Chronic Kidney Disease – Symptoms, Risk Factors and More

Introduction

The disease of the kidney lasting for more than 3 months is known as Chronic Kidney Disease (CDC). This includes problems arising in the kidney due to chronic conditions like Diabetes, Hypertension and other autoimmune disorders. 

Kidneys are a pair of vital organs responsible for a number of functions such as

• Filtering blood 
• Removing excess water
• Maintaining acid-base balance 
• Maintaining blood strength
• Eliminating waste and toxic substances from the body

Chronic Kidney Disease refers to progressive loss of kidney function that happens over a period of time. The functionality of the kidney is determined by “Glomerular Filtration Rate (GFR)”. This is calculated by different methods by the treating doctor or in the laboratory. The parameters usually required to calculate a person’s GFR are Serum Creatinine value, body weight and age.

Stages of CKD

Depending on the value of the Glomerular filtration rate, Chronic Kidney Disease can be classified into the following stages:

Stage 1: Mild kidney damage, GFR 90 or higher 

Kidneys continue to perform all vital functions. It can be associated with an abnormal urine test. 

Stage 2: Mild loss of kidney function, GFR 60-89 

It can be associated with mild swelling of the legs, abnormal urine tests, high blood pressure or urinary tract infections.

Stage 3: Mild to a severe loss of kidney function, GFR 30-59 

Associated with swelling in hands and legs, weakness/ fatigue, dry, itchy skin, back pain and muscle cramping.

Stage 4: Severe loss of kidney function, GFR 15-29 

Anaemia, decreased appetite, bone disease, abnormal levels of phosphorous, calcium and Vitamin D.

Stage 5: End-stage Kidney disease, GFR less than 15

Uremia, fatigue, shortness of breath, nausea, vomiting, abnormal parathyroid level, swelling in hands/leg/ face/ lower back, generalised body pain and muscle pain.

Health consequences of CKD

Anaemia

Anaemia is a common complication in Chronic Kidney Disease. It happens due to a lack of Erythropoietin synthesis. Erythropoietin synthesis takes place in the kidney. This is essential for the formation of Red Blood cells (RBCs) which can lead to Anaemia. 

Increased occurrence of infections

Chronic Kidney Disease is an immunocompromised state and can lead to the occurrence of a number of infections.

Low calcium levels

Low calcium levels occur in Chronic Kidney Disease since the balance between phosphorous and calcium is maintained by the kidneys. The kidney also indirectly acts on the parathyroid gland contributing to further problems in the bone mineral density.

Loss of appetite

This is a common symptom and one of the main presenting symptoms in Chronic Kidney Disease. This is due to the accumulation of toxic metabolites in the body that is normally cleared by the kidneys. Loss of appetite is accompanied by nausea and vomiting as well. 

Depression

Clinical depression is also common in both non-dialysis dependent and dialysis-dependent Chronic Kidney Disease. Depression in Chronic Kidney Disease needs to be diagnosed and treated promptly for a better outcome and to maintain the general health of the individual.

Symptoms of CKD

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Urinating more or less
• Decreased mental sharpness

Risk factors of CKD

• Diabetes
• High blood pressure
• Heart disease
• Certain infections
• Heavy metal poisoning
• Autoimmune diseases
• Cancer
• Family history of Chronic Kidney Disease
• Use of certain pain medicines and antibiotics

Treatments of CKD

• High blood pressure medications
• Medications to relieve swelling
• Medications to treat Anaemia
• Medications to lower cholesterol levels
• Medications to protect your bones
• Medications to balance the electrolyte levels in your body

Treatment for end-stage kidney disease

Dialysis

Dialysis is when an external agent does the function of filtration of blood when the person is diagnosed with end-stage kidney disease. Dialysis is also used in acute kidney failure temporarily till the kidneys recover. 

Kidney Transplant

This is a definitive treatment for patients with end-stage kidney disease where a donor’s kidney is placed inside the recipient’s body. 

Prevention of CKD

Get a regular check-up

It is important to undergo regular annual/bi-annual health check-ups to diagnose diseases at an early stage.

Control blood pressure

Maintain a target blood pressure of less than 140/90, and for those with other co-existing medical problems like Diabetes, heart disease, etc., the target blood pressure should be less than 135/85.

Manage blood sugar

• Diabetes should keep their sugar levels in control by a regular visit to their treating doctor, checking blood sugar levels, and following a diabetic diet with regular physical activity. The target HbA1C for each age group should be reached and maintained. 
• Eat a healthy diet. Reduce the intake of simple carbohydrates and increase complex carbohydrates, proteins and fibres. 
• Regular exercise to maintain ideal weight and reduce the risk of developing other chronic diseases. 
• Quit Smoking.
• Do not overuse pain medicine and antibiotics.
• Do not use protein or health supplements that are not recommended by a doctor. 

Conclusion

Kidneys are a pair of organs located in the abdominal cavity and have a number of vital functions. In Chronic Kidney Disease, due to under-functioning or non-functioning kidneys, these essential functions are not maintained, which can be life-threatening. The initial stages of the disease can be managed with regular check-ups, medications and management of fluid and salt intake. 

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