Did you know that after every 30 min, your kidneys, which are about the size of a pc mouse, cleanse all of your blood? They put forth a lot of effort to get rid of wastes, toxicants, and extra fluid. They also aid in the management of blood pressure, the stimulation of RBC synthesis, the maintenance of healthy bones, and the regulation of vital blood molecules. Healthy kidneys are essential for optimal health, but the chronic renal disease affects more than one out of every seven individuals.

What is Chronic Kidney Disease?

Chronic kidney disease (CKD) is a condition in which your kidneys are weakened and unable to process the filtration of blood as effectively as they ought to. The condition is referred to as “chronic” since the harm to your kidneys occurs gradually over time. Wastes might pile up in your system as a result of this injury. The kidneys’ primary function is to filter excess water and wastes from your blood in order to produce urine. The kidneys balance the salts and minerals in the blood, like calcium, phosphorus, sodium, and potassium, to keep your body running smoothly. Your kidneys also produce hormones that aid in blood pressure regulation, red blood cell production, and bone health. To stay healthy if your kidneys collapse, you’ll require kidney transplantation or dialysis. The earlier you recognize that you have kidney illness, the earlier you can take steps to safeguard your kidneys.

Who is at a higher risk of developing chronic kidney disease?

If you have any of the following, you may be at danger of kidney disease:

1. Diabetes – is the most common reason of chronic kidney disease. Diabetes causes hyperglycemia, commonly known as blood sugar, which damages the capillaries in your kidneys. 

2. Hypertension – The next primary reason for Chronic kidney disease is hypertension. High blood pressure, like high blood sugar, can harm the capillaries in your kidneys. 

3. Cardiovascular diseases – There is a relationship between renal illness and cardiovascular problems, according to studies. Heart disease puts individuals at greater risk for renal disease and vice versa. Scientists are trying to figure out how renal illness and cardiovascular disease are connected.

4. Renal illness in the family – You are at the potential for chronic kidney disease if your parents or siblings have kidney problems. Renal illness is a condition that runs in families. Advise relatives to be checked if you have a renal illness. 

Kidney illness becomes more likely as you become older. Kidney disease is more common if you have hyperglycemia, hypertension, or cardiovascular illness for a prolonged time. African Americans, Hispanics, and American Indians are more likely to have chronic kidney disease. The increased risk is mostly owing to these populations’ higher incidence of hypertension. Other probable causes of this elevated risk are being investigated by scientists.

Cause Of Chronic Kidney Disease ​

Chronic kidney disease is commonly known as a condition in which the kidney is unable to or has a problem fully filtering the fluids present in our body. In this situation, the kidney cannot do its basic function of filtration because of the damage caused to it over a prolonged period of months or even years. 

There can be several conditions and diseases that can lead to chronic kidney disease, which include:

  • Diabetes (type 1 or type 2)
  • High blood pressure
  • History of Polycystic kidney disease
  • Glomerulonephritis (the cells of the kidney swell in this condition)
  • Interstitial nephritis (inflammation of the kidney’s surrounding structure)
  • Diseases and conditions that cause chronic kidney disease include:
  • Extended urinary tract obstruction is caused by conditions like kidney stones, enlarged prostate, and even some cancers.
  • Vesicoureteral reflux (urine backs up into the kidneys)
  • Pyelonephritis, a kidney infection 

What are the signs and symptoms of chronic kidney disease (CKD)?

Early Chronic kidney disease may develop no symptoms, and you might be perplexed as to how you might have CKD and seem perfectly normal. Our kidneys have more ability to function than is required to make us healthier. You can, for example, give one kidney while remaining fit. 

You can have renal dysfunction without any indications because your kidneys are still performing sufficient functions to maintain your feeling well despite the impairment. For many patients, blood and urine tests are the only means to determine whether or not they have kidney disease.

As the renal illness progresses, a person’s body may swell, a condition known as edema. Edema occurs when the kidneys are unable to eliminate excess fluid and salt.

Severe CKD symptoms include:

  • Chest discomfort
  • Dry skin itchiness or numbness tiredness headaches
  • Urination (increased or reduced)
  • A decrease in appetite
  • Cramping in the muscles
  • Nauseousness, shortness of breath, and sleep disturbances
  • Unable to concentrate vomiting
  • Slimming down
  • Anemia, bone disease, and malnutrition are all possible side effects of CKD.

