CHRONIC KIDNEY DISEASE

Chronic kidney Disease

Chronic kidney disease is a dangerous disease as it may lead to the failure of many other body functions that are directly or indirectly related to our kidneys. In Chronic Kidney Disease, a person’s kidney is damaged and can’t do the basic functions of filtering all sorts of fluids in our body, and urine production is also ceased. CKD also hampers the kidneys from maintaining the minerals like potassium, sodium, calcium, etc., the flow in our veins within the blood.

Functions like the production of hormones that control blood pressure, manufacturing of red blood cells, and even strength of our bones are compromised due to chronic kidney disease .It is also capable of causing nerve damage to the system. As the name suggests, “chronic” is a disease that developed for a long period. If diagnosed and treated early, all the complications mentioned above and struggles can be avoided. Kidney diseases tend to show severe symptoms, usually in the later stages, in which major damage has been caused already. The only options viable to maintain health and life if the kidney fails are dialysis or getting a kidney transplant.

CKD - Stages of Chronic Kidney Disease

Stages Of Chronic Kidney Disease(CKD)

The experts and nephrologists have come up with the division of the various stages according to the level of filtration the kidney is still doing into five major stages in the order of the severity of the disease. All the stages are based and categorized according to the glomerular filtration rate or commonly known in medical terms as GFR. 

GFR is done to test and check the level of functioning of the kidneys. The results are in the structure of mL/min, calculating the amount of blood passing through the smallest unit of the kidney (glomeruli) that filters the fluids in a minute.  The GFR of the body is affected by various factors apart from the serum creatinine levels, like the body size, sex, age, and even ethnicity of the person being tested.

In stage 1 of CKD, the kidney is normal. eGFR of 90 or greater means that the pair of kidneys is healthy and working fine, but the patient has other signs and symptoms that damage the kidney. Usually, a person with CKD stage 1 does not realize that they have it until they go through a test for some conditions like high bp or diabetes and are diagnosed for it. It is because the level of functioning is almost as good as 100 eGFR. Physical damage to the kidneys and the presence of protein in the urine are also signs of damage to the level of filtration. A family history of polycystic kidney disease (PKD) can also lead to CKD.

  Below we have mentioned some of the ways and precautions one must take if they are diagnosed with CKD stage 1:

  • Eat a healthy diet – it helps the overall body to function and nourish rightfully as required.
  • Check your diabetes- keeping a check on diabetes can also help you in stage 1 CKD.
  • Maintaining blood pressure – is another important indirect function that can help the kidneys.
  • Stop smoking- inhaling smoke will only worsen your situation. 
  • Be active and maintain weight- the body is strengthened, and stamina helps the kidney recover if possible.
  • Refer to a nephrologist- an expert is always the right person to go to than a general physician they can prescribe you the correct medicines and help you reduce symptoms.

In stage 2 of CKD, the kidney is mildly damaged and still does all the work functionally, and the patient might not even know that his filtration has gone down because the kidney still does a pretty good job at that level. The patient might find out about stage 2 again through other conditions like high blood pressure and diabetes or signs like protein in their urine. 

  Below we have mentioned some of the ways and precautions one must take if they are diagnosed with CKD stage 2:

  • Eat a healthy diet – it helps the overall body to function and nourish rightfully as required.
  • Check your diabetes- keeping a check on diabetes can also help you in stage 2 of CKD.
  • Maintaining blood pressure – is another important indirect function that can help the kidneys.
  • Stop smoking- inhaling smoke will only worsen your situation. 
  • Be active and maintain weight- the body is strengthened, and stamina helps the kidney recover if possible.
  • Refer to a nephrologist- an expert is always the right person to go to than a general physician they can prescribe you the correct medicines and help you reduce symptoms.

In stage 3, the nephrologists have further subdivided the condition according to the further decline in eGFR. When the eGFR is between 45 to 59 ml/min, the disease is said to be in stage 3 A, and a further decline of eGFR to between 30 – 44 ml/min indicates that it is stage 3 B. in this stage, the kidney is moderately damaged. They stop working as efficiently as they should, showing us the signs of kidney damage. These signs and conditions can include high blood pressure levels, anemia (fewer blood cells in a unit of blood than required to provide oxygen efficiently ), and/or bone diseases. A condition of ‘uremia’ also develops if a person reaches this stage.

