Chronic Kidney Disease (CKD) sometimes resulting from Polycystic Kidney Disease can lead to renal failure if not treated properly. Read more at Meri Sehat.

Chronic Kidney Disease (CKD)

PNS SHIFA

Online Consultation

Syed Intisar Hussain

Overview

Chronic kidney disease (CKD) or chronic kidney failure is characterized by a gradual loss of kidney function. The function of the kidneys is to filter wastes and excess fluids from your blood which are then removed from the body in the urine. However, in the case of advanced chronic kidney disease, there is a dangerous build-up of fluid, electrolytes, and waste in the body. In the early stages of the disease, there are fewer signs or symptoms, or the symptoms might not be evident until the condition has advanced.

&nbsp;

CKD is known to be a leading cause of death and disability not only in Pakistan but also globally. Moreover, chronic kidney disease was the 27th&nbsp;leading cause of death in 1990. However, in 2010, it became the 18th leading cause of death<a href="#accordion ">[1]</a>. Unfortunately, around 1 million people were estimated to have died because of CKD in 2013<a href="#accordion ">[2]</a>. Though despite of being a global concern, the disease continues to affect people from low-income countries. In Pakistan, chronic kidney disease is prevalent among 29.9% of the general population<a href="#accordion ">[3]</a>. However, contrastingly, the lowest prevalence was seen in 12.5% among people aged &ge;40&nbsp;years<a href="#accordion ">[4]</a>.&nbsp;

Treatment for chronic kidney disease primarily focuses on slowing the progression of kidney damage by controlling the cause. Though, in several cases, even controlling the cause does not prevent the damage and the disease may progress to end-stage kidney failure, which is fatal without dialysis or a kidney transplant.

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Signs And Symptoms

In some cases, chronic kidney disease does not present with any signs or symptoms. It is detected either on routine blood or urine tests or through lab tests done for other reasons. Signs and symptoms of chronic kidney disease may include:&nbsp;

<ul>
	<li>Decreased output of urine. Although, the urine output may remain normal occasionally.&nbsp;</li>
	<li>Water retention causes swelling in the legs, ankles, and feet.&nbsp;</li>
	<li>Weight loss and poor appetite&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Fatigue&nbsp;</li>
	<li>Blood in urine&nbsp;</li>
	<li>The urgency to urinate at night&nbsp;</li>
	<li>Difficulty sleeping</li>
	<li>Itchy skin&nbsp;</li>
	<li>Muscle cramps&nbsp;</li>
	<li>Feeling sick&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/migraines-73">Headaches</a>&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/erectile-dysfunction">Erectile dysfunction</a></li>
</ul>

&nbsp;

Causes

Chronic kidney disease is often a result of a combination of different underlying medical conditions. In addition, it can be caused by other conditions that put a strain on the kidneys. It can be caused by:

<ul>
	<li><a href="https://merisehat.pk/disease/hypertension-57">High blood pressure</a> &ndash; High blood pressure can put a strain on the small blood vessels in the kidneys over time, and stop the kidneys from working properly.&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a> &ndash; If the levels of glucose in the blood are high, it can damage the tiny filters in the kidneys.&nbsp;</li>
	<li>High <a href="https://merisehat.pk/disease/cholesterol">cholesterol</a> &ndash; A&nbsp;build-up of fat in the blood vessels that supply the kidneys can make it difficult for them to work properly.&nbsp;</li>
	<li>Kidney infections&nbsp;</li>
	<li>Kidney inflammation</li>
	<li>Polycystic kidney disease</li>
	<li><a href="https://merisehat.pk/disease/kidney-stones-66">Kidney stone</a></li>
	<li>Enlarged prostate</li>
	<li>Long-term use of medications such as non-steroidal anti-inflammatory drugs and lithium</li>
</ul>

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Diagnosis

In several cases, chronic kidney disease is only diagnosed during routine blood or urine tests. Tests for CKD include:&nbsp;

<ul>
	<li>Blood Test &ndash; The blood test will measure the levels of creatinine, a waste product, in the blood. In addition, the blood test will also be used to calculate the milliliters of waste the kidneys should be able to filter in a minute, known as the glomerular filtration rate. Healthy kidneys can filter more than 90 ml/minute. In the case of CKD, the filtration rate will be lower than this.&nbsp;</li>
	<li>Urine Test &ndash; The urine test will check the albumin: creatinine ratio (ACR) or levels of albumin and creatinine. It will also check for blood or protein in the urine. The test gives an accurate picture of how well the kidneys are functioning.&nbsp;</li>
	<li>GFR (Glomerular Filtration Rate) &ndash; To test how well the kidneys are filtering waste. 
	&nbsp;</li>
</ul>

<h5>Stages Of CKD And Its Association With GFR&nbsp;</h5>

The glomerular filtration rate is used to assess how well the kidneys are filtering waste, in addition to what stage the disease is at. The different stages of kidney disease are as follows:&nbsp;

&nbsp;

<ul dir="ltr">
	<li>Stage 1</li>
</ul>

In the 1st stage, the patient&rsquo;s glomerular filtration rate is 90 ml/min per 1.73 meters squared (m2). Though this indicates a normal kidney function, there is other evidence of kidney damage in stage 1, for example, physical damage or traces of protein in the urine.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>Stage 2</li>
</ul>

