Chronic Kidney Disease - Causes, Symptoms, Risk Factors, Diagnosis, Complications, and Treatment

What Is Chronic Kidney Disease?

Kidneys are organs whose primary function is to filter waste and excess fluids from the blood. In chronic kidney disease, there is a gradual loss of the function of filtering the blood and so there is an accumulation of more fluid and waste in the body. In very severe cases, the build-up can reach dangerous levels. But, initially, there are no to few symptoms felt by the patient. Therefore, many do not realize they have a problem until kidney function has deteriorated to a great extent.

What Are the Causes of CKD?

• Long-standing uncontrolled diabetes.

• Kidney damage due to high blood pressure.

• Obstruction of urine flow due to a kidney stone.

• Vesicoureteral reflux, a condition that causes the urine to move back to the kidneys.

• Recurrent infections such as pyelonephritis.

• Prostate enlargement or a tumor.

• Polycystic kidneys.

• Abuse of over-the-counter medications and illegal substances.

• Exposure to lead and other toxic chemicals.

What Are the Signs and Symptoms of CKD?

• Nausea and vomiting.

• Loss of appetite.

• Generalized fatigue.

• Sleep disturbance.

• Chest pain.

• High blood pressure.

• Decreased urinary output.

• Decreased mental sharpness.

• Dark urine.

• Blood in the urine.

• Dryness of skin.

• Reduced mental clarity.

• Muscle twitches and cramps.

• Swelling of feet and hands.

• Puffy face.

• Persistent itching.

• Proteinuria, a condition where a large amount of protein is excreted in the blood.

• Increased frequency of urination at night.

What Are the Risk Factors?

1. Diabetes.

2. Hypertension.

3. Obesity.

4. Smoking.

5. A family history of kidney diseases.

6. Age over 60 years.

How to Get the Diagnosis?

• Blood test.

• Urine test.

• Urine output measurement.

• Albumin and serum creatinine.

• CT or Ultrasound scan of kidneys.

• Sometimes, a biopsy may be ordered.

• GFR test (Glomerular Filtration Rate).

How GFR Plays an Important Role?

Glomerular Filtration Rate (GFR) is the calculated value to find out how well the blood is purified by kidneys. When kidneys aren't working well, important substances that should remain in the body, for example, protein, are filtered out, and wastes that should be removed build up in the blood. A normal GFR value is more than or equal to 90 mL/min. The value of GFR tends to decrease due to aging. So having a GFR value between 60 mL/min and 89 mL/min is considered normal for elderly people.

What Are the Stages of Chronic Kidney Disease?

The stages of CKD are:

• Stage 1 - Normal or high GFR of more than 90 mL/min (milliliter per minute).

• Stage 2 - Mild CKD with GFR value between 60 and 89 mL/min.

• Stage 3A - Moderate CKD with GFR value between 45 and 59 mL/min.

• Stage 3B - Moderate CKD with GFR value between 30 and 44 mL/min.

• Stage 4 - Severe CKD with GFR value between 15 and 29 mL/min.

• Stage 5 - End-stage CKD with GFR of less than 15 mL/min.

What Are the Complications of CKD?

• Swelling in the arms and legs due to fluid retention. Accumulation of fluid in the feet is known as pedal edema.

• Pulmonary hypertension and edema (high blood pressure and fluid in the lungs).

• Increased potassium levels in the blood (hyperkalemia). This might affect the functioning of the heart and result in life-threatening complications.

• Heart disease.

• Brittle bones increase the risk of bone fractures.

• Anemia.

• Decreased sex drive.

• Erectile dysfunction.

• Loss of fertility.

• Difficulty in concentration or seizures because of damage to the central nervous system.

• Increased risk of infection as the immune response is affected.

In a span of 10 to 15 years, CKD can progress to kidney failure or end-stage renal disease (ESRD). Usually, kidneys are highly adaptable organs and make up their loss of function by various compensatory mechanisms. That is the reason there are no obvious symptoms initially. Later, as they fail, there is a need for an artificial filtering process known as dialysis or in some cases, a renal transplant may be required for survival. In both cases, the chance of success is good. While without treatment, the survival rate is only a few months, with recent advancements and treatment modalities, the life expectancy goes up to many years.

