About Your Diagnosis

Your doctor is treating you for chronic renal failure (CRF). This means there is an abnormality in your kidney function. The kidneys are important in many ways: they regulate the amount of water and byproducts of the body’s metabolism; they excrete certain waste products, whose accumulation would be detrimental; they maintain your body water, blood salt, and calcium levels; and they help the bone marrow to make blood. Chronic kidney failure may be caused by a variety of diseases: long-standing diabetes; hypertension; certain drugs you may have taken; and chronic inflammation of the kidneys. It is a very common problem. Many Americans live with this diagnosis, the only inconvenience being regular trips to the doctor, close attention to your blood pressure control, and being careful of the foods you eat. Rarely, you may have an inheritable form of kidney disease passed on from parent to child (polycystic kidney disease); your doctor will be able to tell you whether your disease fits this type. Often kidney disease is diagnosed incidentally, or by a routine urine or blood test. Some patients are seen by their physician because their blood pressure is very high, needing urgent treatment. Kidney
physicians and other researchers are working to find means to cure CRF. At this time the best treatment is to take care of the kidney function you have
left, by avoiding certain medicines, treating your blood pressure, and avoiding certain foods.

Living With Your Diagnosis
Although often without symptoms, as kidney failure progresses it can lead to fatigue, lack of energy, anemia, shortness of breath, and nausea. Keeping regular appointments with your doctor for blood tests and treatment changes are vital to avoid these distressing problems. You may feel tired and depressed with kidney disease. Occasionally, patients are seen at the hospital because of complications arising from noncompliance: getting too much water, potassium, or phosphorus into the body that cannot be eliminated.

Treatment
Your doctor will advise you of the optimum treatment to help treat your failing kidneys. He will use blood and urine tests to follow your progress. Generally, patients with CRF do well to avoid foods containing potassium, phosphorus, or too much salt or protein. Your dietitian can help you plan your diet. It’s very important to keep your blood pressure under good control; your physician will help choose a therapy that suits you. You might also need iron pills or calcium pills to boost your body stores; CRF plays a role in depleting our body stores of nutrients. Sometimes your physician might want to refer you to a kidney specialist for further advice. The treatments for CRF are the same as for those of the underlying cause. Often, patients need diuretics (“water pills”) to keep from gaining excess fluid, in addition to caring for the stores of iron, calcium, and vitamins in the body. We know that patients who don’t take care of themselves do worse than those who do; some patients need to receive dialysis treatments if the conservative measures fail. Dialysis is essentially a treatment where the patient is placed on an artificial kidney two or three times per week (Fig 1). There are other excellent alternatives available. Your physician can describe these in detail.

The DOs
• Do keep taking your blood pressure medicines. If you find a medication disagrees with you, consult your doctor for an alternative.
• Do keep to your diet. Your dietitian will show you how to restrict items like bananas, fruits, dairy products, or excess meat protein.
• Do exercise as much as you can within your tolerance.
• If your doctor has advised restricting fluid intake, be careful to follow that advice. He may be prescribing calcium supplements to boost your stores and reduce the amount of phosphorus in your blood. These are important too.
• Do give up smoking, and prolong your life. Patients with kidney failure are more prone to abnormal cholesterol, hypertension, angina, and heart attacks.

The DON’Ts
• Don’t forget to ask questions about drug side effects.
• Don’t eat foods you should avoid; a potassium buildup in the blood can make you very ill.
• Don’t take over-the-counter drugs without checking first that they are safe.
• Don’t overdo exercise to exhaustion. Call if you are feeling unwell, nauseous, chest pains, or shortness of breath.
• Don’t drink too much water or liquids if you have been placed on a restriction, because you may gain too much fluid in the tissues, leading to worsening edema and hypertension.

When to Call Your Doctor
You should call your doctor if you develop shortness of breath, nausea, vomiting, or chest pains. Chronic kidney failure is an often silent disease; you should be sure and keep appointments so your blood tests can be done.