Chronic kidney disease

Overview

The kidneys are part of the renal system, which filters pollutants from the blood. The ureters transport urine from the kidneys to the bladder, while the urethra transports urine from the bladder to the outside world. Kidney illness impacts people in various ways, both physically and emotionally. It can have an effect on many parts of one's life, including personal relationships, employment, and social life.

What is chronic kidney disease?

Chronic kidney disease, commonly known as chronic renal disease or CKD, is a disorder that causes a steady decrease of kidney function over time. Chronic kidney disease refers to illnesses that damage your kidneys and reduce their capacity to keep you healthy by filtering wastes from your blood. If your kidney condition develops, wastes can accumulate to dangerously high amounts in your blood, making you feel ill.

Kidney illness significantly raises your chances of developing heart and blood vessel disease. These issues may emerge gradually over time. Early identification and treatment can typically prevent chronic kidney disease from worsening. When kidney disease worsens, it may eventually lead to renal failure, which necessitates dialysis or a kidney transplant to preserve life.

The elderly are more likely to have CKD. While younger patients with CKD often have increasing loss of renal function, 30% of people over the age of 65 with CKD have stable illness. CKD increases the risk of cardiovascular disease and end-stage renal disease (ESRD). In the United States, kidney disease is the ninth largest cause of mortality.

Understanding our kidneys

Most individuals have two kidneys (although one in 10,000 are born with only one), and if we are healthy, our two kidneys operate by filtering waste items from the circulation and excreting them as urine. Our kidneys assist to regulate our blood pressure and produce a hormone that aids in the production of red blood cells, therefore preventing anemia. They also play a crucial function in preserving bone health.

Furthermore, they maintain the proper levels of a variety of salts and substances in the body, including sodium, potassium, phosphate, and calcium. Any chemical imbalances might create difficulties in other regions of the body, and because renal illness can interfere with drugs, patients should visit their doctor or a consultant.

What are the main causes of chronic kidney disease?

Diabetes and high blood pressure, or hypertension, account for two-thirds of all occurrences of chronic renal disease.

Diabetes:

Diabetes develops when your blood sugar levels remain abnormally high. Uncontrolled blood sugar levels can harm several organs in your body over time, including the kidneys, heart, blood vessels, nerves, and eyes.

High blood pressure:

High blood pressure happens when the pressure of your blood on the walls of your blood vessels rises. High blood pressure, if uncontrolled or poorly regulated, can be a primary cause of heart attacks, strokes, and chronic renal disease. Chronic renal disease can also lead to high blood pressure.

What are other conditions that affect the kidney?

Other disorders or events can also lead to renal disease.

Glomerulonephritis:

Glomerulonephritis is a category of disorders that cause inflammation and damage to the filtration units of the kidney. These are the third most frequent form of renal disease.

Inherited diseases:

Polycystic kidney disease, often known as PKD, is a hereditary condition that causes enormous cysts to grow in the kidneys, causing damage to the surrounding tissue.

Kidney and urinary tract abnormalities before birth:

Malformations that occur during the development of a baby in its mother's womb. A constriction, for example, may occur, preventing normal urine outflow and causing urine to flow back up to the kidney. This creates infections and has the potential to harm the kidneys.

Autoimmune diseases:

An autoimmune illness occurs when the body's defensive system, the immune system, turns against it. Lupus nephritis is an inflammatory illness that causes inflammation (swelling or scarring) of the tiny blood capillaries in your kidney that filter waste.

Other causes:

Kidney injury can result from obstructions caused by kidney stones or tumors. In males, an enlarged prostate gland or recurrent urine infections can also cause kidney impairment.

What are the risk factors of chronic kidney disease?

Chronic renal disease may strike anyone at any age. Some people, however, are more likely than others to acquire renal disease. You are more likely to get kidney disease if you:

Have diabetes
Have high blood pressure
Have a family history of kidney failure
Are older
Be a member of a demographic with a high prevalence of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, or American Indians.

What are the symptoms of CKD?

The majority of people do not experience CKD symptoms. Even if your kidneys are damaged, they can still function well enough to keep you from experiencing any symptoms. You can be born with only one kidney and live a normal life.

