Chronic Kidney Disease - A Detailed Knowledge About It!

Chronic kidney disease (CKD) means that your kidneys are not working as well as they once did. Various conditions can cause CKD. Severity can vary but most cases are mild or moderate, occur in older people, do not cause symptoms and tend to become worse gradually over months or years.

People with any stage of CKD have an increased risk of developing heart disease or a stroke. This is why it is important to detect even mild CKD. Treatment may not only slow down the progression of the disease but also reduce the risk of developing heart disease or stroke.

Chronic kidney disease symptoms
You are unlikely to feel unwell or have symptoms with mild-to-moderate CKD - that is, stages 1 to 3. (However, there may be symptoms of an underlying condition such as kidney pain with certain kidney conditions.) CKD is usually diagnosed by the eGFR test before any symptoms develop.

Symptoms tend to develop when CKD becomes severe (stage 4) or worse. The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual and just not feeling well. With more severe CKD, symptoms that may develop include:

• Difficulty thinking clearly.
• A poor appetite.
• Weight loss.
• Dry, itchy skin.
• Muscle cramps.
• Fluid retention which causes swollen feet and ankles.
• Puffiness around the eyes.
• A need to pass urine more often than usual.
• Being pale due to anemia.
• Feeling sick.

If the kidney function declines to stage 4 or 5 then various other problems may develop - for example, anemia and an imbalance of calcium, phosphate and other chemicals in the bloodstream. These can cause various symptoms, such as tiredness due to anemia, and bone thinning or fractures due to calcium and phosphate imbalance. End-stage kidney failure (stage 5) is eventually fatal unless treated.

What causes chronic kidney disease?
A number of conditions can cause permanent damage to the kidneys and/or affect the function of the kidneys and lead to CKD.
 

• Diabetes - Diabetic kidney disease is a common complication of diabetes.
• High blood pressure - Untreated or poorly treated high blood pressure is a major cause of CKD. However, CKD can also cause high blood pressure, as the kidney has a role in blood pressure regulation. About nine out of ten people with CKD stages 3-5 have high blood pressure.
• Ageing kidneys - There appears to be an age-related decline in kidney function. About half of people aged 75 or more have some degree of CKD. In most of these cases, the CKD does not progress beyond the moderate stage unless other problems of the kidney develop, such as diabetic kidney disease.

Other less common conditions that can cause CKD includes:
 

• Diseases of the tiny filters (glomeruli), such as inflammation of the glomeruli in the kidneys (glomerulonephritis).
• Narrowing of the artery taking blood to the kidney (renal artery stenosis)
• Polycystic kidney disease.
• Blockages to the flow of urine, and repeated kidney infections.

How is chronic kidney disease diagnosed?

Kidney function is assessed using a combination of a blood test called the estimated glomerular filtration rate (eGFR) and a measure of the amount of protein in the urine (proteinuria). Increased protein in the urine and decreased eGFR are both associated with an increased risk of progressive CKD.

An ultrasound scan of the kidneys or a kidney biopsy may be advised if certain kidney conditions are suspected. For example, if you have a lot of protein or blood in your urine if you have pain that seems to be coming from a kidney, etc.

A scan or having a sample taken (a biopsy) is not needed in most cases. This is because most people with CKD have a known cause for the impaired kidney function, such as a complication of diabetes, high blood pressure or ageing.

If the CKD progresses to stage 3 or worse then various other tests may be done. For example, blood tests to check for anemia and an altered level of parathyroid hormone (PTH). PTH is involved in the control of the blood level of calcium and phosphate.

What is the treatment for chronic kidney disease?
The aims of treatment include:

• If possible, to treat any underlying kidney condition.
• To prevent or slow down the progression of CKD.
• To reduce the risk of developing cardiovascular disease.
• To relieve symptoms and problems caused by CKD.
• There are various conditions that can cause CKD. For some of these there may be specific treatments for that particular condition - for example:
• Good blood sugar (glucose) control for people with diabetes.
• Blood pressure control for people with high blood pressure.
• Antibiotic medication for people with recurring kidney infections.
• Surgery for people with a blockage to urine flow.

Treating end-stage kidney failure
You will need to attend regularly for follow-up - how often depends on how much your kidney function is affected and how stable your results are. As well as monitoring your kidney function, your team is likely to carry out certain blood tests:

• Full blood count 
• Calcium.
• Phosphate.
• Vitamin D.
• Parathyroid hormone.

The options for treatment include:

1. Haemodialysis - your blood is removed from a vein in your arm, filtered to remove waste products and returned through another tube.
2. Peritoneal dialysis - a thin tube is inserted into your stomach near your tummy button. The fluid is pumped into your stomach cavity to filter waste products and drained into a bag.
3. Kidney transplant.

In case you have a concern or query you can always consult Best Nephrologist in Delhi & get answers to your questions!