Common Kidney Diseases and Chronic Kidney Disease, CKD

The kidneys are amazing organs with the responsibility to keep us healthy, by removing toxins, waste products and excess water from the body. Kidneys help to control blood pressure, to produce red blood cells and keep bones healthy. Kidneys also control blood levels of many minerals and molecules including sodium and potassium and help control acid levels.

Chronic kidney disorder, where the kidney suffers irreversible damage, has become closely linked with lifestyle related disorders. In India one in ten people has some form of chronic kidney disease. Diabetes and hypertension are responsible for more than 60 per cent cases of chronic kidney disease. Other causes include glomerular diseases, famililial renal disease like polycystic kidney disease, immuniological diseases, kidney stones, urinary tract obstruction, and drug toxicity.

 Fifteen per cent of adults in urban areas are diabetic and 40 per cent of these are likely to develop kidney disease. About 20-30 per cent of the adults are hypertensive and many of them will develop chronic kidney disease. Many patients of chronic kidney disease die of cardiovascular complications.

What are the common kidney diseases?

The kidneys can be affected by a variety of diseases

  • Acute kidney injury
  • Chronic kidney disease
  • Renal stones
  • Nephrotic syndrome
  • Urinary tract infection
  • Inherited / congenital diseases

What is Chronic Kidney Disease?

Chronic kidney disease (CKD) is a progressive loss in kidney function over a period of months to years. Chronic kidney disease ultimately leads to End Stage Renal Disease requiring dialysis or transplant.

Who are at risk of Kidney Disease?

High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. Diabetes has been established as the commonest cause of CKD in most developed countries. High blood pressure is responsible for approximately a quarter of all cases of kidney failure.

Other less common conditions include inflammation (glomerulonephritis) or infections (pyelonephritis). Sometimes CKD is inherited (such as polycystic disease) or the result of longstanding blockage to the urinary system (such as enlarged prostate or kidney stones).

Some drugs can cause CKD, especially some pain-killers if taken over a long time.

What are the symptoms of kidney disease?

The various symptoms for kidney failure or problem may include changes in urination. It should be noted that urine may be foamy or bubbly and you may urinate more often than the usual or it can be vise versa you may urinate less often, or in smaller amounts than usual. Some times you may also have to apply pressure while urinating. There can be swellings in the parts like legs, ankles, feet, face, and/or hands. Other symptoms may be like fatigue, skin rash or itching, ammonia breath, nausea and vomiting, shortness of breath, blood in the urine. These manifestations can be seen other disease process also apart from kidneys. So physician consult and appropriate tests like urine, blood and ultrasound imaging are must before deriving any conclusion.

What tests can detect kidney disease?

Simple blood and urine tests can be done to detect kidney disease. The early detection of failing kidney function is crucial because it allows suitable treatment before total kidney damage or deterioration manifests itself through other complications.  

  • Serum Creatinine: Creatinine is a waste product in blood that comes from muscle breakdown. It is normally removed from blood by the kidneys, but when kidney function slows down, the creatinine level rises.
  • Urine protein: The presence of excess protein in the urine is also a marker of CKD.

What are the stages of kidney disease?

Kidney disease starts silently, and progresses slowly over a number of years. CKD is divided into 5 stages depending on degree of residual renal function. The outcomes and complications worsen as one progresses from stage 1 to stage 5.

Can chronic kidney disease be cured?

The aim of treatment is to prevent further damage to the kidneys and slow or halt the progression of disease. This helps prevent other serious complications from developing. Therefore, the earlier the better.

Key preventative measures have been defined and proven successful in those with early stages of CKD:

  • Reduction of high blood pressure
  • Specific medications to reduce protein in urine as well as lower blood pressure
  • Reduce salt intake
  • Control of glucose, lipids
  • Smoking cessation
  • Increase of physical activity
  • Control of body weight

Treatment of kidney disease varies depending on the underlying disease, disorder or condition. The goals of treatment is to cure the underlying condition, prevent excessive fluid and waste from accumulating in the body, and stop or slow the progression of damage to the kidneys. Treatment also aims to minimize complications of kidney disease. Treatment plans also include a multifaceted approach tailored to the specific type and cause of kidney disease. Patients with advanced renal failure require renal replacement therapy. Currently hemodialysis or CAPD (Continuous ambulatory peritoneal dialysis) are commonly practiced. In case of hemodialysis patient has to go to dialysis centre twice or thrice a week. During hemodialysis blood is accessed from body, through arteriovenous (AV) fistula and circulated through filter called dialyser. After filtration blood is returned in body. In peritoneal dialysis, the space between the abdominal wall and organs is filled with a cleansing solution that absorbs toxins from the abdominal lining. The solution is then drained out into a bag. This procedure is done at home one to four times a day, seven days a week or overnight using a cycling machine. Apart form dialysis patient may need oral medications such as antihypertensives, phosphate binders, hematinics and erythropoietin treatment.

Kidney transplantation offers the best outcomes and the best quality of life. Transplanted kidneys may come from living related donors, living unrelated donors, or people who have died of other causes (cadaveric donors). However, not everyone is a candidate for a kidney transplant. People need to undergo extensive testing to ensure their suitability for transplantation. All transplant recipients require lifelong immunosuppressant medications to prevent their bodies from rejecting the new kidney. Immunosuppressant medications require careful monitoring for their adverse effects.

Dr Ganesh N Mhetras. (M.D., D.M.)
Cosultant Nephrologist - Kharadi, Pune

Tags: CKD , Chronic Kidney Disease , Kidney diseases , Symptoms Treatment , Diagnosis

 

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