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Chronic kidney disease is a gradual and ongoing loss of function of the kidneys due to kidney damage.

The structure of a healthy kidney is very complex. It comprises of small individual filtration units called nephrons. Each nephron has a glomerulus attached to a tubule – these structures provide the filtration within the kidney. The kidney is responsible for filtering blood, removing waste products and excess fluids. Ultimate waste products and excess fluids are excreted from the body as urine. Kidney disease is caused by damage to structures within the kidney, resulting in a decreased filtration ability. Since the kidneys aren’t functioning correctly, waste products and excess fluid build up within the body, and cause harm.

There are five stages of chronic kidney disease categorized by the glomerular filtration rate – the best overall measure of the kidney function. These range from stage one – light damage with normal filtration – through to stage five – kidney failure.

In early stages of kidney disease, the kidneys can compensate for some damage by making other areas work harder. Recognizable signs of kidney disease may not appear until much later when the kidneys are struggling after significant damage has occurred over a long time.


There are many causes of kidney disease – all involve damage to the kidneys in different ways. High blood pressure as well as type 1 and 2 diabetes are the major causes of kidney disease. They are responsible for up to two-thirds of all cases. Polycystic kidney disease, where cysts form in the kidneys and fill with fluid, is the most common inherited cause.

Other causes include:

  • Frequent kidney or urinary tract infections causing scar tissue build up
  • Glomerulonephritis, inflammation of glomeruli
  • Some diseases of the immune system
  • Damage caused by blockages such as kidney stones or tumors

Since chronic kidney disease treatment usually focuses on the underlying problem, it is important to identify the specific cause of each case kidney disease.


Chronic kidney disease symptoms include:

  • Swollen ankles, feet and legs
  • Tiredness or fatigue
  • Overnight muscle cramps
  • Puffiness around eyes – particularly in the morning
  • Shortness of breath
  • Excessive urination – particularly at night
  • Trouble sleeping
  • Itchy, dry skin
  • High blood pressure

Due to the kidney’s impressive abilities to compensate for declining function, early stage kidney disease can be symptomless. Sometimes the signs of kidney disease do not appear until the disease has already progressed. Unfortunately this can mean that significant damage has already occurred. For this reason, people in high risk groups will often undergo routine and regular screening.


Kidney disease diagnosis usually comprises several combined elements.

Urine tests may provide indications of the presence of kidney disease and can sometimes help to identify the cause. This can involve a ‘dip stick’ test to look for the presence of certain substances. It can also involve analysis under a microscope to look for blood cells or solid crystals.

Blood test analysis, looking for the presence of waste products like urea and creatinine, are an important part of the diagnosis. Blood results alongside other patient information can be used to determine the glomerular filtration rate – the best measure of kidney function. This measure will indicate what stage the kidney disease is at.

Imaging, such as CT or ultrasound, may also be undertaken to check the size and structure of the kidneys and to identify any blockages. A kidney biopsy may be required in certain cases to give more information as to the cause.


Treatment for chronic kidney disease focuses on targeting the cause and alleviating the symptoms. For this reason, treatment for all stages of kidney disease will be highly individualized in a German hospital.

To target causes, interventions include:

  • Controlling blood sugar levels of patients with diabetes
  • Antihypertensive drugs for those with hypertension
  • Lifestyle interventions – healthy eating, stopping smoking and taking regular exercise

To treat symptoms and reduce complications, interventions include:

  • Iron supplementation
  • Diuretics – to help control water retention
  • Cholesterol lowering drugs
  • Interventions to lower phosphate levels
  • Vitamin D supplements

In the most severe cases, dialysis – where medical devices remove excess fluid and waste products – or a kidney transplantation may be recommended.

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