Chronic kidney disease

Overview

Chronic kidney disease (CKD) is the gradual loss of kidney function due to conditions such as diabetes, hypertension, and genetic disorders. Common types include polycystic kidney disease, glomerulonephritis, and lupus nephritis.

CKD progresses through five stages, leading to symptoms like swelling, high blood pressure, and fatigue. While it cannot be cured, managing blood pressure, diet, and regular check-ups can slow progression. Advanced stages may require dialysis or kidney transplants.

What are Chronic Kidney Disease?

Chronic kidney disease (CKD) is characterised as a progressive condition where kidneys lose the ability to filter waste and extra fluid from the blood, causing a build-up in the body. This build-up leads to kidney damage and other health complications including heart and bone disease. Symptoms are often ‘hidden’ in the early stages of CKD, and gradually cause a complete loss of function in the kidneys.

Types of Chronic Kidney Disease

Following are the different types of chronic kidney disease based on its causes:

Polycystic Kidney Disease

Genetic disorders cause clusters of cysts or fluid-filled sacs to grow in the kidneys. It changes the shape of kidneys, making them much larger compared to harmless kidney cysts. These cysts may also lead to kidney failure.

Glomerulonephritis

Also known as glomerular disease, it is the damage and inflammation of the glomeruli (filtering part of the kidneys). This condition constrains the kidney from filtering out excess fluid, toxins and metabolic wastes, leading to build-up and causing swelling, pain and bone disease.

Vasculitis

It is a group of autoimmune diseases that cause swelling of the blood vessels. Over 20 types of vasculitis affect capillaries, veins and organs. It can lead to aneurysms, organ and tissue damage and bleeding inside the body.

Goodpasture Syndrome

This is a rare disorder that occurs when the immune system attacks the kidneys and lungs. It is accompanied by symptoms such as blood in the urine, breathlessness and coughing. Complications of this condition include lung damage or chronic kidney damage.

Nephrotic Syndrome

Damage to the glomeruli causes this kidney disorder. The body leaks too much protein into the urine, leading to swelling in the ankles, feet, eyes, and a weakened immune system.

Lupus Nephritis

Lupus Nephritis is an autoimmune disease that causes autoantibodies to affect the kidneys, making it challenging for them to filter out wastes and extra fluid. Complications may include protein or blood in the urine, hypertension, and poor kidney function or failure.

Alport Syndrome

It is an inherited disease that causes problems in the ears, kidneys and eyes. Signs may primarily appear through blood in urine and progress into chronic kidney disease, raising the risk for kidney failure.

Symptoms of Chronic Kidney Disease

As kidney damage progresses through stages, loss of kidney function can cause various symptoms, based on the severity of waste and extra fluid build-up in the body. These include loss of appetite, urinating more or less, muscle cramps, sleep problems, vomiting and nausea, dry and itchy skin, swelling in feet and ankles, high blood pressure, chest pain, shortness of breath and decreased mental sharpness.

Causes of Chronic Kidney Disease

High blood pressure, genetic disorders and diabetes are the most common causes of chronic kidney disease. Other disorders that lead to CKD are listed in the following table:

Disorders or Diseases	Impacts
Lupus	Produces antibodies against kidney tissue
Polycystic kidney disease	Reduces kidney functionality
Obstructions of the urinary tract	Obstructed flow of urine
Vesicoureteral reflux	Urine flows backwards into the kidneys or uterus
Diabetes-related nephropathy	Causes hypertension
Membranous nephropathy	The immune system attacks the filter units (glomeruli) in the kidney
Glomerulonephritis	Damage to glomeruli in the kidneys
Pyelonephritis	Severe kidney infection

Risk factors of Chronic Kidney Disease

Health conditions such as diabetes, heart disease and high blood pressure raise the risk of kidney damage, narrowing the blood vessels and reducing blood flow. Being overweight or obese can also raise the risk of hypertension and diabetes. In addition to this, having a family member with CKD can also increase the risk. Other factors may include race (being native American, black or Asian American), smoking, and use of illegal drugs or medications that can damage the kidneys.

Diagnosis of Chronic Kidney Disease

The healthcare professional conducts a physical exam primarily, asking about the symptoms noticed and current medications. Blood tests help check kidney function, in which an individual’s GFR (glomerular filtration rate) and serum creatinine level are checked.

Urine tests help check blood or protein in urine. Other diagnostic tests may include MRI, ultrasound, CT scan and a biopsy.

Chronic kidney disease is categorised into different stages, where the functioning of the kidneys worsens over time. The stages include the following:

Stage 1 (eGFR = 90 mL/min or >)

eGFR, a blood test that shows how well the kidneys are working, is normal or greater, causing mild damage. The kidneys work well without showing any signs of kidney damage. However, the presence of protein in urine is a common sign one may notice in this stage.

Stage 2 (eGFR 60 - 89 mL/min)

eGFR goes down to between 60 and 89, indicating mild kidney damage. While symptoms may not show up as the kidneys still work well, common signs of kidney damage in this stage may include physical damage or protein in urine.

Stage 3 (eGFR 30 - 59 mL/min)

eGFR of 30 - 59 indicates poor kidney function, difficulty in filtering extra fluid, and waste out of blood. The waste builds up in the body and causes health problems such as bone disease and high blood pressure. Swelling in hands or feet and exhaustion are common symptoms in this stage.

Stage 4 (eGFR 15 - 29 mL/min)

This is the last stage before kidney damage that shows an eGRF of 15 - 29. The kidneys do not filter waste out of your blood, causing complications including heart disease, hypertension and bone disease. Symptoms include inflammation of feet and hands and lower back pain.

Stage 5 (eGFR < 15 mL/min)

Severe kidney damage is caused in this stage, where the kidneys have stopped working or getting close to failure. The build-up of waste products in the body makes one vulnerable to other health problems, including anaemia, metabolic bone disease, mineral and bone disorders and hypertension.

Treatment for Chronic Kidney Disease

Chronic kidney disease cannot be treated or cured, however, bringing a healthy lifestyle and dietary changes can help maintain the stability of kidney function. Ensure visiting a healthcare provider regularly and getting screened. End-stage kidney damage may require dialysis or a kidney transplant.
A professional may prescribe medications, depending on the cause of kidney disease. The following table highlights the medications:

Prevention of Chronic Kidney Disease

Measures can be taken to preserve kidney function, ensuring they work normally for a longer period. These measures include managing blood pressure and blood glucose levels, making regular appointments with healthcare providers, consuming a kidney-friendly diet, exercising frequently and limiting smoking. One must also avoid taking medications or painkillers that may increase the damage to the kidneys.

Myths and Facts Related to Chronic Kidney Disease

Following are the myths and facts related to chronic kidney disease:

Myth 1: Frequent urination is a sign of healthy kidneys
Fact: Chronic kidney disease causes the kidneys to damage progressively in 5 different stages. In the initial stages, a person may pass more urine as the kidney’s functionality reduces gradually.

Myth 2: Feeling fine means one doesn’t have kidney problems
Fact: An individual may not experience any symptoms in the early stages of chronic kidney disease. As the kidney function worsens over time, one may experience lower back pain, swelling of feet and arms, and protein or blood in the urine.

Myth 3: Dialysis cures chronic kidney disease completely
Fact: Dialysis helps clear extra fluid and wastes from the blood. However, it cannot cure kidney failure or replace kidney function completely.

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