Since kidneys are so efficient that a person can live a long life even on one healthy kidney, the patient might not show any symptoms. But if there are any, they might be as below:

  • Swelling of hands and feet 
  • Kidney pain in the back 
  • Urination level is less or more than usual
  • Fatigue
  • Fluids might even start retaining the body itself
  • Muscle cramps, especially leg cramps 

  Below we have mentioned some of the ways and precautions one must take if they are diagnosed with CKD stage 3:

  • Eat a healthy diet – it helps the overall body to function and nourish rightfully as required.
  • Check your diabetes- keeping a check on diabetes can also help you in stage 3of CKD.
  • Maintaining blood pressure – is another important indirect function that can help the kidneys.
  • Stop smoking- inhaling smoke will only worsen your situation. 
  • Be active and maintain weight- the body is strengthened, and stamina helps the kidney recover if possible.
  • Visit a nephrologist- a kidney nephrologist is the one who can give you a plan for correct and effective treatment and will tell you the number of times you need to get checked.
  • Opt for a dietician: it becomes critical to follow a good diet for better treatment and recovery.
  • Take the prescribed medicine and ask for ACE inhibitors and ARBs- surveys have shown that certain medicines slow the damage of the kidney from getting worse. Medicines should be taken as prescribed. 

In stage 4, the kidney is severely damaged and might even need dialysis after consulting a nephrologist or a kidney donor for transplantation. Since it’s the stage before the kidney disintegrates and fails, it should be taken very seriously. Apart from the conditions of uremia, high blood pressure, anemia, and bone weakening, cardiovascular diseases and heart disease can also knock on the door of the patient.



At Stage 4, a person can see clearer symptoms and a larger number of them in patients with CKD. Some of them are as follows:

  • swelling of hands and feet 
  • Kidney pain in the back 
  • Urination level is less or more than usual
  • Fatigue
  • Fluids might even start retaining the body itself
  • Muscle cramps, especially leg cramps 
  • Vomiting and a feeling of nausea
  • Metallic taste in mouth after taste change
  • Breath stinks as the level of urea increases in blood
  • Loss of hunger 
  • Concentration is a struggle 
  • Nerve issues: toe and/ or fingers go numb or tingling sensation.

 

Since it’s a very grave issue to have stage 4 CKD, one must take more steps than just what they should generally take in stages 1,2 &3. Below, we have mentioned the important steps one must take if they are diagnosed with CKD stage 4:

 

  • Eat a healthy diet – it helps the overall body to function and nourish rightfully as required.

 

  • Check your diabetes- keeping a check on diabetes can also help you in stage 4 of CKD.

 

  • Maintaining blood pressure – is another important indirect function that can help the kidneys.

 

  • Stop smoking- inhaling smoke will only worsen your situation. 

 

  • Be active and maintain weight- the body is strengthened, and stamina helps the kidney recover if possible.

 

  • Schedule regular appointments with a nephrologist- a kidney nephrologist, is the one who can give you a plan for correct and effective treatment and will tell you the number of times you need to get checked.



  • Opt for a dietician: it becomes critical to follow a good diet for better treatment and recovery.

 

  • Take the prescribed medicine and ask for ACE inhibitors and ARBs: surveys have shown that certain medicines slow the damage of the kidney from getting worse. Medicines should be taken as prescribed. 

The patient must also be ready for kidney failure and discuss how to prepare for it and deal with it with the nephrologist. Post kidney failure, the patient has two options to live further: Dialysis and Kidney Transplant. Both the options must be discussed with the patients, and the best suited should be pursued, as at this level, it’s very hard to live for a very long time without either.

In stage 5 of CKD, the kidneys are on the verge of failing or have already failed and are not working anymore, after which the water starts building up in the body, and severe symptoms rise along with it. 