Chronic kidney disease has five phases.

Kidney disease is categorized into five phases by the National Kidney Foundation (NKF). Because each stage necessitates various tests and treatments, this aids doctors in providing the best care possible. Doctors use the glomerular filtration rate (GFR), a numerical formula that takes into account a person’s age, gender, and serum creatinine level to assess the stage of kidney disease (identified through a blood test). The waste product creatinine, which is produced by muscular action, is a significant measure of renal function. When the kidneys are performing properly, they eliminate creatinine from the blood; however, when renal function declines, creatinine levels in the blood grow.

Stage 1

An individual with stage 1 chronic kidney disease (CKD) has kidney impairment and a glomerular filtration rate (GFR) of less than or equal to 90 ml/min. There are generally no signs or indications that the kidneys have been harmed. Because kidneys work well even when they aren’t fully functional, most people are unaware that they have stage 1 CKD. 

Stage 1 kidney disease symptoms include:

Creatinine or urea levels in the blood are higher than usual.

Urine with blood or protein

An MRI, CT scan, ultrasound, or contrast X-ray may reveal kidney disease.

Polycystic kidney disease runs in the family (PKD)

Diagnosing and treating stage 1 renal disease

Monitoring for protein in the urine and serum creatinine on a regular basis can reveal whether kidney impairment is advancing. Kidney disease can be slowed down by leading a healthy lifestyle. 

People with stage 1 CKD are advised to:

  • Include a variety of cereals (particularly whole grains), fresh fruits, and vegetables in your diet.
  • Switch to a low-saturated-fat, low-cholesterol, and moderate-to-moderate-total-fat diet.
  • Limit your intake of high-sugar, high-sodium refined, and processed meals.
  • Select and prepare foods that are low in sodium or contain high-sodium elements.
  • Go for a healthy weight and do some exercise every day.
  • Maintain a healthy protein intake, as advised by a kidney nutritionist.
  • Make sure you’re getting enough calories.
  • Follow your doctor’s vitamin and mineral recommendations.
  • Unless blood levels are very high, potassium and phosphorus are typically not limited.
  • Maintain a healthy blood pressure level.
  • For diabetics, 125/75 is recommended.
  • Non-diabetes and non-proteinuria patients should have a blood pressure of 130/85.
  • Non-diabetes with proteinuria: 125/75
  • Maintain control of their blood sugar or diabetes.
  • Have frequent medical visits that include a serum creatinine test to determine GFR.
  • Take their medications as directed by their doctor.
  • Exercise on a regular basis.
  • Quit smoking.

Living with stage 1 renal illness – While there is no treatment for kidney disease, it may be feasible to halt or reduce its progression. In many circumstances, proper medication and lifestyle adjustments may help an individual and their renal life longer and healthier lives.

Stage 2

An individual with stage 2 chronic kidney disease (CKD) has modest kidney impairment and a glomerular filtration rate (GFR) of 60-89 ml/min. There are generally no signs or indications that the kidneys have been harmed. Because kidneys work well even when they aren’t fully functional, most people are unaware that they have stage 2 CKD. If people discover they have stage 2 kidney disease, it’s generally because they were being checked for anything other than renal illness, including hyperglycemia or hypertension, the 2 most prevalent factors of kidney illness.

Stage 2 kidney disease symptoms include:

  • Creatinine or urea levels in the blood are higher than usual.
  • Urine with blood or protein
  • An MRI, CT scan, ultrasound, or contrast X-ray may reveal kidney disease.
  • Polycystic kidney disease runs in the family (PKD)
  • Diagnosing and treating stage 2 renal disease
  • Screening for protein in the serum and urine creatinine on a regular basis can reveal whether kidney impairment is advancing. Kidney disease can be slowed down by leading a healthful lifestyle. 

Living with stage 2 renal illness – While there is no treatment for kidney disease, it may be able to halt or reduce its progression. In many circumstances, proper medication and lifestyle adjustments may help an individual and their kidneys live relatively long and better lives.

