Chronic Kidney Disease

The main functions of the kidneys are to filter out excess fluid and wastes from the blood and make urine. The kidneys help maintain a proper balance of the salts and minerals (like potassium, sodium, phosphorus, and calcium) that are present in the blood circulation so that the body is able to function properly. The kidneys also produce certain hormones that help regulate the blood pressure and the production of red blood cells. If the kidneys get damaged due to some reason, there is a build-up of wastes, which is harmful to the body. Chronic kidney disease is a medical condition with multifactorial causation that develops over a period of time and slowly damages the kidneys.

10% of the global population has CKD. Every year, this disease has proven to be fatal for millions of people who do not receive or cannot afford the treatment cost. The 2010 Global Burden of Disease study ranked CKD 18th on the list of causes of global disease-related deaths. In the coming years, It is estimated that in the upcoming years, there will be more cases of kidney failure, especially in the developing countries, such as China and India, as these countries have an increasing number of elderly population.

CKD is categorized into five stages depending upon the severity of kidney damage. The severity of kidney damage is assessed by the Glomerular Filtration Rate (GFR). The GFR estimates the amount of blood that passes through the “glomeruli” (singular-“Glomerulus”) each minute. “Glomerulus” is the nest of small blood vessels that act as the filtering unit of the kidneys. Here are the stages:

• Stage 1 
  There is damage to the kidneys but the GFR is either normal or slightly increased (>90 mL/min/1.73 m2).
• Stage 2 
  Mild decrease in the GFR (60-89 mL/min/1.73 m2).
• Stage 3a 
  Moderate decrease in the GFR (45-59 mL/min/1.73 m2).
• Stage 3b 
  Moderate decrease in the GFR (30-44 mL/min/1.73 m2).
• Stage 4 
  Severe reduction in the GFR (15-29 mL/min/1.73 m2).
• Stage 5 
  Kidney/renal failure (GFR < 15 mL/min/1.73 m2 or dialysis).

The symptoms of CKD include:

Early symptoms

In general, the human body is able to function successfully even when there is a significant decrease in the kidney function. Therefore, in the early stages, CKD usually does not show any noticeable symptoms. The early symptoms of CKD are usually vague. These symptoms include:

• Loss of appetite.
• Nausea.
• Dry and itchy skin (pruritus).
• A headache.
• A general feeling of being unwell.
• Fatigue.
• Unexplained or unattempted weight loss.
  
  Troubled by obesity? Failed to lose weight? Now control weight easily by myUpchar Ayurveda Medarodha Weight Control Tablet. Get started today and take steps towards a healthy life.

If routine blood or urine tests detect any possible problem, then CKD can be picked up at this early stage. Early diagnosis and treatment of CKD can help stop the progression of the disease to an advanced stage.

Late symptoms

If kidney disease is not picked up in the early stages or if the disease worsens in spite of treatment, then the following symptoms can develop:

• Bone pain due to an imbalance in the levels of calcium and phosphorus in the blood caused by kidney damage.
• Numbness or swelling in the hands, feet, and ankles due to water retention.
• Bad breath that has an ammonia-like odour or fishy odour due to a build-up of wastes in the body.
• Loss of appetite and weight loss.
• Vomiting.
• Frequent hiccups.
• Increased frequency of urination, especially at night.
• Shortness of breath.
• Weariness.
• Passing blood in the urine or stools.
• Difficulty in concentrating or thinking.
• Muscle cramps/spasms.
• Bruising easily.
• Frequent need to drink water.
• Absent menstrual periods (amenorrhea).
• Sleeplessness (Insomnia).
• Change in skin colour to either too light or too dark.
• Sexual dysfunction.

The last stage of CKD is known as kidney/renal failure or end-stage renal disease (ESRD), which may eventually require a dialysis or kidney transplant.

CKD needs to be distinguished from the following conditions, which may show symptoms similar to CKD.

• Urinary tract obstruction
  Blockage to the flow of urine to the outside of the body. This may cause acute or chronic renal (kidney) disease.
• Diabetic Nephropathy
  A kidney disease that progresses over time. In this disease, there is damage to the kidney cells type 1 or type 2 diabetes.
• Acute Kidney Injury
  Sudden kidney failure that happens within a few hours or days.
• Systemic lupus erythematosus (SLE)
  An autoimmune disease that affects the kidneys along with other body parts such as the joints, skin, and brain among others.
• Renal Artery Stenosis
  A reduction in the blood flow to the kidney due to narrowing (stenosis) of the passage of the renal artery, which supplies blood to the kidneys.
• Chronic Glomerulonephritis
  Slow and progressive kidney damage that results due to the inflammation or swelling of the glomeruli (small filtering units in the kidneys).
• Nephrolithiasis
  Stones (calculi) in the kidneys.
• Rapidly Progressive Glomerulonephritis
  Rapid loss of kidney functions.
• Anti-glomerular Basement Membrane Disease
  A rare autoimmune condition affecting the membrane to which the cells of glomeruli are attached, thus causing kidney damage.
• Alport Syndrome
  A genetic disorder characterized by a triad of diseases - kidney disease, loss of hearing, and vision issues.
• Nephrosclerosis
  Kidney damage due to long-term high blood pressure.
• Multiple Myeloma
  Multiple myeloma is a type of blood cancer related to white blood cells (plasma cells).

