Photo by Karolina Grabowska
Signs and symptoms of kidney disease may not appear until irreversible damage has occurred. Because many medical conditions increase the risk of kidney disease, including diabetes, high blood pressure, obesity, and cardiovascular disease, and in the early stages of kidney disease these signs may not be apparent, medical treatment focuses on understanding and controlling the underlying cause of the condition. Even though chronic kidney disease can progress to a need for dialysis or transplant, there are preventive steps to reduce the risk of developing kidney disease. These include conferring with your doctor about controlling other medical conditions that contribute to or increase the risk of kidney damage, maintaining a healthy weight, and discontinue smoking. Psychological attitudes about this condition are also important to its management.
The following is derived from the
Handbook of Health and Behavior: Psychological Treatment Strategies for the Nursing Home Patient
Joseph M. Casciani, PhD
This is part of a series where Dr. Casciani makes you aware of and informs you about series medical conditions your patient or loved one may be facing.
A more detailed, clinical, and complete description can be found in the handbook.
Medical Condition – KIDNEY DISEASE
Kidney disease generally progresses over time and is classified according to how much functioning is lost in both kidneys. Renal failure occurs when kidney function is insufficient to meet the body’s demands, and can be chronic or acute, permanent, or temporary.
Damage to one or both of the kidneys can eventually progress to renal disease, including end stage renal disease. Renal failure reduces the body’s ability to remove water and wastes adequately, and to filter blood adequately. This produces wastes that would have otherwise been excreted by the body through urine to a condition where the wastes are circulated through the body. A condition is considered renal impairment when 50% of the function in both kidneys is lost. When the condition progresses to a loss of 20 to 40% of kidney function, the term renal insufficiency is used. End stage renal disease (ESRD) is present when less than 15% of normal function remains. At this stage, dialysis is the recommended treatment.
Acute renal failure can occur when blood flow to the kidneys is inadequate, possibly due to sudden shock , a blood clot, medications, or transfusions from an incompatible blood group. Acute renal failure can be treated and sometimes result in no permanent damage to the kidneys. Treatment may include dialysis to take over the kidney function until the cause can be identified and treated. Dialysis can also be used temporarily to remove toxic drugs from the body, such as after an overdose.
Chronic renal failure can result from an untreated acute condition, from the disease of the kidney itself, from systemic disease such as hypertension, diabetes, or arteriosclerosis. Early stage treatments of kidney disease include fluid restriction, and carefully monitoring body weight and food intake. Late stage treatment includes either dialysis or transplantation. Individuals with
ESRD must remain on dialysis the rest of their lives or receive a transplanted kidney. With sufficient degree of damage or trauma to a kidney, it can be surgically removed (nephrectomy). Individuals may live normal lives with one kidney but must constantly monitor for infection or injury to the remaining kidney.
What are the Medical Consequences?
Individuals with ESRD must follow a strict diet because the body is no longer able to excrete waste products. Dietary restrictions include protein, potassium, and sodium. Because water is no longer excreted through urine, swelling and weight gain results. In addition, there is added strain on the heart muscle and an elevated blood pressure, requiring antihypertensive medications. Fluid intake is also severely restricted. ESRD is also accompanied by anemia and iron deficiency due to the limited food intake, to reduced physical activity, and to the disease itself, resulting in a generalized weakness, muscle changes, and low exercise tolerance. ESRD also causes peripheral neuropathy, including numbness, tingling, and sometimes paralysis in the extremities, and can also lead to osteoporosis following over-activity of the parathyroid glands. In later stages, intellectual changes can occur with ESRD, including difficulty with concentration and attention.
What are Contributing Factors?
Kidney disease can result from a variety of systemic conditions, infection, stones (calculi), cysts or tumors, or a congenital abnormality. Diabetes is the leading cause of end stage renal disease. Kidney damage may also result from hypertension.
What Negative Attitudes can Develop?
Emotional reactions to the diagnosis can be devastating for the patient, who will experience a range of symptoms ranging from depression and resignation to total denial. Suicidal thinking may be covert, usually in the form of non-compliance with the medical treatment plan. The cognitive distortions that may manifest themselves include attributions of self-blame, the permanent, disabling nature of the kidney disorder, and the expected negative impact that the disorder will have on the patient’s family and support system. Other distortions include embarrassment that accompanies the changes in functioning.
For Professionals – Themes And Strategies in Behavioral Treatment can be found in the Handbook.