Stage 3

The renal deterioration in an individual with stage 3 chronic kidney disease (CKD) is serious. This stage is divided into two parts: Stage 3A has a glomerular filtration rate (GFR) of 45-59 mL/min, while Stage 3B has a GFR of 30-44 mL/min. Toxic waste can cause a buildup when kidney function degrades, resulting in a disease termed “uremia.” An individual with renal illness in stage 3 is more prone to have problems such as elevated blood pressure, anemia, or early bone disease.

Stage 3 kidney disease symptoms include:

  • Fatigue
  • Difficulty breathing, fluid retention, and swelling (edema) of the extremities
  • Urination can become frothy, dark orange, brown, tea-colored, or red if it includes blood, or it can become more or less often than usual.
  • Their backs hurt from kidney discomfort.
  • Muscle pains or anxious legs might disrupt sleep.

See a doctor if you have stage 3 CKD – Patients with stage 3 CKD should consult a nephrologist if their condition worsens. Patients are examined and lab tests are performed by nephrologists in order to acquire data about their situation and provide the finest treatment suggestions. The purpose of a nephrologist is to assist their patient in keeping their kidneys functioning as long as feasible.

Stage 4

An individual with stage 4 chronic kidney disease (CKD) has substantial kidney impairment and a glomerular filtration rate (GFR) of 15-30 ml/min. Hemodialysis or renal transplantation is expected in the near future for someone with stage 4 CKD.

As kidney function deteriorates, waste materials accumulate in the blood, resulting in uremia. A person with kidney disease at stage 4 is more prone to have consequences such as high blood pressure, anemia (a lack of red blood cells), bone disease, heart disease, and other cardiovascular disorders.

Stage 4 kidney disease symptoms include: 

  • Fatigue
  • Shortness of breath, fluid retention, and swelling (edema) of the extremities
  • Changes in urination 
  • Their backs hurt from kidney discomfort.
  • Muscle aches and pains or restless legs can disrupt sleep.
  • Vomiting and/or nausea
  • On the tongue, the flavor turns to a metallic taste.
  • Urea accumulation in the blood causes bad breath.
  • Loss of appetite: Some people report a metallic taste in their mouth or poor breath, while others say they don’t feel like eating.
  • Difficulty concentrating: It is possible to have difficulty accomplishing simple tasks such as balancing a checkbook or focusing on reading the newspaper.

When you suffer from stage 4 CKD, you should consider the following therapeutic options:

1. Hemodialysis: It is a procedure that can be performed in a hospital or at home with the help of a carer. To clear up toxins that the kidneys can’t eliminate efficiently, dialysis machinery takes a tiny portion of a patient’s blood via a man-made membrane known as a dialyzer or artificial kidney. After that, the filtered blood is restored to the body.

2. Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free procedure that does not require the assistance of a care partner. PD can be done at work or at home.

3. Kidney transplantation is a popular therapeutic option since it does not involve as many special diets as hemodialysis or PD.

4. Meeting with a dietician: You may be recommended to a nutritionist if you have level 4 CKD. As eating is such an essential aspect of therapy, the dietician will go through the findings of a person’s lab tests and prescribe a meal plan that is tailored to their specific needs. A healthy diet can assist to maintain kidney function and general health.

Diet for Stage 4 of CKD:

  • Lowering protein intake could help reduce the development of protein waste in stage 4 CKD
  • Including grains, fruits, and veggies in your diet
  • Phosphorus restriction helps maintain normal PTH levels, prevents bone disease, and even preserves existing kidney function.
  • If blood potassium concentrations are abnormally high, potassium restriction is necessary.
  • Calcium intake reduction
  • Those with diabetes should limit their carb intake.
  • Lowering cholesterol by reducing saturated fats
  • By avoiding processed and pre-packaged foods, individuals with high blood pressure or fluid retention can reduce their sodium intake.
  • Calcium restriction if blood calcium concentrations are excessive
  • Consuming water-soluble supplements like Vit C (100 mg per day) and Vit B complex, or skipping any other heavy nutritional supplements totally (unless approved by the nephrologist)

Handling stage 4 CKD – In addition to consuming well and taking prescribed medications, frequent exercise and quitting smoking will help you stay healthy. Patients should discuss an exercise regime with their physicians. Specialists can also offer you advice on how to quit smoking.

Stage 5

Final renal illness (ESRD) is defined as a glomerular filtration rate (GFR) of 15 ml/min or lower in an individual with stage 5 CKD. The kidneys have exhausted virtually all of their capacity to do their function properly at this stage of renal illness, and hemodialysis or kidney transplantation will be required to survive.