Causes

Chronic kidney disease is often caused by conditions that put a strain on the functioning of the kidneys. CKD can be caused by the following:

• Diabetes
  Increased blood glucose/sugar levels damage the kidneys by straining the filtering units (glomeruli) in the kidneys. When the filters are damaged, the albumin (a protein) that is usually not filtered out by healthy kidneys, passes out into the urine.
• High blood pressure
  High blood pressure can harden and cause damage to the blood vessels in the kidneys. As a result, the kidneys may not filter the blood efficiently. As a result, there is an accumulation of fluid as well as waste products in the body. This extra fluid in the blood vessels may further increase the blood pressure, creating a vicious cycle. Along with diabetes, high blood pressure is the most common cause of CKD.
• High cholesterol
  High cholesterol levels result in the deposition of a fatty substance in your blood vessels. This may eventually lead to blockage of the blood vessels in the kidneys, which affects the kidneys’ filtration function.
• Kidney infections
  Viral, bacterial or parasitic infections can destroy the kidney cells over a period of time.
• Side effects of medications
  Certain medications such as painkillers (NSAIDs) and drugs used for cancer treatment may also result in kidney damage.
• Blockage in the urinary outflow
  A blockage in the urinary tract may be due to frequent kidney stones or an enlargement of the prostate gland.
• Reflux nephropathy
  Renal damage due to the reverse flow of urine, from the bladder to the kidneys.
• Glomerulonephritis
  Inflammation of the filtering units of the kidneys
• Renal Artery Stenosis
  A reduction in the blood flow to the kidneys due to narrowing (stenosis) of the passage of the renal artery, which supplies blood to the kidneys. The reduced blood flow eventually causes renal (kidney) damage.
• Systemic lupus erythematosus (SLE) 
  Autoimmune condition. 
• Hereditary disorders of the kidneys
  Such disorders include polycystic kidney disease in which there is a presence of cysts in the kidneys due to which the kidneys become less efficient over a period of time.

Risk Factors

Risk factor means any factor that increases the likelihood of developing CKD. Risk factors of CKD are as follows:

• Family history
  People with a family history of CKD have a high chance of developing it as well.
• Gender
  Many studies have reported that end-stage renal disease is more frequently seen in men than women.
• Age
  In both the genders, kidney function tends to decrease with age.
• Low birth weight
  Low birth weight is associated with a decreased number of kidney cells and glomeruli, thus increasing the filtration workload and blood pressure. Such infants have a higher risk of developing CKD.
• Obesity
  Besides having a high BMI (Body Mass Index), the presence of extra belly fat is linked to an increased risk of developing CKD. Obesity increases the risk of inflammation or swelling, low oxygen supply to the kidneys, and other such factors. 
• Socioeconomic status
  One study reported that those suffering from CKD are more likely to come from families of a low socio-economic status (unskilled workers).
• Smoking
  Smoking increases the risk of developing CKD significantly by reducing the oxygen supply to the kidneys, damaging the blood vessels, and damage to the tubules that carry the filtered blood in the kidneys.
• High blood pressure
  As discussed above, high blood pressure is an established risk factor of CKD.
• Diabetes
  As mentioned earlier, diabetes is the most important risk factor in developing CKD.
• Acute kidney injury
  People with a history of recurrent acute kidney injury have a higher risk of developing CKD.
• Nephrotoxins
  These are substances that are harmful to the kidneys. Such substances include alcohol, excessive use of painkillers, recreational drugs, and exposure to heavy metals, which have also been linked to the progression of CKD.

While chronic kidney disease cannot always be prevented, however, it is possible to reduce your chances of developing CKD by taking certain measures, such as:

• Quit smoking.
• Exercise regularly.
• Manage any underlying disease that could lead to CKD.
• Eat a healthy and balanced diet.
• Limit or avoid alcohol intake.
• Avoid over-the-counter medicines, especially painkillers.

The doctor establishes a diagnosis by thorough history, physical examination, and investigations. Investigations include:

Blood test 

It is performed to see how efficiently your kidneys function. It includes the estimation of the following factors

• Complete blood count (CBC)
• Creatinine clearance
• Creatinine
• Blood urea nitrogen (BUN)
• Albumin
• Calcium
• Cholesterol
• Electrolytes

The value of the creatinine test will determine your GFR.

Urine test 

Urine tests are carried out to check for:

• The levels of albumin and creatinine in your urine.
• The presence of proteins or blood in your urine.

