Chronic Kidney Disease is an irreversible loss of kidney function which develops over months to years.
The term "chronic kidney disease (CKD)" or "chronic renal disease (CKD)" is more preferred over "chronic renal failure (CRF)."
Clinical signs and symptoms
Eventually, clinical symptoms and signs ensue due to
● severe loss of metabolic functions
● excretory and endocrine functions of the kidneys (uremia)
● Blood urea and serum creatinine are raised
Kidney failure symptoms may include
● Loss of appetite
● Difficulty in breathing
● Abdominal pain
● Back pain
If you notice one or more of the kidney mentioned above failure symptoms, it may be an indication for you to consult your doctor at the earliest.
Read more to know about CKD.
End-stage renal disease (ESRD) is a severe stage CKD (GFR 10-15 ml/min), in which the patient is permanently dependent on kidney replacement therapy to avoid life-threatening uremia.
Newer classification of CKD: According to the estimated GFR, chronic kidney disease is classified as per guidelines issued by the National Kidney Foundation
Stages of CKD
● Kidney damage with average/increased GFR- >90 or more
● Kidney damage with mildly decreased GFR- 60 to 89
● Moderately decreased GFR- 30 to 59
● Severely decreased GFR- 15 to 29
● Kidney failure GFR- <15
Causes of CKD
● Diabetes mellitus
● Heart diseases
● polycystic renal disease
● tubulointerstitial diseases
● obstructive nephropathies
● Age (>60)
● Chronic features (>3 months) of uremia Hypertension
● Renal osteodystrophy
● The low specific gravity of urine
● Broadcast in the urine
● Small contracted kidneys (On ultrasonography)
1. Diet management: Adequate caloric intake should be maintained to avoid excessive catabolism. Protein intake should be restricted up to 0.6 g/kg/day to reduce the accumulation of nitrogenous waste products and slow down kidney failure progression. Fluid, salt, potassium, and phosphorus intake should also be restricted.
2 Management of metabolic complications: Hyperkalemia is managed using calcium, insulin, bicarbonate, and glucose. Sodium bicarbonate is given to control acidosis.
3. Management of renal osteodystrophy: Restriction of phosphate-containing products (milk, cheese, eggs) in the diet and use of phosphate-binding drugs such as calcium carbonate and aluminum hydroxide gel. Supplementation of vitamin D and calcium is needed to correct hypocalcemia (decreased calcium)
4. Control of blood pressure: Hypertension must be controlled rigorously with a blood pressure target less than 130/80 mmHg. In CKD patients with diabetes mellitus or proteinuria greater than 1gm / 24 hours, BP should preferably be reduced to 125/75 mm Hg.
5. Adjustment of drug dosage: The dosage of the drugs adjusts according to the severity of kidney failure. Nephrotoxic drugs should be avoided.
6. Management of anemia: Erythropoietin is helpful in the management of anemia. Iron stores must be adequate to ensure a response to erythropoietin. Supplementation of vitamin B12 and folic acid is also required. Anemia not responding to erythropoietin is corrected by blood transfusion.
7. Kidney replacement therapy: This is indicated in End-Stage Renal Disease (ESRD) patients. Different forms of replacement therapy are (1) Peritoneal dialysis, (2) Hemodialysis (3) Renal transplantation.
You can stop the damage already done from getting worse by
● Not smoking and reduce or eliminate consumption of alcohol.
● Exercise daily and keep a healthy weight.
Dialysis indicates refractory hyperkalemia, acidosis or volume overload, and uremic complications.
Dialysis helps to clean the blood when the kidney fails to perform its function of blood filtration.
There are two types of dialysis
1. Peritoneal dialysis
It is a surgical procedure wherein a healthy kidney is transplanted into the recipient's body donated by a compatible donor.