CONDITIONS
Chronic Kidney Disease
Chronic kidney disease (CKD) is the gradual loss of kidney function of filtering wastes and excess fluids from the blood, thereby removed in the urine. Advanced chronic kidney disease may cause dangerous levels of fluid, electrolytes and wastes to build up in your body.
There are 5 stages of CKD and the early stages of CKD may show only a few signs and symptoms.
There has been a 30% increase in prevalence of CKD in the last decade of the US. In India, the prevalence of CKD was found to be 13–15% with stage 1, 2 and 3 as 7%, 5% and 3% respectively.
What are the symptoms of chronic kidney disease?
If symptoms happen in early stages, they may include:
- Foamy urine
- Urinating (peeing) more often or less often than usual
- Itchy and/or dry skin
- Feeling tired
- Nausea
- Loss of appetite
- Weight loss without trying to lose weight
People with more advanced stages of CKD may also notice:
- Trouble concentrating
- Numbness or swelling in your arms, legs, ankles, or feet
- Achy muscles or cramping
- Shortness of breath
- Vomiting
- Trouble sleeping
- Breath smells like ammonia (also described as urine-like or “fishy”)
What are the causes and risk factors of Chronic Kidney Disease?
Multiple or single long term(chronic) disease or condition impairs the kidney function, causing kidney damage to worsen over several months or years. This is how CKD starts.
Diseases and conditions that cause chronic kidney disease include:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis – an inflammation of the kidney’s filtering units
- Interstitial nephritis – an inflammation of the kidney’s tubules and surrounding structures
- Polycystic kidney disease
- Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
- Vesicoureteral reflux, a condition that causes urine to back up into kidneys
- Pyelonephritis (Recurrent kidney infection)
Some people are at a higher risk than others of developing CKD. The most common CKD risk factors are:
- Diabetes
- High blood pressure (hypertension)
- Heart disease and/or heart failure
- Obesity
- Over the age of 60
- Family history of CKD or kidney failure
- Personal history of acute kidney injury (AKI)
- Smoking and/or use of tobacco products
- Frequent use of medications that damages the kidneys
How is Chronic Kidney Disease diagnosed?
Checking for CKD is easy with two simple tests:
- A blood test known as the estimated glomerular filtration rate (eGFR)
- estimates how well kidneys are removing waste products from the blood.
- It is calculated using the serum creatinine level, age, and sex.
- Having an eGFR under 60 for three months is a sign of kidney disease.
- A urine test known as the urine albumin-creatinine ratio (uACR)
- measures the levels of two different substances in the urine – albumin (protein) and creatinine.
- uACR over 30 for three months or more is a sign of kidney disease.
- Imaging tests may be done to assess kidneys’ structure and size and kidney tissue sample testing (kidney biopsy) may be done in rare cases to understand the kidney problem.
What are the treatment options for Chronic Kidney Disease?
Management of CKD has 4 important goals:
- Managing the disease or conditions most likely causing the CKD (for example, your diabetes, high blood pressure)
- Taking steps to slow down the CKD disease progression
- Lowering your risk of cardiovascular disease (having a heart attack or stroke)
- Treating any complications due to CKD
Medications:
The doctor may prescribe one or more medicines to help slow down or stop CKD from getting worse. These medicines can include high blood pressure medicines, medications to relieve swelling, to treat anemia and to lower cholesterol levels (statins).
Guidelines recommend a statin for people with CKD with diabetes, a history of heart disease, or are age 50 or older. Even without high cholesterol, a statin can help lower the risk of having a heart attack or stroke.
Other medications calcium and vitamin D supplements would be to protect the bones and a lower protein diet to minimize waste products in your blood.
Treatment for end-stage kidney disease
If the kidneys cannot manage waste and fluid clearance on their own, a person may develop complete or near-complete kidney failure. This stage is the end-stage kidney disease and at this point, a dialysis or a kidney transplant may be required.
Dialysis: Artificial removal of waste products and extra fluid from the blood when kidneys can no longer do this.
Kidney transplant: A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. After a transplant, medications for the rest of life would be prescribed to keep the body from rejecting the new organ.
Can development of CKD be prevented?
To reduce your risk of developing kidney disease:
Follow instructions on over-the-counter medications: When using nonprescription pain relievers, such as aspirin, ibuprofen and paracetamol, follow instructions on the package. Taking too many pain relievers for a long time could lead to kidney damage.
Maintain a healthy weight: Maintain healthy weight by being physically active most days of the week.
Don’t smoke: Cigarette smoking may damage the kidneys and make existing kidney damage worse. Support groups, counseling and medications can all help you to stop.
Manage your medical conditions with doctor’s help: If certain diseases or conditions increase the risk of kidney disease, work with the doctor to control them. Ask the doctor about tests to look for signs of kidney damage.
References
- Varma PP. Prevalence of chronic kidney disease in India – Where are we heading? Indian J Nephrol. 2015 May-Jun;25(3):133-5. PMID: 26060360; PMCID: PMC4446915.
- Chronic Kidney Disease. Mayo Clinic. March 2024. https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527
- What Is Chronic Kidney Disease? WebMD. March 2024. https://www.webmd.com/a-to-z-guides/diet-and-chronic-kidney-disease
