OVERVIEW
Chronic kidney disease (CKD), also called chronic kidney failure, is a condition that results in the decline of kidney function over a long period. It is a slow, gradual and progressive kidney disease condition. If left unchecked, chronic kidney failure could progress to end-stage renal disease, which will require dialysis or a kidney transplant.
The kidneys filter and eliminate waste from the body, maintain a balance of fluids, and synthesise vitamin K, hormones and red blood cells. Chronic kidney disease causes a reduction in kidney size and accumulation of wastes and fluids. This makes a person feel sick.
An individual with chronic kidney disease will have zero to mild symptoms at the initial stage. Chronic kidney disease symptoms become apparent at the later stage of the disease.
KEY FACTS
- Chronic kidney disease reduces the functioning power of the kidneys over time. Maintaining a healthy lifestyle prevents one from getting the disease.
- Blacks, Native Americans and Asian Americans have a higher risk of chronic kidney failure. Diabetes and elevated blood pressure are the major causes of chronic kidney failure.
- Symptoms include poor appetite, weight loss, muscle cramps, swelling in the legs and hands, frequent urination, and shortness of breath.
- There is no cure for chronic kidney disease. Treatment is symptomatic. As a result, an individual needs to see the doctor immediately after symptoms are noticed.
SYMPTOMS AND DIAGNOSIS
SYMPTOMS
Symptoms of chronic kidney disease (CKD) appear gradually with time. They become more evident as the condition deteriorates. Undergoing routine tests usually helps detect
chronic kidney disease at its early stage.
Most symptoms of CKD are not specific to the disease condition because they are also present in other illnesses. This makes distinguishing CKD from other illnesses difficult, particularly at the early stage.
Chronic kidney disease symptoms include:
- Swollen ankles and feet (oedema)
- Weight loss
- Decreased appetite
- Increased blood pressure (hypertension)
- Insomnia (difficulty in falling asleep)
- Anaemia
- Shortness of breath
- Tiredness
- Itching
- Muscle cramps
- Reduced urination
- Weak erection in men
- Chest pain
DIAGNOSIS
Detailed history taking and certain laboratory tests help doctors diagnose chronic kidney disease. Blood tests and urine tests are the most common tests carried out. Certain markers in these fluids (blood and urine) indicate impaired renal function.
- Blood test: Blood creatinine levels are measured through the blood test. Creatinine is a waste product obtained from the breakdown of creatine phosphate during muscle metabolism.
This test helps the doctor calculate the estimated glomerular filtration rate (eGFR). The eGFR is the rate at which the glomerulus of the kidney filters substances. The eGFR in a healthy individual is greater or equal to 90mil/min. An eGFR that is less than the normal range indicates possible chronic kidney disease.
- Urine test: The urine test helps in the estimation of the albumin-creatinine ratio (A.C.R.). The ratio of albumin to creatinine in healthy individuals is less than 30mg. An increase in this ratio is indicative of kidney disease.
The presence of blood and proteins in the urine points toward kidney disease. In healthy individuals, blood or proteins cannot be detected in the urine.
Other tests include:
- Kidney biopsy
- Ultrasound scan to determine the kidney morphology
- Chest X-ray to check for fluid accumulation in the lungs
Chronic kidney disease has a better prognosis if it is diagnosed at an early stage. The later stages are difficult to manage.
STAGES
There are five stages of chronic kidney failure based on the estimated glomerular filtration rate (eGFR) and the level of kidney damage. These stages are:
- Stage 1 CKD: In chronic kidney disease stage one, there is mild renal damage with normal or increased estimated glomerular filtration rate. The eGFR is usually greater than 90mil/min. Proteins may be detected in trace amounts.
Patients with chronic kidney disease stage 1 are usually asymptomatic.
- Stage 2 CKD: In chronic kidney disease stage 2, there is mild kidney damage with a reduced estimated glomerular filtration rate. The eGFR is usually between 60-89 mil/min.
Patients with stage 2 chronic kidney disease usually do not present symptoms.
- Stage 3 CKD: In chronic kidney disease stage 3, moderate renal damage is observed. The eGFR falls between 30 – 59 mil/min. Chronic kidney disease stage 3 is subdivided into two:
- Stage 3a: Patients in this stage have an eGFR of 45-59 ml/min.
