Chronic kidney disease (CKD)

Chronic kidney disease (CKD) is a long-term, progressive condition in which the kidneys gradually lose their ability to function properly. The kidneys play a critical role in filtering waste and excess fluids from the blood and removing them from the body in the form of urine. When the kidneys are damaged, waste products can build up in the body, leading to a range of complications.

Classifications of CKD:

Chronic kidney disease (CKD) is typically classified into five stages based on the level of kidney function, as measured by a blood test that looks at creatinine levels and estimated glomerular filtration rate (eGFR):

• Stage 1: Kidney damage with normal or high eGFR (≥90 mL/min/1.73 m²).In this stage, there is evidence of kidney damage, such as protein in the urine or abnormal imaging results, but the kidney function is normal or near-normal.

• Stage 2: Kidney damage with mild decrease in eGFR (60-89 mL/min/1.73 m²).In this stage, there is evidence of kidney damage as in Stage 1, but there is also a slight decrease in kidney function.

• Stage 3: Moderate decrease in eGFR (30-59 mL/min/1.73 m²).In this stage, there is a moderate decrease in kidney function. Patients may experience symptoms such as fatigue, swelling, and changes in urination patterns.

• Stage 4: Severe decrease in eGFR (15-29 mL/min/1.73 m²).In this stage, there is a severe decrease in kidney function. Patients may experience symptoms such as nausea, vomiting, itching, and muscle cramps.

• Stage 5: Kidney failure or end-stage renal disease (eGFR <15 mL/min/1.73 m²).In this stage, the kidneys have lost almost all of their function. Patients require dialysis or a kidney transplant to survive.

Causes:

The most common causes of chronic kidney disease (CKD) are high blood pressure and diabetes. Other causes can include:

• Kidney inflammation: Inflammation of the kidneys can damage them and lead to CKD. This can be caused by infections, such as glomerulonephritis, or autoimmune diseases, such as lupus.

• Obstructive causes: Blockages in the urinary tract, such as kidney stones or tumors, can cause urine to back up into the kidneys and cause damage over time.

• Inherited disorders: Some inherited disorders, such as polycystic kidney disease, can cause cysts to form in the kidneys, leading to damage over time.

• Long-term use of certain medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics, can cause kidney damage if used for long periods of time or at high doses.
• Prolonged dehydration: Chronic dehydration can cause damage to the kidneys and increase the risk of kidney disease.

• Other diseases and conditions: Other conditions that can cause or contribute to CKD include HIV/AIDS, sickle cell anemia, and multiple myeloma.

Sign and Symptoms:

In the early stages of chronic kidney disease (CKD), symptoms may be minimal or absent altogether. As the disease progresses, the following symptoms may develop:

• Fatigue and weakness: As kidney function declines, the body may produce less erythropoietin, a hormone that helps produce red blood cells. This can lead to anemia and fatigue.

• Swelling: As the kidneys become less efficient at removing excess fluids from the body, swelling (edema) can occur in the feet, ankles, legs, and/or face.

• Changes in urination: The frequency, amount, and color of urine may change. Urine may be foamy or contain blood.

• Shortness of breath: Fluid buildup in the lungs can cause difficulty breathing.

• High blood pressure: CKD can lead to high blood pressure, which can cause further kidney damage.

• Nausea and vomiting: Waste products build up in the blood and can cause nausea and vomiting.

Risk Factors of CKD:

There are several risk factors that can increase a person’s likelihood of developing chronic kidney disease (CKD). These include:

• Diabetes
• High blood pressure
• Family history of kidney disease
• Age
• Obesity
• Smoking
• Cardiovascular disease
• Ethnicity: Certain ethnic groups, such as African Americans.

Complications:

Chronic kidney disease (CKD) can lead to a range of complications, particularly if it is not diagnosed and managed early. Some of the common complications of CKD include:

• Cardiovascular disease: People with CKD are at an increased risk of developing heart disease, including heart attacks and strokes.

• Anemia: As kidney function declines, the production of red blood cells can decrease, leading to anemia.

• Bone disease: CKD can lead to bone disease, including osteoporosis and fractures.

• Fluid buildup: As the kidneys become less efficient at removing excess fluids from the body, fluid buildup can occur in the lungs, causing difficulty breathing or in other parts of the body, causing swelling.