When Is Dialysis Done?

When the GFR has come down to 15 mL/min, It means that the kidney has come to the end-stage kidney. The kidney helps in removing waste, salt, and extra water to prevent them from building up in the body. It helps in keeping a safe level of certain chemicals in your blood, such as potassium, sodium, and bicarbonate.

What Is Hemodialysis?

• In hemodialysis, an artificial kidney called hemodialyzer is used to remove wastes. Extra chemicals and fluid from your blood will also be removed. In order to get the blood into the artificial kidney, the doctor makes an opening into the blood vessels. This can be achieved by minor surgery to your arm or leg. In certain cases, it may be necessary to make it a bigger vessel by joining an artery and vein.

• The duration of the treatment is 4 hours and has to be done three times a week.

• Dialysis will not cure the underlying kidney disease. This will substitute for the functioning of a healthy kidney.

What Is the Treatment?

• There is no permanent cure for CKD, but the treatment focuses on making lifestyle changes. Focus on controlling chronic conditions such as diabetes and hypertension, if present.

• Take a low sodium and potassium diet.

• Exercise regularly for at least 30 minutes a day.

• Maintain your BMI (body mass index) in the ideal range.

• Quit smoking, if you do.

• Stop consuming alcohol.

What Does a Kidney Transplant Mean?

Kidney transplantation means swapping a sick kidney for a healthy one. Healthy kidneys can come from living donors, like family or friends, who can still live fine with one kidney. Or they can come from deceased donors who chose to donate their organs. Both donors are carefully checked to make sure they match and do not carry any diseases. Usually, it takes about three to five years to get a kidney from a deceased donor. But getting one from a living donor is usually faster.

Is It Possible to Prevent Chronic Kidney Disease?

Here are some measures that help to prevent chronic kidney disease (CKD):

• Control high blood pressure.

• Control blood sugar levels if one has diabetes.

• Adopt a balanced diet.

• Avoid smoking or using tobacco products.

• Engage in at least 30 minutes of physical activity on at least five days per week.

• Keep a healthy weight.

• Use over-the-counter pain relievers strictly as directed; excessive intake can harm the kidneys.

• Limit consumption of alcoholic beverages.

What Is the Diet Plan for CKD?

Foods to be avoided: Banana, coconut, dates, lemon, white beans, black beans, orange, and tomatoes.

Food to be consumed: Papaya, apple, guava, olive oil, cardamom, carrot, garlic, ginger, turnip, radish, wheat, rice, and low-fat milk.

What Are the Differential Diagnoses?

• Renal artery stenosis.

• Urinary obstruction.

• Wegner’s granulomatosis.

• Systemic lupus erythematosus.

When Should One Seek Medical Care?

Schedule an appointment with the doctor if one experiences any signs or symptoms of kidney disease. Detecting it early could potentially halt its progression to kidney failure. Suppose someone is suffering from any medical condition that heightens the risk of kidney disease. In that case, the doctor might monitor their blood pressure and kidney function through urine and blood tests during the follow-up visits. Consult a doctor to determine if these tests are appropriate for a particular person.

The majority of individuals do not exhibit symptoms of chronic kidney disease (CKD) until it has progressed to a severe stage. If anyone experiences more fatigue than usual, loss of appetite, increased frequency of urination, difficulty sleeping or concentrating, muscle cramps, itchy skin, or swelling in the feet and ankles, it is crucial to reach out to a healthcare provider.

Conclusion:

Kidneys are the primary organ required for filtering waste from the body. If this gets affected it can result in severe issues. Although chronic kidney disease (CKD) can result in fatalities, numerous individuals diagnosed with this condition lead fulfilling and extended lives. The majority of those who receive treatment for kidney disease and effectively manage their condition do not advance to kidney failure or experience mortality