The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood. Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or year. It slowly gets worse over time. In the early stages, there may be no symptoms. The loss of function usually takes months or years to occur. It may be so slow that symptoms do not occur until kidney function is less than one-tenth of normal. The final stage of chronic kidney disease is called end-stage renal disease (ESRD). The kidneys no longer function and the patient needs dialysis or a kidney transplant.

Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually months to years. The term "renal" refers to the kidney; so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency. Chronic loss of function causes generalized wasting (shrinking in size) and progressive scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that most patients begin to experience symptoms of kidney failure. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CRF, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine.

Table 1. Stages of Chronic Kidney Disease

Stage	Description	GFR* mL/min/1.73m2
1	Slight kidney damage with normal or increased filtration	More than 90
2	Mild decrease in kidney function	60-89
3	Moderate decrease in kidney function	30-59
4	Severe decrease in kidney function	15-29
5	Kidney failure	Less than 15 (or dialysis)

*GFR is glomerular filtration rate, a measure of the kidney's function

The cause for CRF sometimes can be determined by a detailed medical history, a comprehensive physical examination, and laboratory studies. More often than not, determining the cause of CRF is difficult if not impossible

• The most common causes of CKD are diabetic nephropathy, hypertension, and glomerulonephritis. Together, these cause approximately 75% of all adult cases.
• Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidney
• Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage
• Less common causes of chronic renal failure include:
  • Polycystic kidney disease,
  • reflux nephropathy,
  • kidney stones, and
  • Prostate disease.
• On rare cases, pin worms infecting the kidney can also cause idiopathic nephropathy

Who Is At a Risk For CRF
If you have any of the following conditions, you are at higher-than-normal risk of developing chronic kidney disease. Your kidney functions may need to be monitored regularly.

• Diabetes mellitus type 1 or 2
• High blood pressure
• High cholesterol
• Heart disease
• Liver disease
• Amyloidosis
• Sickle cell disease
• Systemic Lupus erythematosus
• Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia
• Vesicoureteral reflux (a urinary tract problem in which urine travels the wrong way back toward the kidney)
• Require regular use of anti-inflammatory medications
• A family history of kidney disease

CKD is initially without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney function decreases. Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.

Effects and symptoms of chronic kidney disease include;

• Need to urinate frequently, especially at night (nocturnal);
• Swelling of the legs and puffiness around the eyes (fluid retention);
• High blood pressure;
• fatigue and weakness (from anemia or accumulation of waste products in the body);
• loss of appetite, nausea and vomiting;
• Itching, easy bruising, and pale skin (from anemia);
• Shortness of breath from fluid accumulation in the lungs;
• Headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome;
• Bleeding (due to poor blood clotting);
• Inability to excrete potassium and rising potassium levels in the serum (hyperkalemia) is associated with fatal heart rhythm disturbances (arrhythmias) including ventricular tachycardia and ventricular fibrillation.
• Generalized weakness may be due to anemia, a decreased red blood cell count, because lower levels of erythropoietin produced by failing kidneys do not adequately stimulate the bone marrow.
• bone pain and fractures; and

• As waste products build in the blood, loss of appetite, lethargy, and fatigue become apparent. This will progress to the point where mental function will decrease and coma may occur.
• Chest pain due to pericarditis (inflammation around the heart); Because the kidneys cannot address the rising acid load in the body, breathing becomes more rapid as the lungs try to buffer the acidity by blowing off carbon dioxide. Blood pressure may rise because of the excess fluid, and this fluid can be deposited in the lungs, causing congestive heart failure.
• Decreased sexual interest and erectile dysfunction

Diagnosis of kidney failure is confirmed by blood tests measuring the buildup of waste products in the blood. BUN, creatinine, and GFR are routine blood tests used to measure the buildup of waste products in the blood. BUN and creatinine become elevated, and the glomerular filtration rate (GFR) decreases. This is the rate with which blood is filtered through the kidneys and can be calculated based upon the creatinine level, age, race, and gender. Abdominal ultrasound is commonly performed, in which the size of the kidneys are measured. Kidneys with CKD are usually smaller (< 9 cm) than normal kidneys with notable exceptions such as in diabetic nephropathy and polycystic kidney disease.

Diet is an important consideration for those with impaired kidney function. Consultation with a dietician may be helpful to understand what foods may or may not be appropriate. Since the kidneys cannot easily remove excess water, salt, or potassium, these may need to be consumed in limited quantities. Foods high in potassium include bananas, apricots, and salt substitutes.
Phosphorus is a forgotten chemical that is associated with calcium metabolism and may be elevated in the body in kidney failure. Too much phosphorus can leech calcium from the bones and cause osteoporosis and fractures. Foods with high phosphorus content include milk, cheese, nuts, and cola drinks.

Kidney Failure at a Glance

• Kidneys are the organs that help filter waste products from the blood. They are also involved in regulating blood pressure, electrolyte balance, and red blood cell production in the body.
• There are numerous causes of kidney failure, and treatment of the underlying disease may be the first step in correcting the kidney abnormality.
• Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible.
• Symptoms of kidney failure are due to the build-up of waste products in the body that may cause weakness, shortness of breath, lethargy, and confusion. Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. Initially, there may be no symptoms of kidney failure.
• The diagnosis of kidney failure usually is made by blood tests measuring BUN, creatinine, and glomerular filtration rate (GFR).
• Treatment of the underlying cause of kidney failure may return kidney function to normal. Lifelong efforts to control blood pressure and diabetes may be the best way to prevent chronic kidney disease and its progression to kidney failure. Usually, kidney function gradually decreases over time.
• Homoeopathy offers comprehensive treatment. Homoeopathic drugs act by bringing kidney function back to normal.