- Stage 3b: Patients with this CKD stage present with an eGFR of 30-44 ml/min.
Patients having chronic kidney disease stage 3 may present with symptoms and positive clinical signs of the kidney disease.
- Stage 4 CKD: There is severe renal damage at this stage. The eGFR drops drastically between 15-29 mil/min.
Patients with chronic kidney disease stage 4 are symptomatic with positive clinical signs and laboratory findings.
- Stage 5 CKD: The eGFR in an individual with chronic kidney disease stage 5 is below 15 ml/min. This stage is also referred to as end-stage renal disease (ESRD) or end-stage kidney disease.
In chronic kidney disease stage 5, the kidneys pack up, and the patient will require dialysis or renal replacement therapy (kidney transplant).
CAUSES
Anything that puts stress on the kidneys can result in chronic kidney disease (CKD). Some of the causes of this kidney disease include:
- Diabetes
- Hypertension
- Recurrent kidney stones
- Enlarged prostate
- Kidney diseases (example: polycystic kidney disease)
- Prolonged obstruction of the urinary tract
- Severe dehydration
RISK FACTORS
Certain factors put one at risk of coming down with chronic kidney disease. Some causes of CKD are risk factors as well. Major risk factors of chronic kidney disease are:
- Diabetes
- Hypertension
- Family history of kidney disease
- Old age (greater than 60 years of age)
- Race: Blacks, Native Americans and Asian Americans have a greater risk of getting CKD.
- Obesity
- Elevated cholesterol levels
- Smoking
Complications
Certain complications arise if chronic kidney disease is left unchecked and progresses to kidney failure. Some complications are:
- Anaemia
- Fluid retention
- Gout
- Weak bones due to low vitamin D levels (osteomalacia)
- Increased blood potassium levels (hyperkalemia) that could possibly lead to heart damage
- Pericarditis
- Sexual dysfunction, especially in males
- Mineral disorders
PREVENTION
Maintaining a healthy lifestyle is essential in preventing chronic kidney disease. The kidneys are involved in the removal of waste products from the body. The kidneys also maintain water and salt balance. Hence, any disease affecting the kidneys will accumulate waste and fluids.
To prevent chronic kidney disease (CKD), you must take care of your kidney by doing the following:
- Eating healthy: Balanced diet and regular exercise helps maintain a healthy weight. A healthy weight reduces the stress placed on the kidneys by keeping the blood pressure and cholesterol levels within normal. This prevents kidney disease.
- Exercise regularly: Adequate exercise allows the heart to function properly, thereby controlling blood pressure.
- Follow instructions while using NSAIDs (non-steroidal anti-inflammatory drugs): Certain medications are toxic to the kidneys when used for long periods. NSAIDs (aspirin, diclofenac, Ibuprofen) are examples of drugs having a toxic effect on the kidneys. Follow the guidelines on the pack when taking such medications.
- Avoid smoking: Smoking damages the kidney. It also predisposes one to cardiovascular diseases, which increases the risk of chronic kidney disease.
- Reduce alcohol intake: Alcohol increases cholesterol levels. High cholesterol levels are harmful to the kidneys. Reducing alcohol intake helps prevent CKD.
TYPICAL TREATMENTS
Chronic kidney disease has no ultimate cure. Symptomatic management is the treatment plan for chronic kidney failure. This treatment plan will reduce the symptoms of kidney disease and prevent the condition from worsening.
The treatment plan includes the following:
- Drugs to lower blood pressure, like angiotensin-converting enzyme inhibitors and angiotensinogen receptor blockers
- Dialysis: a treatment that helps the kidneys filter waste
- Antidiabetic medications like the biguanides.
- Statins, to reduce cholesterol levels
- Kidney transplant if the disease progresses to kidney failure
CONCLUSION
Chronic kidney disease is a condition that makes the kidneys go bad over a long period. It usually worsens till it gets to end-stage renal disease.
Routine tests help detect the disease early to prevent it from worsening. There is no cure for CKD, but patients can live relatively normal lives with proper management.
MOST COMMON
