Kidneys are bean-shaped paired organs in the body. Their main function is to filter the waste products and excess fluids from blood, which are then excreted in the form of urine. CHRONIC KIDNEY DISEASE (CKD) is actually the loss of kidney function with the passage of time. As the purpose of the filter is to separate the waste products similarly kidneys work to filter the harmful and waste products from the body. The kidneys also produce certain necessary hormones (erythropoietin, calcitriol, and renin) and help to regulate blood pressure by producing life-sustaining chemicals. During one (01) day, the kidneys clean out 200 quarts of blood.
Chronic kidney disease (CKD) is the gradual loss of kidney function over a period of years.
CKD is a long term condition in which kidneys are not working properly. It can affect anyone but it is more common in people who are Black Americans, Hispanics, and are of South Asian origin.
CKD can get worse over the period of years and eventually the kidneys may stop working altogether but it is very uncommon. Many people are able to live a long life with chronic kidney disease (CKD). If the kidneys lose even 30% to 40% of function, one might not even notice. However, when kidney function falls below25%, serious problems develop. A person with less than 10% to 15% kidney function will need to have treatment to replace kidney function. If even only one kidney is functional or working normally it can work well. So by the term kidney failure, it means the failure of both kidneys.
Kidney disease is a non-communicable disease (NCD) and currently affects 850 million people worldwide. One in ten adults has chronic kidney disease (CKD). The global burden of CKD is increasing, and it has projected to become the 5th most common cause of years of life lost globally by 2040.
March is international kidney awareness month.
World Kidney Day is celebrated every year on the second Thursday of March. It is the global awareness campaign to raise the importance of kidneys to our health & to reduce the impact of kidney disease & its associated health problems worldwide.
Chronic Kidney Disease Causes
Chronic kidney disease is caused by other conditions that put a strain on kidney function. More often it is a result of the combination of other problems.
Below are the major reasons of chronic kidney failure:
Diabetes (Type 1 or Type 2)
If there are persistently increased blood sugar levels it can damage the tiny filters in the kidneys. Till it remains unchecked or not followed properly it can lead to chronic kidney disease.
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High Blood Pressure
If there is consistent raise blood pressure it can put a strain on the small blood vessels in the kidneys over the period of years and can stop kidneys to work properly
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Polycystic Kidney Disease (PKD)
It is genetic problem that runs in families, in this disease growths called cysts develop in the kidneys, which progressively destroys renal function. People who are suffering from polycystic kidney disease (PKD) ultimately need renal replacement therapy (either in the form of dialysis or a transplanted kidney)
High cholesterol can slowly cause a buildup of fatty deposits in the blood vessels supplying the kidneys; this condition of blood vessels is called atherosclerosis. It hardens the walls of blood vessels and makes it difficult for them to work properly
Prolonged Obstruction of Urinary Tract
Blockage in the flow of urine or prolonged obstruction of the urinary tract from conditions such as kidney stones, enlarged prostate, and some cancers can lead to CKD.
Recurrent kidney infections also called pyelonephritis can lead to CKD.
Glomerulonephritis is a condition in which kidneys filtering unit called glomeruli get inflamed and not function properly.
Interstitial Nephritis is an inflammation of kidney’s tubules and structure.
It is a condition that causes urine to back up into your kidneys. Examples are certain autoimmune disorders such as Kawasaki disease, systemic lupus erythematosus (SLE), etc.
Use of NSAIDS/Pain Killers
Regular and Long term use of non -steroidal anti -inflammatory drugs (NSAIDS) can lead to CKD
Certain factors may increase the risk of chronic kidney disease such as
- High blood pressure/hypertension
- Family history of kidney disease
- Being African- American, Asian- American, or Native- American, Hispanics
- Heart and blood vessel (cardiovascular disease)
- Abnormal kidney structure
- Older age
Chronic Kidney Disease Symptoms
CKD is a silent killer not showing symptoms at an early stage. In the early stages of chronic kidney disease; one may have no symptoms at all or few signs or symptoms. Chronic kidney disease may not become apparent until kidney function is significantly impaired. It may only be diagnosed if you have a blood or urine test for another reason and the result shows a possible problem with your kidneys. Symptoms and signs of chronic kidney disease develop if kidney damage progresses slowly. Sign and symptom of kidney disease may include
- Swelling/puffiness of face & eyelids more pronounced in early morning
- Pedal or ankle edema
- Generalized body edema
- Low urine output/oliguria
- Blood in the urine
- Pruritus, itching all over the body due to increased blood urea nitrogen levels
- Changes in the pattern of sleep
- Drowsiness due to accumulation of waste products (nitrate products ammonia, urea)
- Ketone smell in a breath because of the high level of ammonia
- Brittle nails
- Loss of appetite
- Abdominal pain
- Low Hemoglobin/anemia
- Malaise, Tiredness, fatigue
- Muscle twitching or cramps
- Fragile bones because of imbalance of calcium & phosphorus metabolism & low vitamin D levels. But It happens in advanced kidney failure
- Bone pain due to increased parathyroid hormone level in advanced CKD.