• Malnutrition: CKD can cause a loss of appetite and weight loss, leading to malnutrition.

• Nerve damage: CKD can cause nerve damage, leading to tingling or numbness in the hands and feet.

• Kidney failure: In severe cases, CKD can progress to end-stage renal disease (ESRD), which requires dialysis or kidney transplantation.

Diagnosis of CKD:

Chronic kidney disease (CKD) can be diagnosed through a variety of tests and evaluations. The following are some common methods used for diagnosing CKD:

• Blood tests: Blood tests, such as serum creatinine tests, are used to measure the level of waste products in the blood. The glomerular filtration rate (GFR) can also be calculated based on the creatinine level. A GFR of less than 60 mL/min/1.73 m² for three or more months is indicative of CKD.
• Urine tests: Urine tests, such as a urinalysis, are used to detect the presence of blood or protein in the urine, which may indicate kidney damage.
• Imaging tests: Imaging tests, such as an ultrasound or CT scan, may be used to evaluate the size and shape of the kidneys and detect any abnormalities.
• Kidney biopsy: A kidney biopsy involves taking a small sample of kidney tissue to examine for signs of damage or disease.

Medical history and physical examination: A healthcare professional will evaluate the patient’s medical history and perform a physical examination to look for signs of kidney damage, such as high blood pressure or edema.

Treatment of CKD:

The treatment of chronic kidney disease (CKD) depends on the stage and severity of the condition. The goal of treatment is to slow the progression of the disease, manage complications, and improve the patient’s quality of life. Here are some common treatments for CKD:

Medications: Medications may be prescribed to manage blood pressure, reduce cholesterol levels, control blood sugar levels in people with diabetes, and treat anemia.

• Medications to control blood pressure: High blood pressure is a common cause and complication of CKD. Medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may be prescribed to lower blood pressure and protect the kidneys.
• Medications to lower cholesterol levels: High cholesterol levels can damage blood vessels and lead to kidney damage. Statins and other medications may be prescribed to lower cholesterol levels.
• Medications to control blood sugar levels: Diabetes is a leading cause of CKD. Medications such as insulin or oral hypoglycemic agents may be prescribed to control blood sugar levels.
• Medications to treat anemia: CKD can cause anemia, which is a shortage of red blood cells. Medications such as erythropoietin-stimulating agents (ESAs) may be prescribed to stimulate the production of red blood cells.
• Medications to control calcium and phosphorus levels: High levels of calcium and phosphorus in the blood can lead to bone disease and other complications in CKD. Medications such as calcium carbonate and phosphate binders may be prescribed to lower calcium and phosphorus levels.
• Medications to treat fluid overload: In advanced stages of CKD, excess fluid may build up in the body, causing swelling and other complications. Medications such as diuretics may be prescribed to remove excess fluid.

Dialysis: In advanced stages of CKD, dialysis may be required to remove waste products and excess fluid from the body.

Kidney transplant: A kidney transplant may be an option for people with end-stage renal disease (ESRD) who are suitable candidates.

Management of CKD:

The management of chronic kidney disease (CKD) aims to slow the progression of the disease, prevent or manage complications, and improve the quality of life of the patient. The following are some common methods used for managing CKD:

• Diet and nutrition: A healthy diet that is low in sodium, phosphorus, and protein may be recommended to manage CKD. A dietitian can help create a meal plan that meets the patient’s nutritional needs.
• Fluid intake: The patient may need to restrict fluid intake to prevent fluid buildup and manage blood pressure.
• Physical activity: Regular physical activity can help manage blood pressure and improve overall health.
• Quitting smoking: Smoking can increase the risk of cardiovascular disease, which is a common complication of CKD. Quitting smoking can help manage CKD and prevent complications.
• Avoid prolonged use of pain relievers: Overuse of pain relievers, such as ibuprofen and aspirin, can damage the kidneys.

Conclusion:

It is a condition in which the kidneys gradually lose their function over time. It is a progressive and potentially life-threatening condition that can lead to kidney failure and the need for dialysis or a kidney transplant. Early diagnosis and treatment of CKD can help slow the progression of the disease and prevent or manage complications. Regular checkups and screenings are important for people at risk for CKD to detect the condition early and manage it effectively.