In the 2nd stage, the GFR is 60-89 ml/min per 1.73 m2. This indicates that the kidneys are working well. However, there are other signs of kidney damage, for example, protein in the urine and physical damage to the kidneys.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>Stage 3&nbsp;</li>
</ul>

In the 3rd stage, the GFR is 30-59 ml/min per 1.73 m2. The stage can be divided into two subcategories:

<ol>
	<li>Stage 3a with GFR of 45⁠&ndash;59 ml/min per 1.73 m2</li>
	<li>Stage 3b GFR of 30⁠&ndash;44 ml/min per 1.73 m2 
	&nbsp;</li>
</ol>

Similarly, although patients in the 3rd stage may not present with any symptoms, some may experience:&nbsp;

<ul>
	<li>Swelling in the hands and feet&nbsp;</li>
	<li>Back pain&nbsp;</li>
	<li>Frequent urination</li>
	<li><a href="https://merisehat.pk/disease/anemia">Anemia</a>&nbsp;</li>
	<li>High blood pressure&nbsp;</li>
	<li>Bone disease&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Stage 4</li>
</ul>

By the 4th stage, the GFR decreases to 15&ndash;29 ml/min per 1.73 m2. In this stage, the kidneys are moderately or severely damaged. A person with stage 4 CKD is likely to experience swollen hands and feet, back pain, and frequent urination. Complications may include bone disease or anemia.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>Stage 5</li>
</ul>

In the 5th stage, the GFR is 15 ml/min per 1.73 m2 or less. Symptoms of kidney failure include:&nbsp;

<ul>
	<li>Itching&nbsp;</li>
	<li>Muscle cramps&nbsp;</li>
	<li>Nausea&nbsp;</li>
	<li>Vomiting&nbsp;</li>
	<li>Swelling in hands and feet&nbsp;</li>
	<li>Back pain&nbsp;</li>
	<li>Frequent urination&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/sleep-apnea-91">Difficulty sleeping</a>&nbsp;</li>
	<li>Difficulty breathing</li>
</ul>

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Other tests used to assess the level of damage to the kidneys include:&nbsp;

<ul>
	<li>Ultrasound scan, MRI scan, and CT scan to check what the kidneys look like, and if there are any blockages.&nbsp;</li>
	<li>Chest X-ray to check whether there are any signs of edema (fluid retention) in the lungs.&nbsp;</li>
	<li>Kidney biopsy to examine the kidney for signs of damage.</li>
</ul>

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<h4>"Chronic diseases can lower your heart rate variability. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and get your reading today!"</h4>

Treatment

Depending on the stage of the kidney disease, people may either need to take medications to treat the symptoms or follow lifestyle changes.&nbsp; 
&nbsp;

<h5 dir="ltr">1. Diet&nbsp;</h5>

Following a proper diet is essential for the treatment of kidney failure. For example, reducing the amount of protein in the diet may help slow down the progression of the disease. Whereas, consuming too much protein may worsen the disease. The dietary changes may help alleviate the symptoms of nausea. In addition, limiting the amount of salt in the diet can control hypertension. Patients with CKD may also need to limit their intake of potassium and phosphorous because of the harmful effects of the minerals. Speak with a doctor or dietician to find out about the best diet for you.&nbsp; 
&nbsp;

<h5 dir="ltr">2. Non-Steroidal Anti-Inflammatory Drugs&nbsp;</h5>

People with chronic kidney disease are advised to avoid non-steroidal anti-inflammatory drugs, for example, ibuprofen, in addition to certain antibiotics. There is an increased risk of side effects when using these medications because of how the kidneys may metabolize these drugs.&nbsp; 
&nbsp;

<h5 dir="ltr">3. End-Stage Treatment&nbsp;</h5>

End-stage treatment generally begins when the kidneys are functioning at 15%. In the case of end-stage renal disease, patients may require a kidney transplant to survive. Other end-stage kidney disease treatment approaches include:&nbsp;

<ul>
	<li>Kidney dialysis&nbsp;</li>
	<li>Kidney transplant 
	&nbsp;</li>
</ul>

<ul>
	<li><a href="https://merisehat.pk/disease/congenital-heart-diseases">Heart disease</a>&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/obesity">Obesity&nbsp;</a></li>
	<li>Family history of CKD&nbsp;</li>
	<li>Inherited kidney disorders&nbsp;</li>
	<li>History of kidney damage&nbsp;</li>
	<li>Old age 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Chronic kidney disease is described as the gradual loss of kidney function.&nbsp;</li>
	<li>It is a leading cause of death and disability in Pakistan&nbsp;and is prevalent among 29.9% of the population.&nbsp;</li>
	<li>Treatment for chronic kidney disease primarily focuses on slowing the progression of kidney damage by controlling the cause. 
	&nbsp;</li>
</ul>

[1] Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., Saran, R., Wang, A.Y.M. and Yang, C.W., 2013. Chronic kidney disease: global dimension and perspectives. The Lancet, 382(9888), pp.260-272.

[2] Abubakar, I.I., Tillmann, T. and Banerjee, A., 2015. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), pp.117-171.

[3] Jafar, T.H., Schmid, C.H. and Levey, A.S., 2005. Serum creatinine as marker of kidney function in South Asians: a study of reduced GFR in adults in Pakistan. Journal of the American Society of Nephrology, 16(5), pp.1413-1419.

[4] Jessani, S., Bux, R. and Jafar, T.H., 2014. Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan-a community based cross-sectional study. BMC nephrology, 15(1), pp.1-9.