Kidney Disease Diagnosis
Chronic kidney disease remains undiagnosed sometimes years-long and people come to know only when they tested their blood or urine for some other reason. Because chronic kidney disease often has no symptoms at the early stages, people at high risk should be tested regularly. According to the National Kidney Foundation testing for kidney disease, 3 tests are recommended for testing for kidney disease:
- Measurement of blood pressure, .(blood pressure levels are not only a factor causing chronic kidney disease but may also indicate chronic kidney disease)
- Urine test for the presence of proteinuria (that is presence of proteins in the urine i.e. albumin or other proteins) or blood in the urine.
- Measuring serum creatinine to provide for the calculation of glomerular filtration rate (GFR).
Creatinine is the waste product (it is the breakdown product of creatine phosphate from muscle and protein metabolism), it is released at a constant rate by the body
Your doctor use your creatinine value results plus your age, size gender and ethnic group to calculate how many milliliters of waste your kidneys should be able to filter in a minute. This calculation is known as your estimated glomerular filtration rate (eGFR).
In addition to these tests measurement of the level of urea nitrogen in the blood can also be useful.
If above mentioned tests come back with an indication of kidney disease, your doctor or local health care provider may require additional testing before making a diagnosis. These may include imaging tests such as
- Ultrasound of kidneys (to check the size, structure ,presence of cysts etc. of kidney)
- Magnetic resonance imaging (MRI)
- Computerized tomography (CT)
- Sometimes your doctor may require kidney biopsy in order to make a diagnosis for underlying problem. A renal (“renal” describes kidney) biopsy is a procedure used to extract kidney tissue for laboratory analysis. This test helps your doctor to identify the type of kidney disease you have, how severe it is and the best treatment for it.
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Chronic Kidney Disease Stages
Your results can be used to determine how damaged your kidneys are, known as the stage of CKD. It can help your doctor to decide the best treatment for you and also helps to monitor you accordingly regarding you tests. Normal value of eGFR is more than 90 ml/min.
Your eGFR result is given as a stage from 1 of 5:
- (G1) Stage 1 – a normal eGFR above 90ml/min, but other tests have detected signs of kidney damage.
- (G2) Stage 2 – a slightly reduced eGFR of 60-89 ml/min, with other signs of kidney damage
- (G3a) Stage 3a – an eGFR of 45 to 59 ml/min
- (G3b) Stage 3b – an eGFR of 30 to 44 ml/min
- (G4)- Stage 4 – an eGFR of 15 to 29 ml/min
- Stage 5- an eGFR below 15 ml/min meaning the kidneys have lost almost all of their function.
Chronic Kidney Disease Treatment
There is no cure for chronic kidney disease (CKD) but various steps can be taken at early stages of CKD to preserve a higher level of kidney function for a longer period of time. Early detection of CKD and proper treatment can help relieve the symptoms and stop it getting worse. People who are suffering from reduced kidney function should follow following steps
- Make and keep regular appointment with your kidney specialist (nephrologist) on regular intervals and follow your doctor advice.
- Avoid taking painkillers and other medications that may make kidney disease worse.
- Make healthy lifestyle changes
- Stop smoking & drinking alcohol if you smoke or drink alcohol.
- Do regular physical activity according to health giver advice.
- Eat a healthy, balanced diet
- Restrict your salt intake to less than 6gm a day -that is around 1 teaspoon
- You may need to restrict your potassium intake
- Keep your blood pressure level under control
- Diabetics need to keep their blood sugar level under control
- Many people with advanced-stage CKD develop anemia which is lack of red blood cells. If you have anemia, you may also be given injection of a medicine called erythropoietin. This is a hormone that helps your body produce more red blood cells. If you have an iron deficiency as well, iron supplements may also be recommended
- Some people with CKD have low vitamin D , it need to be replaced because vitamin D is necessary for healthy bones
- People with CKD have to limit their protein intake
- People with advanced CKD have calcium phosphorus imbalance. Your health care may prescribe you phosphate binders and calcium supplements.
Proper/ regular medical care and follow ups. Because there is no cure for CKD PEOPLE who are in the later stage of kidney disease must consider options. options of treatment for end stage kidney disease is in the form of
- DIALYSIS (Hemodialysis / Peritonial Dialysis)
- KIDNEY TRANSPLANTATION
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