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Chronic Kidney Disease: Causes, Symptoms,Treatment, Prevention

Chronic kidney disease (a.k.a: chronic renal disease or chronic kidney failure) is one of the leading causes of mortality worldwide. About 86% of the patients with chronic kidney disease have at least one comorbid condition. Chronic kidney disease is also referred to as renal insufficiency.

Chronic Kidney DiseaseWhat is Chronic Kidney Disease?

Damage to the kidney or loss of the functional ability of kidney for >12 weeks or 3 months is called chronic kidney disease. The damage is gradual or has slow progression over months to years leading to various problems in the body. The kidney filters the blood and eliminates waste from the body in the form of urine. It is also essential for maintaining acid-base balance, fluid levels, and electrolyte levels in the body.

Acute kidney disease can be differentiated from chronic disease by duration of the disease. However, presence of azotemia is a clear indication of chronic kidney disease. Azotemia is a condition in which nitrogenous wastes such as urea and creatinine are present in the blood.

What Causes Chronic Kidney Disease?

Causes of chronic kidney disease are:

  • Hypertension
  • Diabetes
  • Glomerulonephritis
  • Pyelonephritis
  • Kidney stones
  • Polycystic kidney disease
  • Gout
  • Lupus nephritis

These diseases are nephrotoxic and cause damage to nephrons leading to impairment of kidney function. If it is unnoticed or left untreated, the disease progresses slowly and causes chronic kidney disease.

Symptoms of Chronic Kidney Disease:

The following are the symptoms of chronic kidney disease are:

In the initial stages, the patient may experience:

  • Headache
  • Loss of appetite
  • Weight loss
  • Weakness
  • Fatigue
  • High blood pressure
  • Edema in the legs and face
  • Nausea
  • Vomiting
  • Muscle cramps
  • Persistent and generalized itching

In the later stages, the patients may experience the following signs and symptoms:

  • Polyuria (frequent urination) or oliguria (decrease in urine output)
  • Frequent urination in the night
  • Uremic frost (urea is excreted in sweat and crystallized after the sweat evaporates)
  • Blood in the vomit or stools
  • Sleep problems
  • Decreased mental alertness
  • Erectile dysfunction (in men)

Risk Factors of Chronic Kidney Disease:

The risk factors of chronic kidney disease are:

  • Family history of kidney disease or inherited and genetic factors
  • Hypertension
  • Diabetes
  • Smoking
  • Long-term use of analgesics, such as acetaminophen
  • Urinary tract infections

Complications of Chronic Kidney Disease:

The complications of chronic kidney disease are:

Sodium and water imbalance: It leads to hypertension. Fluid retention occurs leading to edema and heart failure.

Impairment in elimination process: It leads to uremia (presence of urea in the blood), further causing skin disorders, gastrointestinal, immune, and neurological problems.

Decreased erythropoietin production: Erythropoietin hormone is produced by kidney. Chronic kidney disease leads to decrease in erythropoietin levels resulting in anemia.

End-stage renal disease: In few cases, chronic kidney disease can progress to end-stage renal disease. In this condition, kidneys are irreversibly damaged which require maintenance dialysis or surgical intervention (kidney transplantation).

Hyperkalemia, pericarditis, and risk of bone fractures are also the complications of chronic kidney disease.

Diagnosis of Chronic Kidney Disease:

Initially, the healthcare provider obtains the family and medical history and performs a physical examination. Blood pressure is also monitored during the physical exam. Diagnostic tests that are performed are:

Blood tests– Kidney function tests are performed to measure the glomerular filtration rate (GFR), creatinine, urea, and electrolyte levels in the blood.Serum cholesterol and blood sugar levels are also measured.

Urine output – Urine output is monitored regularly in case of hospitalized patients.

Urine tests – Urine tests are performed to determine the underlying cause and complications of the disease. Presence of proteins, such as albumin in the urine is an important indicator of kidney disease.

Ultrasound – Ultrasound scan is performed to identify the changes in the size and shape of kidneys that may occur due to inflammation. Generally, the kidneys appear small in size and margins become irregular in case of chronic kidney disease.

Biopsy – A sample of tissue is obtained and examined under the microscope to identify the changes and extent of damage in the kidney. This test is performed if there is no intrinsic cause found for chronic kidney disease.

5 Stages of Chronic Kidney Failure Based On GFR:

  • Stage 1 – There is slight kidney damage, but kidney functions and GlomerularFiltration Rate (≥ 90 mL/min) are normal.
  • Stage 2 – There is mild kidney damage with Glomerular Filtration Rate 60 to 89 mL/min.
  • Stage 3 – There is moderate kidney damage with GlomerularFiltration Rate 30 to 59 mL/min.
  • Stage 4 – There is severe kidney damage with Glomerular Filtration Rate 15 to 29 mL/min.
  • Stage 5 – There is kidney failure or end-organ disease with Glomerular Filtration Rate < 15 mL/min.

Chronic Kidney Disease Treatment:

The main goals of the therapy are:

  • Treating the underlying cause
  • Reducing the symptoms
  • Minimizing the complications
  • Estimating the progression and slowing down the progression of the disease­­

The treatment of chronic kidney disease includes:

  • Antihypertensive medications such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are prescribed.
  • Antidiabetic medications are recommended in case of presence of diabetes.
  • Erythropoietin or iron supplements are given to treat anemia.
  • Diuretics can be given to decrease fluid retention.
  • Renal replacement therapy (dialysis or transplantation) is recommended for end-stage kidney disease. The treatment costs for dialysis are higher than transplantation. However, it is not easy to undergo transplantation as it requires matching donor and considers the overall health of the patient.

Chronic Kidney Disease Prevention and Cure:

Measures that help in prevention and cure of chronic kidney disease are:

  • Shed excess weight if you are obese.
  • Maintain adequate water intake.
  • Consume healthy and balanced diet rich in fruits and vegetables. Limit protein rich and high-fat foods.
  • Reduce salt and meat intake.
  • Avoid foods rich in potassium, such as banana and tomato.
  • Exercise regularly. Perform physical activity for at least 30 min in a day.
  • Quit smoking.
  • Limit alcohol consumption.
  • Reduce stress by following relaxation techniques.
  • Control sugar and blood pressure levels.
  • Take the medications as per prescription if there is a history of diabetes or hypertension.
  • Undergo routine screening for every 3 to 6 months if you have any one of the risk factors.
  • Identify nephrotoxic drugs, such as nonsteroidal anti-inflammatory agents and limit their use.
  • Seek prompt treatment if you are diagnosed with urinary tract infection or kidney stones.
  • Avoid high intake of calcium if diagnosed with kidney stones.

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