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Overview of chronic kidney disease

Dr. Rajesh Goel, Senior Consultant - Nephrology and Kidney Transplant Medicine, Pushpawati Singhania Hospital and Research Institute.
Overview of chronic kidney disease

A condition known as chronic kidney disease (CKD)

A condition known as chronic kidney disease (CKD), also known as kidney failure or renal failure, occurs when the kidneys lose some of their capacity to filter waste materials and extra fluid from the bloodstream.

Other bodily systems are impacted as waste materials and fluids accumulate, which can be detrimental to human health.

A person with kidney failure, also known as end-stage kidney disease, the most severe form of CKD, typically needs a kidney transplant or dialysis to survive.

Diabetes and high blood pressure are the most frequent causes of CKD. There are no symptoms in the early stages of CKD.

End-stage kidney disease, also known as complete kidney failure, is a possible outcome of the illness.

This happens when kidney function declines to the point where dialysis or a kidney transplant are necessary to preserve health or even life, which typically happens when kidney function is at or below 10% of normal kidney function.


For the majority of people, severe symptoms may not appear until advanced kidney disease. You might, however, notice that you:

• Feel more exhausted and have less energy

• Struggle to concentrate

• Have a poor appetite

• Have trouble sleeping

• Have muscle cramping at night

• Have puffiness around your eyes, especially in the morning

• Have dry, itchy skin

• Need to urinate more frequently, especially at night

Risk Elements:
Numerous factorscan increase the risk of developing CKD

• Such as having diabetes

• High blood pressure

• A family history of kidney disease

• Being an ethnic minority

• Being obese

• Smoking

• Being older

• Having protein in the urine

• Having autoimmune diseases like lupus

Assessment and Diagnosis

In order to diagnose CKD and determine whether there is a treatable underlying cause, a healthcare professional may use a variety of tests. They consist of the following:

Tests for kidney function — The kidneys’ overall filtering capacity is roughly measured by the glomerular filtration rate (GFR).

True (actual) GFR measurement is challenging and impractical for the majority of patients’ care. GFR is typically estimated instead.

Taking a blood creatinine reading and using the result to calculate an estimated GFR (eGFR) level is the most typical method for estimating GFR in adults.

The eGFR provides an estimate of kidney function, but actual kidney function can differ from this estimate in both directions.

• A decrease in GFR indicates the development of another, occasionally treatable kidney condition or the worsening of the underlying kidney disease.
• On the other hand, a rise in GFR suggests improved kidney health.
• In CKD patients, a stable GFR indicates a stable disease.

Urine Tests- Albuminuria or proteinuria, which are both terms for the presence of albumin or protein in the urine, is a sign of kidney disease. In some people, especially those with diabetes and high blood pressure, even trace amounts of albumin in the urine may be an early indicator of CKD.

Imaging Tests – Imaging tests, like computed tomography [CT] or ultrasound, may be advised to check for kidney stones, obstructions of the urinary tract, and other abnormalities, like the numerous, large cysts seen in the genetic condition polycystic kidney disease.

Kidney Biopsy – A small piece of kidney tissue is removed and examined under a microscope during a kidney biopsy. The kidney tissue abnormalities that may be the root of kidney diseases are identified through the biopsy.

Treatment of CKD Patients

The main objective of treatment is to stop CKD from progressing to total kidney failure. The best way to do this is to identify and treat the underlying cause of CKD as soon as possible.

Reducing the Risk of Cardiovascular Disease: People with CKD have a much higher prevalence of cardiovascular disease than people without CKD.

Therefore, lowering cardiovascular risk is a key part of managing CKD. Regardless of the patient’s level of low-density lipoprotein cholesterol, it is advised that patients with CKD 50 years of age or older receive treatment with a low- to moderate-dose statin. Also encouraged should be quitting smoking.

Management of Hypertension: Several guidelines outline which medications should be used to treat hypertension in CKD patients using algorithms. It is important to assess whether albuminuria exists and how severe it is.

Adults with diabetes and a urine albumin-to-creatinine ratio (ACR) of at least 30 mg per 24 hours or any adult with a urine ACR of at least 300 mg per 24 hours are advised to block the renin-angiotensin-aldosterone system using either an ACE-I or an angiotensin II receptor blocker (ARB).

Management of Diabetes Mellitus: Effective diabetes management is also crucial. First, maintaining glycemic control—the majority of recommendations call for a target haemoglobin A1c of less than 7.0%—can halt the progression of CKD.

Second, it might be necessary to adjust the dosage of oral hypoglycemic medications. Generally speaking, medications that are primarily eliminated by the kidneys (such as glyburide) should be avoided, whereas medications that are metabolised by the liver and/or partially eliminated by the kidneys (such as metformin and some DPP-4 and sodium-glucose cotransporter-2 [SGLT-2] inhibitors) may need to be dosed down or stopped altogether, especially when eGFR drops below 30 mL/min/1.73 m2.

Third, people with severely elevated albuminuria should think about using specific drug classes, like SGLT-2 inhibitors.

Nephrotoxins: It is important to advise all CKD patients to stay away from nephrotoxins. A comprehensive list is outside the purview of this review, but a few stand out. Routine NSAID administration in CKD is not advised, especially in patients receiving ACE-I or ARB therapy.

Dietary Management: According to the KDIGO recommendations, protein intake should be decreased in adults with CKD stages G4 to G5 to less than 0.8 g/kg per day (with the proper education) and in other adult patients with CKD who are at risk of progression to less than 1.3 g/kg per day.

More fruits and vegetables and less meat, eggs, and cheese may help reduce the amount of acid in the diet, which may also help prevent kidney damage. Patients with hypertension, proteinuria, or fluid overload are advised to follow low-sodium diets, which typically contain less than 2 g per day.



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