste products from protein breakdown, such as urea, creatinine, uric acid, and other nitrogenous compounds. They also filter over 200 units of water, electrolytes, and excess chemicals from the blood daily.

2.  Blood Pressure Control 

     Kidneys regulate blood pressure by producing the enzyme renin, which helps maintain stable blood pressure levels in the bloodstream.

3.  Water and Salt Balance

     The kidneys maintain the body's water and salt balance, including the regulation of blood pH. Impaired kidney function can lead to acidosis, disrupting normal organ function.

4.  Red Blood Cell Production Control

     Kidneys control red blood cell production by secreting the hormone erythropoietin. This hormone ensures adequate blood supply to various body parts and reduces the risk of anemia.

5.  Vitamin D Activation

     Kidneys activate Vitamin D. Sufficient activated Vitamin D allows the body to efficiently absorb calcium and phosphorus, contributing to strong bones.

Chronic vs. Acute Kidney Failure

     The distinction between acute and chronic kidney failure lies in their onset and reversibility. Acute kidney failure develops rapidly—within hours, days, or weeks—but is often reversible with timely treatment. Therefore, patients experiencing symptoms should seek immediate care from a nephrologist.

     Conversely, chronic kidney failure progresses gradually as kidney function continuously declines. Nephrologists note that patients often do not notice symptoms until dysfunction becomes pronounced or kidney function drops below 50%. Chronic kidney failure is irreversible and can lead to end-stage renal disease.

Treatment

     The Treatment may involve renal replacement therapies like dialysis (hemodialysis or peritoneal dialysis) for symptom management, or kidney transplantation, which can offer a better quality of life than other treatments.

Stages of Chronic Kidney Disease

Nephrologists classify chronic kidney disease into five stages based on the Glomerular Filtration Rate (GFR), which measures the volume of blood filtered by the kidneys per minute (mL/min/1.73 m²):

• Stage 1: GFR ≥ 90. Kidney function is nearly normal, but there are signs of kidney damage (e.g., protein in urine).
• Stage 2: GFR 60-89. Mild to moderate decrease in GFR with signs of kidney damage.
• Stage 3: GFR 30-59. Moderate to severe decrease in GFR.
• Stage 4: GFR 15-29. Severe decrease in GFR.
• Stage 5: GFR < 15. End-stage renal disease (kidney failure).

Self-Care to Prevent Kidney Disease

Maintaining efficient kidney function helps reduce and delay age-related decline. Nephrologists recommend the following guidelines:

• Regular Exercise: At least 30 minutes daily, or a total of 150 minutes per week.
• Adequate Hydration: Drink at least 6-8 glasses (approx. 1.5-2 liters) of plain water daily.
• Healthy Diet: Consume nutritious, cooked, clean, and unprocessed foods.
• Reduce Salt Intake: Limit salty foods and avoid potentially contaminated food.
• Medication Adherence: Take medications at appropriate dosages under the supervision of a nephrologist.
• Avoid Certain Medications: Steer clear of some pain relievers and certain herbs.
• Quit Smoking: Avoid smoking or proximity to smokers.
• Sufficient Rest: Aim for at least 6-8 hours of sleep per day.
• Manage Chronic Conditions: Effectively control underlying diseases such as diabetes, hypertension, gout, and kidney stones.
• Annual Health Check-ups.