Some of the symptoms of kidney failure are:

  • Itch develops
  • Muscle cramps
  • Feeling sick and vomiting 
  • Hunger vanishes
  • hands and feet swell up along with eyes and ankles
  • severe Back pain
  • Breathing issues
  • Sleeping issues 
  • Headaches
  • Fatigue
  • Decreased concentration
  • Making little or no urine
  • Skin color disfiguration 
  • Inclined skin pigmentation

At stage 5 of CKD, the patient needs dialysis after consulting a nephrologist, followed by a kidney transplant to survive. It is the last stage, post which the situations are fatal.

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 includes:

  • 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 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 
Symptoms of chronic Kidney Disease CKD

Symptoms and Signs of Chronic Kidney Disease

The kidney is an organ that works very efficiently, even at higher levels of damage. Its efficiency can also be proved by the fact that we can donate one of the kidneys and yet live a long healthy life .so, early stages of CKD can’t be detected easily as they have no symptoms. Usually, one finds out about the early stages of CKD while testing for other conditions and diseases like diabetes, high blood pressure, heart diseases, and urine tests.

 It is only in the later stages that one starts showing symptoms of CKD. Some of those symptoms are:

  • skin drying 
  • Numbness and /or itching 
  • Fatigue
  • headaches 
  • chest pain
  • urination change 
  • lost hunger 
  • muscle cramps
  • the feeling of nausea and vomiting
  • breathing issue
  • sleeping issue
  • concentration issues
  • weight loss

Investigation and Diagnosis of CKD

The first step that a nephrologist takes for the diagnosis of CKD, he/she discusses 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 the 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 of 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 detection in 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 that 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 curbing the level of damage for a longer period. Medicines for High blood pressure can decline kidney function and change electrolyte levels at first, and 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, 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.

Treatment for End-Stage Kidney Disease

 Usually, people find out about their CKD in the end-stage or the second last stage. Till then, most of the damage is irreversible damage. If the kidneys can’t filter the waste and fluid on their own and develop complete or near-complete kidney failure, you have end-stage kidney disease. At this catastrophic point, you need either dialysis or a kidney transplant immediately. 

Dialysis

  We all know that dialysis artificially eliminates waste products and excess fluid from your blood and body when the kidneys are no longer capable of doing it. There are two major types of dialysis techniques: hemodialysis and peritoneal dialysis.  In hemodialysis, a machine screens the waste and surplus fluids from your blood. You generally need to go to a hospital 3-4 a week for it.

 In peritoneal dialysis, a tinny duct is implanted into your abdomen, filling your abdominal hole with a dialysis fluid or solution that absorbs all the waste and spare fluids. After some time (generally after 3-4 hours), that fluid is drained from the patient’s body, carrying the waste with it.

Kidney Transplant

A kidney transplant includes surgically inserting a healthy kidney from a donor’s body into the person’s body with a damaged kidney and removal of the damaged kidney. Dead or living, both kinds of donors can give their kidneys for transplantation. It must be noted that the recipient of the kidney needs to take medications for a lifetime to keep the body from refusing the new organ. Once the transplant is done, you don’t need dialysis anymore.

 Those who choose not to do any of these can take the help of the conservative treatment methods. Though, once the kidney fails, a person only has a few months to live.

Risk Factors Included

Apart from a person’s lifestyle, various factors pose a risk to developing CKD in a person. While some can be changed, some are non-modifiable factors. 

Factors that may increase your risk of CKD are as follows:

  • High blood pressure
  • Heart and blood vessel (cardiovascular) disease
  • Diabetes
  • Smoking 
  • Obesity 
  • African-American, Native American, or Asian-American lineage
  • Family history of kidney diseases or related factors
  • Atypical kidney structure
  • Old age
  • Low birth weight (generally related to weakened kidney growth, resultant in smaller nephrons.)

Complications

CKD is a disease that not only affects just the kidney but the whole body in general. The function of the kidney is so important that as soon as it stops working or gets damaged, the whole system of organs starts collapsing one by one. Potential complications consist of:

  • Fluid retention
  • sudden rise in potassium levels in your blood 
  • Heart and cardiovascular disease
  • Weakening of bones 
  • Anemia
  • erectile dysfunction and/or reduced fertility
  • The nervous system gets affected
  • weakened immune system
  • Complication in Pregnancy 
  • Irreversible damage to the kidneys

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