A new patient, after reading several of my articles, asked me yesterday:
“Dr. Stone, your insights are truly priceless! As a healthcare provider who gives medically sound advice, I must know: Is chronic kidney disease managed to get a complete recovery?”
It would have been nice to tell her “yes,” but that would have been inaccurate from a medical standpoint.
I was almost inclined to go with “no,” but it would have been conflicting with how things usually turn out in real clinical practice.
After all, the truth is somewhere between, and here is a detailed explanation that is too long for a comment section.
The Definition of Chronic Kidney Disease
The most certain proof of CKD is the kidney biopsy with findings demonstrating irreversible changes in the kidney: glomerulosclerosis and tubular fibrosis.
Because biopsies are invasive, we normally rely on a practical diagnostic criterion:
- Persisting abnormal proteinuria or increased serum creatinine for more than 3 months.
This marker serves as a reliable indicator of chronic damage. In such severe situations, nephrologists trained in clinical judgment can even recognize CKD at the bedside without the 3 months waiting period for diagnostic confirmation, thus initiating treatment right away.
The Treatment Paradox
The truth is difficult to digest: No therapy available at present is able to reverse the fibrosis/sclerosis. Our medical armamentarium—antihypertensive drugs, immunosuppressants, biologics, TCM, or plasmapheresis—has never been intentionally designed for chronic kidney damage amelioration.
So why do these treatments reduce the risk of ESRD? Because they specifically act on “active/acute lesions”:
- Cellular proliferation
- Thickening of the basement membrane
- Inflammatory infiltration
- Interstitial edema
Even “semi-chronic” localized fibrosis may slowly get better with the continuation of the treatment. But total glomerular sclerosis? It’s just like rigor mortis—no doctor can change this biological reality.
Clinical Reality Check
The silver lining? Most biopsy results indicate:
- <50% chronic damage → Function of the kidney is still available
- <95% chronic damage → The need for dialysis can be avoided
By controlling the active lesions properly, patients can have a normal life—they can work, travel, raise their children etc., even if there are irreversible chronic changes. We are not treating CKD directly but only its active components.
The Treatment Dilemma
“Pure” CKD patients are a special case which is difficult to manage clinically:
- Minimal proteinuria (<0.3g/day)
- Stable but creatinine levels are higher than normal
- No acute pathology that can be treated
In such cases, the ethical physicians may:
- Abstain from medications that are not necessary
- Keep the patient under observation for disease exacerbation
- Oppose issuing placebos
Some patients even go to top hospitals abroad only to be sent back home. This is the reason for that. With the development of new active lesions, treatment will be viable again.
A Message to Patients
To those critics who say: “You only treat active cases, not real CKD!”- you are quite right. Medicine as advanced as it is today cannot reverse chronic damage. Expressing your anger online will not help you to overcome this biological constraint.
As nephrologists, our job includes:
- Finding the active treatable causes
- Protect the remaining function
- Postpone the time when dialysis will be necessary
If you wish to contact us for a personalized consultation, please scan the QR code below.
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