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Chronic kidney disease

Prof. Dr. D Sree Bhushan Raju, MD, DM (AIIMS), DNB, MNAMS, MBA, FASN, FISN, FACP, FICP, FISOT, FIACM, Profesor & Head (Unit II) Dept. of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, Telangana INDIA

Published: Nov 9, 2022 01:04:02 PM IST
Updated: Nov 22, 2022 01:47:16 PM IST

Chronic kidney diseaseChronic Kidney Disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by filtering wastes from your blood. If kidney disease worsens, wastes can build to high levels in your blood and make you feel sick. You may develop complications like:

  • High blood pressure
  • Anemia (low blood count)
  • Weak bones
  • Poor nutritional health
  • Nerve damage

Kidney disease also increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long time. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

Chronic kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it's the result of a combination of different problems.

CKD can be caused by:

  • High blood pressure – over time, this can put a strain on the small blood vessels in the kidneys and stop the kidneys from working properly
  • Diabetes – too much glucose in your blood can damage the tiny filters in the kidneys
  • High cholesterol – this can cause a build-up of fatty deposits in the blood vessels supplying your kidneys, which can make it harder for them to work properly
  • Kidney infections
  • Kidney inflammation
  • Polycystic kidney disease – an inherited condition where growths called cysts develop in the kidneys
  • Blockages in the flow of urine – for example, from kidney stones that keep coming back, or an enlarged prostate
  • Long-term, regular use of certain medicines – such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs)

Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or electrolyte problems. Depending on how severe it is, loss of kidney function can cause:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue and weakness
  • Sleep problems
  • Urinating more or less
  • Decreased mental sharpness
  • Muscle cramps
  • Swelling of feet and ankles
  • Dry, itchy skin
  • High blood pressure (hypertension) that's difficult to control
  • Shortness of breath, if fluid builds up in the lungs
  • Chest pain, if fluid builds up around the lining of the heart

Risk Factors
A number of factors can increase the risk of developing CKD, including:

  • Diabetes mellitus
  • High blood pressure
  • A family history of kidney disease
  • African-American and other ethnic minorities
  • Obesity
  • Smoking
  • Older age
  • Having protein in the urine
  • Having autoimmune diseases such as lupus

As a first step toward diagnosis of kidney disease, your doctor discusses your personal and family history with you. Among other things, your doctor might ask questions about whether you've been diagnosed with high blood pressure, if you've taken a medication that might affect kidney function, if you've noticed changes in your urinary habits and whether you have family members who have kidney disease. Next, your doctor performs a physical exam, checking for signs of problems with your heart or blood vessels, and conducts a neurological exam. For kidney disease diagnosis, you might also need certain tests and procedures to determine how severe your kidney disease is (stage). Tests might include:

  • Blood tests: Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
  • Urine tests: Analyzing a sample of your urine can reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.
  • Imaging tests: Your doctor might use ultrasound to assess your kidneys' structure and size. Other imaging tests might be used in some cases.
  • Removing a sample of kidney tissue for testing: Your doctor might recommend a kidney biopsy, which involves removing a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem.

Management of Patients with CKD
Your treatment will depend on how severe your condition is.

The main treatments are:

  • Lifestyle changes to help you remain as healthy as possible
  • Medicine to control associated problems such as high blood pressure and high cholesterol
  • Dialysis – treatment to replicate some of the kidney's functions; this may be necessary in advanced CKD
  • Kidney transplant – this may also be necessary in advanced CKD
  • You'll also be advised to have regular check-ups to monitor your condition.

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