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About Chronic Kidney Disease

About CKD

What is chronic kidney disease?
What are symptoms of kidney failure?
There are less or no symptoms in mild to moderate kidney failure. Thus, early or even late kidney failure is usually detected on a preventive health check-up.
Swelling over body sometimes it is first noticed over feet (around ankles) or over face (around eyes).
Nausea, vomiting, hiccoughs.
Breathlessness on exertion or physical activity.
Low sugar levels (hypoglycaemia) in case of diabetic related kidney failure.
Generalized weakness, easy fatigability.

Life threatening presentation
a. Convulsions
b. Abnormal heart rate (due to high potassium)
c. Chest pain (pericarditis)
d. Altered sensorium (uremic encephalopathy)
e. Severe metabolic acidosis

How to delay chronic kidney disease progression?
Detection of kidney disease at an early stage.
Control of blood pressure (less than 135/85 mmHg, less than 130/80 mmHg in proteinuria cases)
Control of blood sugar (HbA1c less than 7%)
Avoid nephrotoxic agents (common painkillers, some antibiotics and indigenous agents) and many others
Proper treatment of infections.
Proper treatment of urine outflow obstruction.
Avoid tobacco consumption and smoking
Healthy lifestyle
Very high protein intake
Proper treatment of stones
Some kidney harmful or nephrotoxic medications

Diabetic kidney disease
Kidney disease is very common in diabetic patients. In present scenario life style related diseases like obesity, diabetes, and coronary heart disease related kidney disease are very common. Swelling over feet or face is generally a common symptom in diabetic kidney disease.
Blood sugar level should be:
• Between 70 and 130 before eating ;
• Less than 183 about 2 hours After eating ;
• Between 90 and 150 at bedtime.

How to monitor kidney related complications in a diabetic patients?
• Following to be monitored at least 3 to 6 monthly.
• Urine for proteinuria-urine for micro albuminuria, urine for albumin(dipstick)
• Serum creatinine level.

Whether my both kidneys are affected?
Even a single kidney is enough to perform all functions of kidney (remove all toxins, and other functions) from our body. If serum creatinine level is high then either both kidneys (if both kidneys are working) are affected or if there is a single functioning kidney and that only is affected.
Kidney disease run in family
There are few kidney diseases common in family members. Following kidney diseases are:
1 Diabetes related kidney disease.
2 Polycystic kidney disease (PKD) – autosomal dominant PKD or ADPKD is passed from parent to child by an autosomal dominant type of inheritance. Thus if one parent has the disease, each child has a 50-50 chance of developing the disease.
3 Fabry disease- it involves major organs.
4 Kidney stones
5 High Blood Pressure
6 Alport Syndrome- leading to CKD (hereditary nephritis), deafness and eye abnormalities.
7 Unknown family related kidney disease.

2. How to manage chronic kidney disease?

How to know how much my kidneys are working?
Glomerular-filtration Rate: It is a rate at which blood is filtered through glomeruli in a minute. It tells us that how much the kidneys are functioning. It can be measured or estimated. There are various formulas for measuring GFR:
1. Cockcroft gault formula (CGF)
2. The Modification of Diet in Renal Disease (MDRD) equation
3. Creatinine clearance (Urine)
4. Others
How to estimate GFR:
1. Inulin
2. DTPA
Most commonly used are CGF and DTPA
Using this GFR we can differentiate chronic kidney disease (CKD) into different stages
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 5 ND (not on dialysis) Stage 5 D (on dialysis) Stage 5 T (post-transplant) Patient can himself calculate GFR easily by computed formulas which are easily available on mobile applications and internet.

How to prevent kidney diseases?
Kidney diseases are common in:-
A. Diabetic patients
B. Hypertensive patients
C. Coronary heart diseases patient
D. Cerebrovascular disease patient
E. Over weight and Obese patient
F. Persons who are on long term kidney harmful medicines like painkillers (NSAIDS, lithium), some anti-biotic, some indigenous medication.
G. Smokers and chronic tobacco users.
H. Patients having recurrent urine infections.
I. Patients having multiple kidney stones
J. Persons in whom family member is suffering from kidney disease
K. Some genetic related kidney disease.
L. Urine outflow obstructive diseases.
M. Hyperuricemia and gout.
N. Connective tissue diseases like sjogrens, rheumatoid, sarcoidosis and others.
O. Others

If there are above risk factors than routinely kidney function test (creatinine) and urine routine examination to be done.
If any modifiable risk factor is present than we need to modify them.

Medicines for chronic kidney disease (CKD)
In managing CKD there are lots of medicines are required. There is a major issue of pill burden (number of pills per day). Following medicines are used in treating CKD.
• Hypertension-anti-hypertension medicines.
• Anemia-oral or intravenous iron, injection erythropoietin, darbepoetin, mircera.
• Antacids, proton pump inhibitors
• Calcium Supplements.
• Phosphate binders
• Vitamin-D active or Cholecalciferol.
• Vaccination- To prevent hepatitis B, Pneumonia, flu.
• Multivitamins.
• To control acidosis.
• Medicine related to primary disease.
• And others.

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