Description – Chronic Kidney Disease (CKD) is commonly known as chronic renal failure, a condition which has a progressive loss of kidney function in course of time. Which could be from months to years. The condition is a permanent and irreversible one unlike that of the acute kidney injury. Kidneys act as filters to the body, as they purify the blood as well as excrete toxins through urine. Thus it is of utmost importance that they function correctly, but if they lose the ability to to function properly, nitrogenous waste products and toxins would get accumulated in the body, which can result in strong symptoms of CKD. CKD is usually measured by indicators of urea and creatinine levels that can be detected by blood tests.
The whole world has around 5% to 10% of people suffer from CKD, with a rise each year. The most important cause for this increase is the lifestyle that has gradually deteriorated followed by disorders like diabetes and hypertension in people less than 40 years. A large population of ESRD (end stage renal disease) runs to about 229/million when 150,000 patients develop ESRD each year who would eventually need dialysis. Kerala is one state in our country which has been known as the diabetic capital of India, it is now steadily rising with cases of CKD progressing to ESRD and also needing Dialysis treatment or transplant.
Stages of Chronic Kidney Disease
- Diabetes mellitus
- Hypertension/high blood pressure
- Chronic Glomerulonephritis (this disorder is caused due to cumulative damage and scarring of the blood filters in the kidney)
- Chronic Tubulointerstitial Disease ( a type of nephritis affecting the interstitium of the kidneys )
- Continued use of certain drugs(painkillers) and toxins (herbal medicines and heavy metals).
- Congenital disease like polycystic kidney disease.
- Obstructive nephropathy ( due to kidney stones and prostate disease)
- Congenital abnormalities of kidneys and urinary tract.
Symptoms and Signs of Chronic Kidney Disease
The early stages of CKD usually have very subtle symptoms that become more prominent after the kidney function is significantly flawed. The symptoms of CKD include:
- Edema (swelling of legs or puffiness of face)
- Hypertension (high blood pressure)
- Frothy urination
- Decreased urine output
- Nocturia (frequent urination during night)
- Loss of appetite
- Nausea and vomiting
- Itchy skin
- Decreased mental alertness and concentration
- Shortness of breath
- Erectile dysfunction in men
- Altered sensorium
- Bony pains
- Chest pain
Five Stages of Chronic Kidney Disease
Doctors determine the stage of kidney disease using glomerular filtration rate (GFR), wherein a math formula is used along with the person’s age, gender and their serum creatinine level. Creatinine is a waste product that comes from muscle activity and it is an important indicator of kidney function. Normal kidney function enables the removal of creatinine from the blood, but a malfunctioning kidney cannot remove the creatinine hence raising the levels of creatinine from the blood.
- Stage 1 with normal or high GFR (GFR > 90 mL/min)
- Stage 2 Mild CKD (GFR = 60-89 mL/min)
- Stage 3A Moderate CKD (GFR = 45-59 mL/min)
- Stage 3B Moderate CKD (GFR = 30-44 mL/min)
- Stage 4 Severe CKD (GFR = 15-29 mL/min)
- Stage 5 End Stage CKD (GFR <15 mL/min)
A person with stage 3 chronic kidney disease (CKD) is supposed to be having moderate kidney damage. This stage is divided into two: a decrease in glomerular filtration rate (GFR) for stage 3A being 45-59mL/min and decrease in GFR for stage B being 30-44mL/min. If diagnosed early and managed properly, stage 3 CKD has a longer life expectancy than more advanced stages of kidney diseases. The results can vary based on the age and lifestyle, one such estimate determines the average life expectancy is 24 years in men who are 40 years, while it is 28 years in women of the same age group
Although stage 3 kidney disease cannot be reversed, one can definitely prevent damage from worsening at this stage. Apart from taking prescribed medications and eating a healthy diet, adopting other lifestyle changes can definitely help one manage CKD stage 3. Your nephrologist in Bangalore could help you with coping with CKD.
In order to prevent progression of CKD follow these:
- Control your blood sugar levels if you are diabetic – keep glycosylated levels less than 7.
- Control your blood pressure.
- Restrict salt and fluid intake if hypertensive and edematous.
- Restrict protein intake – avoid red meat, fish, eggs, chicken, pulses and legumes.
- Reduce intake of potassium – that may be present in fruits, fruit juices, coconut, coconut water, raw vegetables, green leafy vegetables and tomatoes.
- Avoid medications that can cause damage to kidneys.
- Exercise regularly to control weight.
- Quit smoking.
- Quit alcohol.
Some treatment options for ESRD (End stage renal disease)
- Hemodialysis – Purification of the blood using an artificial kidney.
- Peritoneal Dialysis – Removing waste by instilling fluid within the abdomen, by using the peritoneal membrane of the patient. This can be done at home.
- Kidney Transplantation – This procedure involves replacing the diseased kidney with a kidney donated by someone that matches yours.
Ensure that you meet a nephrologist at an early stage to get a diagnosis of your chronic kidney disease so that you can prevent any further worsening of the condition. Also it is important for those at high risk to get kidney function checked regularly.