There are several conditions and diseases that can lead to chronic kidney disease (CKD). Hypertension and diabetes are just two of the most common causes. When we talk about hypertension, we are talking about blood pressure. Blood pressure is determined by the force of blood being pumped from the heart, and force of blood against the walls of the arteries. When uncontrolled, blood pressure can be life threatening. Blood pressure that is high can make the heart work too hard, harden the walls of arteries, and can lead to a stroke or brain hemorrhage. It can also cause the kidneys to function poorly or not at all. A blood pressure reading of 140/90 mmHg or higher is considered high. Normal blood pressure is less than 120/80 mmHg.

More than 65 million American adults have high blood pressure according to the National Institute of Health (NIH). The disease is more common among African Americans, and can lead to worse complications. Therefore, African Americans are at greater risk, not only to develop the disease, but also to suffer its consequences. African Americans are more likely to develop the type of hypertension that can be controlled by salt restriction. It is especially important for African Americans to undergo screening tests for hypertension and seek treatment early.

Over time, uncontrolled high blood pressure can damage the blood vessels and nephrons (functional units of the kidneys) in the kidneys. This causes the nephrons to stop doing their job of filtering out wastes, sodium and excess fluids from the blood. With no place to go, the extra fluids and sodium linger in the bloodstream, putting extra pressure on the walls of the blood vessels, and raising the blood pressure. This extra pressure damages the kidneys even further.

On Your Next Visit to the Doctor…
Remember to Ask:

1. What is my blood pressure reading number? (a blood pressure reading of 140/90 mmHg or higher is considered high)

2. What should be my blood pressure goal?

3. What is a healthy weight for me?

4. Is it safe for me to start doing regular physical activity?

5. Would you recommend I start taking blood pressure medication and if so, what is the name of it?

6. Should I change my diet in any way?

Diabetes:
Diabetes is another condition that can lead to CKD. The American Diabetes Association describes diabetes as a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Diabetes often goes undiagnosed because many of its symptoms seem harmless.

Frequent urination
Excessive thirst
Extreme hunger
Unusual weight loss
Increased fatigue
Irritability
Blurry vision

If detected early, treatment can decrease the chance of developing the many complications of diabetes. Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood glucose (also called blood sugar) control and blood pressure. It’s important to your health to control your blood glucose. According to the Center for Disease Control (CDC), keeping your glucose level close to normal helps prevent or delay some diabetes problems, such as eye disease, kidney disease and nerve damage. One thing that can help you control your glucose level is to keep track of it. You can do this by:

•    Testing your own glucose a number of times each day (self-monitoring blood glucose). Many people with diabetes test their glucose 2 to 4 times a day.

•   Getting an A1C test from your healthcare provider about every 3 months if you take insulin and at least every 6 months if you don’t take insulin.

It is very important that diabetic patients keep tight control of their blood pressure. Blood pressure has a dramatic effect on the rate at which kidney disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Four ways to lower your blood pressure are:

1. losing weight,

2. eating less salt,

3. avoiding alcohol and tobacco,

4. and getting regular exercise.

One of the first signs of renal failure is when your kidneys leak small amounts of protein called albumin into the urine. This is called microalbuminuria. If the condition worsens, overt proteinuria can develop. It is vital to see a doctor regularly. The doctor can check blood pressure, urine (for protein), blood (for waste products), and organs for other complications of diabetes.

Again, diabetes and hypertension are just two conditions that can lead to CKD. There are many other conditions that can lead to renal failure.

Other Common Causes of Kidney Disease
Glomerulonephritis is a type of kidney disease caused by inflammation of the internal kidney structures. Glomerulonephritis can be a temporary and reversible condition, or it may get worse. There’s no specific cause for glomerulonephritis. It can lead to chronic renal failure. Kidney structure damage can cause blood and protein to be lost in the urine. The symptoms usually develop gradually. Your doctor may discover it in a urinalysis during a routine physical examination. Glomerulonephritis can cause high blood pressure and may only be discovered as a cause of high blood pressure that is difficult to control. Medline Plus tells us that in about a quarter of people with chronic glomerulonephritis there is no prior history of kidney disease and the disorder first appears as chronic renal failure.

Polycystic kidney disease (PKD) is a common inherited cause of kidney failure. It may be inherited from either your mother or your father. Many parents do not even know they carry the disease. PKD occurs when multiple cysts form on each kidney. As these cysts enlarge, they block normal kidney function. If the disease is severe, the kidney can stop working altogether. Dialysis and transplantation are the only treatment options.

Chronic pyelonephritis results when the kidneys become increasingly damaged due to repeated urinary infections. One in four of the people who are diagnosed as having chronic kidney failure have chronic pyelonephritis. Acute pyelonephritis is most common in adult females but can affect people of either sex and at any age. Its onset is usually sudden, with symptoms that often are mistaken as the results of straining the lower back. Pyelonephritis can be complicated by systemic infection. Left untreated or unresolved, it can progress to a chronic condition that can lead to scarring and possible loss of kidney function.

Jerome A. Bailey is the Communications Coordinator for AAKP.

Information for this report was gathered from the following sources:

1. HealthAtoZ www.healthatoz.com
2. JNC 7 Express: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.
3. National Institute of Health: National Heart, Lung and Blood Institute 
4. National Institute of Health: National Diabetes Clearinghouse
5. www.diabetes.niddk.nih.gov, 1–800–860–8747
6. Medicine Plus

This article originally appeared in the 2006 Special Edition of Kidney Beginnings: The Magazine.