Part 1: Are you at increased risk of chronic Kidney disease?

How do you know?

Your doctor or clinic should check to see if you have any risk factors for chronic kidney disease. These include:

• diabetes
• high blood pressure
• a family history of chronic kidney disease
• older age.

Chronic kidney disease is also more common in African Americans, Hispanic Americans, Asians, Pacific Islanders, and American Indians.

Why are African Americans and other ethnic groups at increased risk for chronic kidney disease?

Diabetes, the leading cause of chronic kidney disease, is more common in these groups. Also, high blood pressure, which is the second leading cause of chronic kidney disease. When combined with other things, such as being overweight, this tendency may lead to disease. Staying at a normal weight and getting enough exercise is very important for these groups to help prevent diabetes and high blood pressure.

What should you do?

You should visit your doctor or clinic and get tested. Your checkup should include:

• Checking your blood pressure
• Having a simple test for protein in your urine. Protein is an important building block in your body. Any filtered protein is normally reabsorbed and kept in your body. When your kidneys are damaged, however, protein leaks into your urine. There are different tests to find protein in your urine. If you have two positive tests over several weeks, you are said to have persistent protein in your urine. This is a sign of chronic kidney disease.
• Having a simple blood test for creatinine, a waste product that comes from muscle activity. Your kidneys normally remove creatinine from your blood. When your kidneys are damaged, however, your blood creatinine may build to a high level. The results of your blood creatinine test should be used to estimate your glomerular filtration rate, or GFR. Your GFR tells how much kidney function you have.

What are the symptoms?

Most people do not have any severe symptoms until their kidney disease gets worse. However, you may:

• feel more tired
• have less energy
• have trouble thinking clearly
• have a poor appetite
• have trouble sleeping
• have dry, itchy skin
• have muscle cramping at night
• have swollen feet and ankles
• have puffiness around your eyes, especially in the morning
• need to urinate more often, especially at night.

What happens if my test results show I may have chronic kidney disease?

Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your treatment. The doctor may do the following:

• Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney function you have. You do not need to have another test to know your GFR. Your doctor can calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your doctor your stage of kidney disease and helps the doctor plan your treatment. (See chart “Stages of Chronic Kidney Disease.”)
• Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your doctor whether your kidneys are too large or too small, whether you have a problem like a kidney stone or tumor and whether there are any problems in the structure of your kidneys and urinary tract.
• Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small pieces of kidney tissue and looks at them under a microscope.

Your doctor may also ask you to see a kidney specialist who will consult on your case and help manage your care.

Stages of Chronic Kidney Disease

Can CKD progression be prevented? 

Most likely. Early detection and treatment can often slow or stop chronic kidney disease. How well your treatment can achieve this goal depends on:

• Your stage of chronic kidney disease when you start treatment. The earlier you start, the better you are likely to do.
• How carefully you follow your treatment plan. Learn all you can about chronic kidney disease and its treatment, and make sure to follow all the steps of your treatment faithfully.
• The cause of your kidney disease.Some kidney diseases are more difficult to control.

Part 2: Children With Chronic Kidney Disease: Tips for Parents

If your child has been diagnosed with chronic kidney disease, you are no doubt feeling distressed and bewildered. These feelings are normal. And once you realize that your child's illness is a reality the family must accept, you can develop some practical ways to cope with the day-to-day aspects of it. Here are some things others have found helpful.

Learn about the disease and its treatments

1. Learn as much about your child's disease and its treatment as you possibly can. And pass this information on to your child. You'd be surprised at how much even very young children can understand. And many times they will accept information more easily than an adult.
2. Encourage your child to ask questions ¾ not only of you but of doctors, nurses and other health professionals. Many times, your child will ask questions you had not thought about or were afraid to ask because you thought they sounded "dumb."
3. Don't try to explain more than your child can understand, but don't lie and don't apologize for any treatments or procedures that have to be followed.
4. Help your child understand that the doctors, nurses, social workers, dietitians, laboratory personnel and everyone else is on his or her side. They all want to help your child feel better, even if that means they have to do things that will cause some temporary pain or discomfort.

Actively participate in your child's care

1. Develop a spirit of mutual respect and cooperation with health professionals.
2. Write out all the details of your child's medical history, including dates. This will make it easier for you each time you come in contact with a new doctor.
3. Try to be with your child as much as possible during treatments and any hospitalization that might be necessary. If you cannot be there, arrange for someone else to be present ¾ a grandparent, other relative, or close family friend. And make sure a favorite book, stuffed animal or special blanket is taken along.
4. If your child is not talking yet, it's a good idea to tape a note to his or her hospital bed or crib with helpful information for the staff, such as favorite foods, special toys or blankets, preferred time and method of taking medicines.

Help your child take control of the illness

1. Try to maintain a normal daily routine, even during hospitalization.
2. Help your child understand about doctor's offices, hospitals, dialysis units and laboratories and how they are used. By helping your child understand the places that are filled with strange and frightening instruments and machines, you can help eliminate a lot of your child's fear.
3. Be creative in finding ways for your child to participate in his or her own care. Your child will feel much more in control if you provide as many opportunities to do so as you can.

Help your child to understand and accept diet restrictions

1. Even a child as young as 2 or 3 can understand about "diet" if it is explained simply. Often, the child will be more compliant with dietary restrictions than an adult will.
2. Have your child make a list of favorite foods and take him or her with you when you talk to the dietitian to see if these foods can be incorporated into the diet plan.
3. Whatever you do, don't ever use bribes or force your child to eat. These tactics rarely work and more often turn mealtime into a very unpleasant experience.

Don't let medicine time ruin your day

1. A matter-of-fact attitude is your best weapon in getting your child to take medication. Even very small children will swallow anything ¾ no matter how distasteful ¾ if they know they have no choice.
2. A good trick with babies and small children is to use syringes minus the needles to dispense the medication. Not only can you measure the medicine more accurately, but you can squirt the liquid directly in the child's mouth instead of having to deal with a teaspoon (associated with food) or a medicine cup. The benefit to your child is in not having to smell the medicine as well as taste it.
3. Your child has no choice about whether or not to take prescribed medication, but you can offer a choice of when and where.
4. And once the choice is made, make a schedule and stick to it. Unpleasantness is a lot easier to cope with if you know exactly when it is coming and don't procrastinate.
5. Sometimes medication must be given with meals, but don't give it at the table where your child eats. Find someplace not associated with food and eating, such as the living or family room while your child is distracted by a favorite TV show.
6. Another weapon you have at medicine time is plain, ordinary water. If your child is on a fluid-restricted diet, water may be one of the things he or she would like to have most, so reserve part of the day's fluid intake for a couple of swallows after medicine time.

Share your experience with others

1. Don't let yourself become isolated. Talk with the renal staff and with other families of children with kidney disease.
2. Don't hesitate to ask relatives and friends for help. Chances are they want to, but don't know how, and are just waiting for you to ask. Sharing your experience will help you find ways to grow with it.