Your kidney is a host to several homeostatic functions. It regulates overall water content, keeps your electrolytes steady, and eliminates waste. That pair of bean-shaped organs even produces hormones.
Chronic kidney disease is when your kidneys develop diminished function over at least three months. It’s a long-term condition that doesn’t have a cure as of today. Even though you have to live with it, it doesn’t mean you can’t relieve the symptoms of the disease.
Check out our handy guide on chronic kidney failure medications and their physiology.
Understanding Chronic Kidney Disease
Understanding chronic kidney disease is central to understanding its treatments. Diabetes and hypertension are responsible for the vast majority of cases of CKD.
The use of NSAIDs or tobacco can also cause kidney damage over time. Infections like HIV and systemic diseases like lupus can yield the same result. These conditions culminate in glomerulosclerosis.
Glomerulosclerosis is a fancy word for the hardening and scarring of the glomerulus.
Signs of kidney failure result from the accumulation of waste products in the blood. Urea is typically excreted in the urine. With nowhere else to go, the urea builds up in the blood.
At first, this only causes discomfort and nausea. However, over time, further build-up affects the CNS and may cause a coma or even death.
Other signs of kidney failure are excessive amounts of potassium, known as hyperkalemia. This manifests as shortness of breath, chest pains, and arrhythmia. Hyperkalemia is a medical emergency.
Since CKD is a symptom, chronic kidney failure medications target the underlying condition.
Hypertension Follows the Kidneys
High blood pressure is one of the main culprits in developing CKD.
Your body is resilient and has several fail-safes to compensate for atypical states. Renal blood flow autoregulation is one of the kidney’s most vital homeostatic mechanisms. It keeps blood flow and filtration constant despite elevated blood pressure.
However, your body can only take so much. To withstand the higher pressure, the walls of the arteries supplying the kidneys thicken.
Think of a pipe thickening its walls. If the diameter of the pipe stays constant, the lumen or hole along the pipe gets smaller.
When the pipe is narrower, less fluid can pass through at a given time. In the context of the body, less blood gets delivered to kidney tissues. Injury caused by diminished blood flow and oxygen is an ischemic injury.
Ischemic injury to the glomerulus triggers a cascade of cellular processes. Glomerular tissue regresses to a primitive state, secreting immense amounts of extracellular matrix. The more matrix the cells release, the more scarring ensues.
Scarred and hardened tissue does not bode well for cells that function for filtering and letting substances pass through. This scarring, known as glomerulosclerosis, is what destroys kidney function. When your nephrons can’t filter blood, this leads to chronic kidney failure.
Medication for Hypertension and CKD
Is hypertension the cause of your kidney problems? Doctors will recommend medication to control blood pressure.
1. ACE Inhibitors
Angiotensin II is a substance that constricts blood vessels. The narrower a blood vessel is, the higher the pressure. The body synthesizes this substance with the help of the Angiotensin-converting enzyme (ACE).
ACE inhibitors intervene with the action of ACE. This prevents the production of angiotensin II, relaxes blood vessels, and lowers blood pressure. Examples of ACE inhibitors are:
Some side effects of ACE inhibitors include dizziness, fatigue, headaches, and a persistent dry cough. Read a more in-depth discussion of how ACE inhibitors alleviate renal disease here.
2. Angiotensin Receptor Blockers
Angiotensin has another special mention here. Knowing the function of angiotensin, you know how it impacts blood pressure.
Drugs like ACE inhibitors prevent its synthesis. On the other hand, Angiotensin Receptor Blockers (ARBs) stop functional angiotensin from binding. The following are examples of ARBs:
When a substance can’t bind to its receptor, it remains unusable by the body. Even though your body synthesizes the angiotensin, it can’t act on your blood vessels.
Beta-blockers are another class of blood pressure control drugs. They work by causing the heart to beat more slowly by preventing the action of adrenaline.
Adrenaline is one of the more famous hormones that trigger fight or flight.
To fulfill this function, adrenaline increases blood pressure. When it’s unable to bind to its receptors, it can’t elevate heart rate.
Some beta-blockers include:
Learn more about the action of beta-blockers on your kidneys here.
Diuretics promote urination. As your body eliminates water and salt, the fluid coursing through your veins decreases. Examples of diuretics include thiazides like:
This principle follows that decreased volume reduces pressure. This eases up on the kidneys and protects them from further damage.
Diabetes and Kidney Damage
Excess blood glucose from diabetes causes glucose molecules to adhere to proteins in the blood. The efferent arteriole in the glomerulus suffers the most from this.
The efferent arteriole of the glomerulus funnels blood out of the glomerulus. The glucose-protein moieties trigger hyaline arteriosclerosis. Hyaline arteriosclerosis involves the stiffening and narrowing of the efferent arteriole.
When the efferent arteriole has an obstruction, this prevents blood from exiting the glomerulus. This, in turn, increases pressure within the glomerulus and results in pushing more fluid through.
In this high-pressure state, supportive cells generate more material called structural matrix. This expands the glomerulus and causes glomerulosclerosis, which as aforementioned, causes CKD.
Medication for Diabetes and CKD
Optimizing blood glucose levels is central to treating diabetes-induced CKD. Oral hypoglycemics lower blood sugar levels and reduce the impact of sugar-protein moieties. However, medication becomes tricky due to nephrotoxicity.
Management of CKD in diabetics involves glycemic regulation first and foremost. This regimen involves:
- First-line treatment with Metformin
- An SGL2 inhibitor, and
- Additional drug therapy to maintain glycemic levels
Some oral hypoglycemics like glyburide are hard on the kidneys, so glipizide is the drug of choice. This article doesn’t substitute a physician’s consult for kidney treatment. Check out The Kidney Institute Houston Texas.
Chronic Kidney Failure Medications Made Simple
Your kidneys perform a slew of homeostatic processes. Deterioration over time is often due to underlying conditions, primarily hypertension, and diabetes. Treating the underlying causes by lowering blood pressure and regulating blood sugar are your best shots at a better life.
Thank you for reading our article on chronic kidney failure medications! Live life to the fullest and have the highest standard of care possible. Check out our other articles and blog posts to explore your health options.