Stage 5 kidney disease symptoms include: 

  • Appetite loss.
  • Vomiting or nausea
  • Headaches
  • Being unable to focus due to exhaustion
  • Itching
  • Urine production is little or non-existent.
  • Swelling around the eyes and ankles, in particular
  • Muscle spasms
  • Tingling sensations in the hands or feet
  • Skin color changes
  • Pigmentation of the skin has increased.

Toxicants build up in the blood when the kidneys are no longer able to eliminate waste and liquids from the body, giving an overall sensation of bad health. Other activities that the kidneys can no longer do include controlling blood pressure, generating the hormone that aids in the formation of red blood cells, and stimulating vitamin D for strong bones. 

If you’ve been detected with phase 5 CKD, you should consult a nephrologist as soon as possible. A doctor who specializes in renal illness, dialysis, and transplantation. The doctor will help you determine if hemodialysis, peritoneal dialysis, or kidney transplantation is ideal for you, and will also prescribe dialysis access. Your nephrologist will create an overall treatment plan for you and oversee your medical care.

A dialysis is a therapy option for those who have reached stage 5 of chronic kidney disease:

When patients start dialysis, they usually feel a lot better. As wastes are extracted from the bloodstream and medications are used to substitute the duties that the kidneys can no longer execute, patients discover that they can lead a normal life. There are two types of dialysis treatments for people with stage 5 kidney disease.

1. Hemodialysis: It is a procedure that can be performed in a hospital or at home with the help of a carer. To clear up toxins that the kidneys can’t eliminate efficiently, dialysis machinery takes a tiny portion of a patient’s blood via a man-made membrane known as a dialyzer or artificial kidney. After that, the filtered blood is restored to the body.

2. Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free procedure that does not require the assistance of a care partner. PD can be done at work or at home.

3. Kidney transplantation is a popular therapeutic option since it does not involve as many special diets as hemodialysis or PD.

When at stage 5 CKD, either dialysis or a kidney transplant is necessary to continue living.

For stage 5 CKD, a healthy diet may include:

  • Including grains, fruits, and vegetables, but restricting or eliminating whole grains and high-phosphorus or potassium fruits and vegetables.
  • A low-saturated-fat, low-cholesterol, moderate-total-fat diet, especially if your cholesterol is excessive or you have diabetes or cardiovascular disease.
  • Limit your intake of high-sodium refined and processed meals, and cook with less salt or high-sodium components.
  • Trying to maintain a healthy lifestyle by eating enough calories and doing as much physical exercise as you can each day.
  • If required, reduce calcium intake.
  • Limiting fluid consumption
  • Protein intake should be increased to the level established by a dietitian’s evaluation of individual needs to compensate for dialysis treatment losses.
  • Take specific renal vitamins that are high in water soluble B vitamins and include no more than 100 mg of vitamin C, vitamin D, and iron, as needed.

Causes:

  • Diabetes type 1 or type 2
  • Blood pressure that is too high
  • Glomerulonephritis is an infection of the filtration units of the kidney (glomeruli)
  • Irritation of the tubules and associated components of the kidney is known as interstitial nephritis.
  • Long-term blockage of the urinary system is caused by disorders such as an enlarged prostate, kidney stones, and several malignancies.
  • Urine backs up into your kidneys, a disease known as vesicoureteral reflux.
  • Pyelonephritis is a recurrent kidney infection.

Factors that are at risk:

  • Diabetes
  • Blood pressure that is too elevated
  • Heart (cardiovascular) illness is a condition that affects the heart and circulatory system.
  • Smoking \ Obesity
  • Kidney structural abnormality when people become older
  • Use of drugs that can harm the kidneys on a regular basis

Investigation and Diagnosis of CKD

The first step that a nephrologist takes for the diagnosis of CKD, he/she discuss your family’s medical history and your medical history with you. You may get a questionnaire form to fill, or the nephrologist might discuss it directly with you. The questions might include:

  • Your blood pressure status.
  • Any medications you might be taking that could affect kidneys if you have been having issues or are facing a changed pattern in your urinary habits.
  • Family history of kidney diseases.

This is followed by a physical exam and any physical symptoms that might indicate kidney disease. This includes tests for heart issues and neurological exams.

