概述

What is kidney disease? An expert explains

Learn more from kidney doctor Andrew Bentall, M.D.

I'm Dr. Andrew Bentall, a kidney doctor at Mayo Clinic. I look after patients with kidney disease, either in the early stages, or with more advanced kidney disease considering dialysis and transplantation as treatment options. In this video, we'll cover the basics of chronic kidney disease. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you are looking for answers for yourself or for someone you love, we're here to give you the best information available.

Chronic kidney disease is a disease characterized by progressive damage and loss of function in the kidneys. It's estimated that chronic kidney disease affects about one in seven American adults. And most of those don't know they have it. Before we get into the disease itself, let's talk a little bit about the kidneys and what they do. Our kidneys play many important roles keeping our bodies in balance. They remove waste and toxins, excess water from the bloodstream, which is carried out of the body in urine. They helped to make hormones to produce red blood cells, and they turn vitamin D into its active form, so it's usable in the body.

There are quite a few things that can cause or put you at higher risk for chronic kidney disease. Some of them are not things that can be avoided. Your risk is simply higher if you have a family history of certain genetic conditions like polycystic kidney disease or some autoimmune diseases like lupus or IgA nephropathy. Defects in the kidney structure can also cause your kidneys to fail, and you have an increased risk as you get older. Sometimes, other common medical conditions can increase your risk. Diabetes is the most common cause of kidney disease. Both type 1 and type 2 diabetes. But also heart disease and obesity can contribute to the damage that causes kidneys to fail. Urinary tract issues and inflammation in different parts of the kidney can also lead to long-term functional decline. There are things that are more under our control: Heavy or long-term use of certain medications, even those that are common over-the-counter. Smoking can also be a contributing factor to chronic kidney disease.

Often there are no outward signs in the earlier stages of chronic kidney disease, which is grouped into stages 1 through 5. Generally, earlier stages are known as 1 to 3. And as kidney disease progresses, you may notice the following symptoms. Nausea and vomiting, muscle cramps, loss of appetite, swelling via feet and ankles, dry, itchy skin, shortness of breath, trouble sleeping, urinating either too much or too little. However, these are usually in the later stages, but they can also happen in other disorders. So don't automatically interpret this as having kidney disease. But if you're experiencing anything that concerns you, you should make an appointment with your doctor.

Even before any symptoms appear, routine blood work can indicate that you might be in the early stages of chronic kidney disease. And the earlier it's detected, the easier it is to treat. This is why regular checkups with your doctor are important. If your doctor suspects the onset of chronic kidney disease, they may schedule a variety of other tests. They may also refer you to a kidney specialist, a nephrologist like myself. Urine tests can reveal abnormalities and give clues to the underlying cause of the chronic kidney disease. And this can also help to determine the underlying issues. Various imaging tests like ultrasounds or CT scans can be done to help your doctor assess the size, the structure, as well as evaluate the visible damage, inflammation or stones of your kidneys. And in some cases, a kidney biopsy may be necessary. And a small amount of tissue is taken with a needle and sent to the pathologist for further analysis.

Treatment is determined by what is causing your kidneys to not function normally. Treating the cause is key, leading to reduced complications and slowing progression of kidney disease. For example, getting better blood pressure control, improved sugar control and diabetes, and reducing weight are often key interventions. However, existing damage is not usually reversible. In some conditions, treatment can reverse the cause of the disease. So seeking medical review is really important. Individual complications vary, but treatment might include high blood pressure medication, diuretics to reduce fluid and swelling, supplements to relieve anemia, statins to lower cholesterol, or medications to protect your bones and prevent blood vessel calcification. A lower-protein diet may also be recommended. It reduces the amount of waste your kidneys need to filter from your blood. These can not only slow the damage of kidney disease, but make you feel better as well. When the damage has progressed to the point that 85 to 90 percent of your kidney function is gone, and they no longer work well enough to keep you alive, it's called end-stage kidney failure. But there are still options. There's dialysis, which uses a machine to filter the toxins and remove water from your body as your kidneys are no longer able to do this. Where possible, the preferred therapy is a kidney transplant. While an organ transplant can sound daunting, it's actually often the better alternative, and the closest thing to a cure, if you qualify for a kidney transplant.

If you have kidney disease, there are lifestyle choices. Namely quit smoking. Consuming alcohol in moderation. If you're overweight or obese, then try to lose weight. Staying active and getting exercise can help not only with your weight, but fatigue and stress. If your condition allows, keep up with your routine, whether that's working, hobbies, social activities, or other things you enjoy. It can be helpful to talk to someone you trust, a friend or relative who's good at listening. Or your doctor could also refer you to a therapist or social worker. It can also be helpful to find a support group and connect with people going through the same thing. Learning you have chronic kidney disease and learning how to live with it can be a challenge. But there are lots of ways to help you to be more comfortable for longer before more drastic measures are needed. And even then, there is plenty of hope. If you'd like to learn even more about chronic kidney disease, watch our other related videos or visit mayoclinic.org. We wish you well.

