Patients may be given multiple medicines aimed at delaying progression and preventing complications of the kidney disease.
To delay progression of kidney disease
- Control the causes of the disease, such as hypertension and diabetes mellitus. Patients with these diseases are known to be at risk of kidney problems. Blood pressure and fasting blood sugar should be less than 130/85 mmHg and 130 mg/dl.
- Restrict dietary protein
- Understand the use of medications to reduce protein in urine and control blood pressure
To prevent and treat complications
The main kidney functions are to control electrolytes and water balance in body, producing erythropoietin, a hormone that helps building up red blood cells and regulate calcium and phosphorus. These play a key role in maintenance of bone mass. Decline in kidney functions may lead to various complications.
- Cardiovascular disease: Blood pressure rises as the result of fluid overload and excessive production of vasoactive hormones, increasing one's risk of developing hypertension and/or suffering from congestive heart failure. Medicines for blood pressure control may be prescribed such as antihypertensive drugs, antilipidemic drugs, and antithrombotic drugs. Patients may be given more than one type of blood pressure medication to ensure optimal blood pressure control.
- High blood potassium: Potassium can accumulate in the body when kidney function is not adequate to remove excessive amounts. Patients may show a wide range of symptoms including malaise and irregular heartbeat. Patients should avoid eating foods with high potassium, such as papaya, banana, lemon, plum, dried fruit, grapes, etc. Also, patients may be prescribed medicine which acts as a potassium binder and removes excessive potassium through the feces. A common side effect of these medicines is constipation.
- Fluid volume overload: This condition happens when kidneys cannot excrete excessive water. Symptoms may range from mild edema and shortness of breath to life-threatening pulmonary edema. Water pills, such as a diuretic, may be prescribed in addition to daily restriction of salt and fluid intake.
- Anemia: Erythropoietin stimulates the red blood cell formation. This hormone level drops due to the decline of kidney function and cause anemia. A doctor may prescribe an erythropoietin to be injected via subcutaneous route and an iron supplement to make sure that a patient’s body can generate red blood cells. Patients may receive iron pills if the amount of iron is very low.
- High blood phosphate: Due to reduced phosphate excretion, this condition is associated with the phosphate deposition in blood vessel walls and lead to vascular obstruction later on. If this accumulation occurs at the main heart vessel, it can cause atherosclerotic heart disease and may impair heart function. Patients should limit their consumption of high-phosphate diets including meat, eggs, dried beans, dairy products, soft drinks, etc., and take a phosphate binder such as calcium carbonate, calcium acetate, or aluminium hydroxide.
- High parathyroid hormone leading to impaired bone metabolism: High blood phosphate and low blood calcium levels can trigger parathyroid hormone secretion. This condition leads to the deterioration of bone density and bone abnormalities. To reduce parathyroid hormone, patients may be prescribed calcitriol, cinacalcet.
- Blood acidosis: The acidified blood may occur because the kidney cannot excrete organic acid products adequate resulting in bone loss or reduced muscle mass. The patient may be prescribed the medicines for this condition.