 Certain procedures and tests are essential when diagnosing kidney diseases. Some are mentioned below:

  • Blood tests: levels of urea, creatinine and many other tests in your blood gives an insight into kidney functioning. 
  • Urine tests: Any abnormalities in urine are a direct link to the detection of any kind of kidney disease, as one of the basic functions of the kidney is to make.
  • Imaging tests. Ultrasound and MRI scans of the body can show the kidneys’ size and structure.
  • A sample of kidney tissue for testing.: nephrologists even recommend a kidney biopsy to get a tissue of the kidney so that it can be tested for further information.

Treatment OF CKD

The treatment for any kind of kidney disease can start based on the hidden cause. But one must keep in mind that chronic kidney disease often doesn’t have a cure. Treatment is done only to control its signs and symptoms, reduce complications of any type, and slow down the advancement of the disease. Since CKD doesn’t show any symptoms until later, one might need to be prepared for end-stage CKD. Controlling high blood pressure and diabetes is one of the measures taken to reduce the advancements of the disease.

 Treatment of complications 

Even though CKD might not be cured, complications can be treated to make the patient comfortable. These Treatments may include:

  • High blood pressure medicines: kidney disease may further worsen high blood pressure conditions, and the nephrologist may prescribe you medications for controlling that. The medicines like ACE help in high blood pressure and curb the level of damage for a longer period. Medicines for High blood pressure can decline kidney function and change electrolyte levels at first, so it’s recommended by nephrologists to take a water pill and a low sodium salt diet.
  • Medications for lowering cholesterol levels. The nephrologist may recommend medications to lower your cholesterol, commonly called statins. People diagnosed with chronic kidney disease often have high levels of bad cholesterol. Which indirectly affects the heart’s functioning.
  • Medications to treat anemia. Many times, the nephrologist may recommend medication and supplements of the hormone erythropoietin along with iron. Erythropoietin helps the body to produce more Red Blood Cells that are the basic cause of anemia.
  • Medications to reduce swelling. Retention of the fluid is a common condition for people who have CKD. This generally leads to swelling in the legs, and ankles especially. Diuretics are prescribed that can help maintain the balance of fluids in your body.
  • Medications to protect your bones. Since bone weakening is one of the early symptoms, calcium and Vit D supplements can also help control that condition and reduce the risk of fracture or strain. 
  • Lower protein nourishment to curtail waste harvests in your blood. To cut the amount of work your kidneys have to do, your medic may recommend a lesser protein intake. 
  • Regular tests: it is best to have your test done as recommended by the nephrologist regularly to see the progress done in the betterment or worsened conditions of the kidney.

Complications:

  • Inflammation in your arms and legs elevated blood pressure, or fluid in your lungs are all symptoms of fluid retention.
  • An abrupt increase in potassium levels in your blood, can affect the function of your heart and be life-threatening.
  • Anemia
  • Coronary artery disease
  • Reduced sexual desire, erectile problems, or fertility
  • Damage to the central nervous system can lead to concentration problems, personality changes, and seizures.
  • The immune response is lowered, making you more susceptible to infection.
  • Pregnancy problems that provide a danger to both the mother and the growing fetus include pericarditis, an inflammation of the saclike membrane that surrounds your heart, and pregnancy complications that pose a risk to both the mother and the developing fetus.
  • The end-stage renal disease causes irreversible damage to your kidneys, necessitating dialysis or a kidney transplant for survival.

Prevention:

  • Follow the directions on over-the-counter drugs – When using non-prescription pain remedies such as aspirin, ibuprofen, or acetaminophen, read the package instructions carefully. Long-term use of too many pain medicines might cause renal damage.
  • Sustain a decent weight – If you’re already at a healthy weight, keep it up by exercising most days of the week. If you need to reduce weight, talk to your doctor about appropriate weight-loss options.
  • Don’t smoke – Smoking can harm your kidneys and exacerbate the existing renal disease. If you are a smoker, speak with your doctor about quitting methods. Stopping can be made easier with the aid of support groups, therapy, and medicines.
  • Monitor your health problems with the support of your doctor – If you have conditions or issues that put you at risk for renal disease, consult with your doctor to get them under control. Inquire with your doctor about testing that can detect symptoms of kidney impairment.