慢性肾病(也称作慢性肾功能衰竭)是指肾脏功能逐渐丧失。肾脏可以从血液中过滤废物和多余液体,然后经尿液排出。当慢性肾病发展至晚期时,体内的液体、电解质和废物可能积聚到危险水平。

慢性肾病早期阶段几乎没有任何体征或症状。在肾脏功能显著受损前,慢性肾病的临床表现可能都不明显。

慢性肾病的治疗重点在于减缓肾脏损伤的进展,通常可通过控制基础病因实现。慢性肾病可能发展至晚期肾功能衰竭,如果没有进行人工过滤(透析)或肾移植,可能危及生命。

肾脏工作原理

症状

如果肾脏损伤进展缓慢,慢性肾病的体征和症状会随着时间推移而发展。肾脏疾病的体征和症状可能包括:

  • 恶心
  • 呕吐
  • 食欲不振
  • 疲劳和虚弱
  • 睡眠问题
  • 排尿量变化
  • 精神敏锐度下降
  • 肌肉抽搐和痉挛
  • 脚和脚踝肿胀
  • 持续瘙痒
  • 如果心内膜周围积液,则会出现胸部疼痛
  • 如果肺部积液,则会出现气短
  • 难以控制的高血压

肾脏疾病的体征和症状通常是非特异性的,这意味着它们也可能由其他疾病引起。由于肾脏适应能力很强,能够补偿失去的功能,因此在发生不可逆的损伤之前,可能不会出现体征和症状。

何时就诊

如果您有任何肾脏疾病的体征或症状,请与医生约诊。

如果您的医疗状况会增加患肾脏疾病的风险,您的医生很可能会在您定期就诊时通过尿液和血液检测来监测您的血压和肾功能。请询问您的医生,这些检测对您是否有必要。

When to see a doctor

Make an appointment with your doctor if you have signs or symptoms of kidney disease. Early detection might help prevent kidney disease from progressing to kidney failure.

If you have a medical condition that increases your risk of kidney disease, your doctor may monitor your blood pressure and kidney function with urine and blood tests during office visits. Ask your doctor whether these tests are necessary for you.

病因

当一种疾病或状况损害肾功能,导致肾脏损害在数月或数年内加重时,就会发生慢性肾病。

引起慢性肾病的疾病和状况包括:

  • 1 型或 2 型糖尿病
  • 高血压
  • 肾小球肾炎,即肾脏过滤单元(肾小球)的炎症
  • 间质性肾炎,即肾小管和周围结构的炎症
  • 多囊性肾病
  • 前列腺肿大、肾结石和某些癌症等状况导致的尿路长期梗阻
  • 膀胱输尿管反流,即导致尿液回流到肾脏的状况
  • 反复肾感染,又称为肾盂肾炎

风险因素

增加慢性肾病风险的因素包括:

  • 糖尿病
  • 高血压
  • 心脏和血管(心血管)疾病
  • 吸烟
  • 肥胖症
  • 是非裔美国人、美洲原住民和亚裔美国人
  • 有肾脏疾病家族史
  • 肾脏结构异常
  • 年龄较大

并发症

慢性肾病可能几乎影响您身体的每个部位。潜在的并发症可包括:

  • 体液潴留,这可能导致您手臂和腿出现肿胀、高血压或肺部积液(肺水肿)
  • 血液中钾水平突然升高(高血钾症),这可能损害您的心脏功能并可能危及生命
  • 心脏和血管(心血管)疾病
  • 骨脆弱,骨折风险增加
  • 贫血
  • 性欲减退、勃起功能障碍或生育能力下降
  • 中枢神经系统受损,可能导致注意力不集中、性格改变或癫痫发作
  • 免疫应答降低可使您更易感染
  • 心包炎,即包裹心脏的囊状膜(心包)发炎
  • 给母亲和发育中胎儿带来风险的妊娠并发症
  • 对肾脏造成不可逆的损伤(终末期肾病),最终需要透析或肾脏移植才能存活

预防

为降低患肾病的风险,请做到:

  • 遵守非处方药用药说明。在使用阿司匹林、布洛芬(雅维、美林 IB 等)和对乙酰氨基酚(泰诺等)等非处方止疼药时,应遵守药品包装上的说明。服用过多止疼药可能会导致肾脏损伤,如患有肾病,通常应避免服用这类药物。咨询医生这些药物对您是否安全。
  • 保持健康体重。如果您的体重正常,请多运动来维持体重。如果需要减重,请咨询医生健康减重策略。通常减肥需要每天进行身体活动,减少热量摄取。
  • 请勿吸烟。吸烟会损害肾脏,并加重现有的肾脏损伤。如果您吸烟,请咨询医生戒烟策略。支持团体、咨询服务和药物都可以帮您戒烟。
  • 在医生帮助下管理您的疾病。如果患有一些会增加肾病风险的疾病,请与医生一起对其进行控制。咨询医生需要做哪些筛查肾损害的检查。

在 Mayo Clinic 治疗

Sept. 03, 2021
  1. Goldman L, et al., eds. Chronic kidney disease. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. http://www.clinicalkey.com. Accessed April 27, 2021.
  2. Chronic kidney disease (CKD). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd#:~:text=Chronic kidney disease (CKD) means,family history of kidney failure. Accessed April 26, 2021.
  3. Rosenberg M. Overview of the management of chronic kidney disease in adults. https://www.uptodate.com/contents/search. Accessed April 26, 2021.
  4. Chronic kidney disease (CKD) symptoms and causes. National Kidney Foundation. https://www.kidney.org/atoz/content/about-chronic-kidney-disease. Accessed April 26, 2021.
  5. Chronic kidney disease. Merck Manual Professional Version. https://www.merckmanuals.com/professional/genitourinary-disorders/chronic-kidney-disease/chronic-kidney-disease?query=Chronic kidney disease. Accessed April 26, 2021.
  6. Ammirati AL. Chronic kidney disease. Revista da Associação Médica Brasileira. 2020; doi:10.1590/1806-9282.66.S1.3.
  7. Chronic kidney disease basics. Centers for Disease Control and Prevention. https://www.cdc.gov/kidneydisease/basics.html. Accessed April 26, 2021.
  8. Warner KJ. Allscripts EPSi. Mayo Clinic; April 21, 2021.
  9. Office of Patient Education. Chronic kidney disease treatment options. Mayo Clinic; 2020.