Other tests 

Other tests which may be carried out to assess the level of damage to the kidneys include:

• Imaging tests
  Ultrasound scan, computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan are some of the imaging tests. These can be carried out to check the appearance of the kidneys and the presence of any abnormalities.
• Kidney biopsy  
  In this test, a small sample of kidney tissue is removed and studied under a microscope to look for any signs of kidney damage.

CKD cannot be cured and the treatment is aimed at alleviating the presenting symptoms and to stop the disease from worsening. The treatment varies on how severe the disease is.

The key elements of treatment are:

• Lifestyle changes 
  These changes are recommended to ensure optimum health. The doctor will advise you to make the following changes:
  • Quit smoking.
  • Eat a balanced diet and healthy food.
  • Reduced your daily salt consumption to less than 6g per day.
  • Exercise regularly for at least 30 minutes of a day and five days per week.
  • Limit alcohol intake to less than 14 alcohol units per week.
  • Lose weight and maintain a healthy weight right for your height and age.
  • Do not self-medicate.

• Medications
  Medicines are prescribed to control other associated problems like diabetes, high blood pressure, or high cholesterol.
  • People with diabetes need to eat a healthy and balanced diet, exercise on a regular basis, and get their regular blood tests done to monitor keep their blood glucose levels in check.20
  • For high blood pressure, the doctor may prescribe angiotensin-converting enzyme (ACE) inhibitors to control blood pressure. In the case of side effects, the doctor may prescribe angiotensin-II receptor blocker (ARB). The treatment goal is to maintain the blood pressure below 140/90 mm/Hg.
  • Statins may be prescribed to reduce cholesterol levels.
  • For swelling in the ankles or hands, diuretic drugs and limiting salt and fluid intake are advised.
  • In the case where long-standing kidney disease results in anaemia, iron supplements may be prescribed or a shot of the hormone ‘erythropoietin’ will be administered as it helps to produce more RBCs.
  • Dialysis may be necessary for people with advanced CKD.
  • A kidney transplant may be needed in people with extensive kidney damage in advanced CKD or renal failure.

• Supportive (palliative /conservative) treatment 
  If you decide not to go for dialysis or a transplant for kidney failure, or if they are not suitable for you, then your health provider will offer you supportive care. Supportive care is aimed at treating, relieving and controlling the symptoms of renal failure and is inclusive of psychological, medical and practical care for both the individuals and their family.

Lifestyle management

You can keep your kidneys in optimal working condition by making some simple lifestyle changes. These include:

• Eating low-sodium meals and avoiding canned or tinned foods, as they are high in sodium.
• Exercise regularly for at least 30 minutes per day. Swimming and brisk walking are good options to be physically active. However, if you have not been physically active before, speak to your health care team to know which exercises are right for you.
• Eating healthy by opting for fresh fruits, vegetables, whole grains, beans, skinless turkey or chicken, lean meat, fish, and low-fat milk or cheese. Avoid sugar-sweetened beverages. Choose low-calorie foods and avoid foods with saturated fat, trans-fat, salt, and sugar.
•  Aim for a healthy weight. Obesity increases the workload on your kidneys. Work with a trained fitness expert and a dietician to keep your weight in check.
• Get enough sleep and aim for 7 to 8 hours of sleep every night. Getting enough sleep is essential for your overall physical, as well as mental health, and can help keep your blood pressure and blood sugar levels in check.
• Quitting smoking as it worsens kidney damage. Smoking cessation will also help to meet your blood pressure goals.
• It is important to deal with stress and depression as chronic stress can raise your blood pressure and your blood glucose levels. Listening to soulful music, focusing calm or peaceful things or activities, or meditating can help to cope with stress.
• Sticking to your medications and take them on time or as prescribed by the doctor.

Prognosis

CKD can range from a mild or asymptomatic condition to a more serious one presenting with a loss of kidney function altogether (kidney failure). 1 in 50 people who have CKD has been reported to suffer from kidney failure. However, even if the disease is mild, your chances of developing other serious medical conditions are high. These conditions include cardiovascular (heart-related) disease, which is inclusive of heart attacks and strokes.

Fortunately, these heart diseases can be managed effectively with medications and healthy lifestyle changes.

Complications

Possible complications of CKD may include the following:

• Anaemia.
• Pain in the bones, joints, and muscles.
• Deteriorating health due to malnutrition.
• Higher chances of getting infections.
• Accumulation of fluid in the tissues surrounding the lungs (pleural effusion) or around the ankles (oedema).
• Stomach or intestinal bleeding.
• Blood sugar fluctuations.
• Cardiovascular or heart-related problems.
• High phosphorous or high potassium levels.
• Nerve damage, especially of those in the legs and the arms.
• Increased levels of the parathyroid hormone.
• Damage to the liver and in certain cases, liver failure.
• Seizures.
• Miscarriages and infertility.