Even if you have CKD, you may still generate normal volumes of urine, but your kidneys are unable to eliminate the toxins from your body that they need to in order to keep you healthy. It is the quality of your pee, not the amount, that is important!

Symptoms may only be noticeable with more advanced kidney disease. These include:

Generally feeling ill, lack of interest in everyday activities and loss of concentration
Tiredness, low energy levels
Muscle weakness
Finding it difficult to breathe (due to a build-up of fluid in the lungs)
Difficulty sleeping at night (insomnia)
Passing urine more often at night
Feeling sick
Headaches
Itching
Aching bones
Muscle cramps

How is CKD diagnosed?

A blood and urine test are used to diagnose the majority of individuals. These tests may be performed as part of a standard check-up or if you are at risk of developing CKD.

Your doctor will determine the stage of CKD you have once you have been diagnosed. This is accomplished by measuring the quantity of creatinine, a waste product that accumulates in renal disease. This can be used by your doctors to estimate how well your kidneys are operating. This is sometimes referred to as your estimated glomerular filtration rate (e-GFR). It is measured in millilitres per minute and is dependent on how rapidly your kidneys filter your blood.

Most persons with CKD stages one to three may manage their illness with the help of their primary care physician and do not require the services of a kidney specialist. CKD can gradually worsen over time, but for the vast majority of individuals, it remains stable, and only a tiny percentage of people require renal replacement therapy such as dialysis. It is rare for kidney function to improve substantially after injury to the kidneys, however it does depend on the etiology of the disease.

Staging of CKD

The various phases of CKD are connected by a continuum. The following are the phases of CKD:

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m 2)
Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m 2)
Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m 2)
Stage 3b: Moderate reduction in GFR (30-44 mL/min/1.73 m 2)
Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m 2)
Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m 2 or dialysis)

GFR measurement alone may not be sufficient for distinguishing stage 1 and stage 2 CKD, because GFR in such individuals may be normal or borderline normal. In such circumstances, the presence of one or more of the following kidney injury indicators might help establish the diagnosis:

Albuminuria (albumin excretion > 30 mg/24 hr or albumin:creatinine ratio > 30 mg/g [> 3 mg/mmol])
Urine sediment abnormalities
Electrolyte and other abnormalities due to tubular disorders
Histologic abnormalities
Structural abnormalities detected by imaging
History of kidney transplantation in such cases

Management of Chronic Kidney Disease

In individuals with chronic kidney disease, early identification and treatment of the underlying cause, as well as the implementation of secondary preventative measures, are critical (CKD). These actions may slow or even stop the growth of the illness. It is critical to see a nephrologist as soon as possible.

The medical care of patients with CKD should focus on the following:

Delaying or halting the progression of CKD
Diagnosing and treating the pathologic manifestations of CKD
Timely planning for long-term renal replacement therapy

Treatment choices

Kidney transplant

This is the most effective renal failure therapy. Done kidneys are obtained from one of two sources: the national deceased (cadaveric) donor pool or a living donor. Living donor kidneys have the greatest overall success rate and eliminate the need to join the national transplant waiting list. In the United Kingdom, one in every three kidney transplants is currently performed from a live donor, either between close family members (blood relatives) or between non-blood relatives, such as partners and acquaintances.

It is critical to discuss living donation with your friends and family. If you have a donor who is eager to give a kidney but cannot be matched to your blood group or tissue type, there is now a nationwide program called 'paired donation' that seeks to match living kidneys across transplant centers in the UK. Some facilities are also working on strategies to allow transplantation despite blood type discrepancies. Some units can provide therapy to eliminate antibodies from the blood, allowing an incompatible transplant between a donor and a recipient to take place.

A kidney transplant before to commencing dialysis (known as a preemptive transplant) is the gold standard of care since patients can skip dialysis entirely and the kidney will likely stay longer.

If you want to learn more about live donation, you should speak with a transplant coordinator who can explain the procedures and alternatives to you. Donors can also speak with members of the transplant team in private before consenting to give.

Unfortunately, not everyone is a candidate for kidney transplantation, particularly those with various medical issues or those who are elderly. All patients must undergo testing to confirm they are healthy enough to have a transplant, and some may require treatment for certain medical disorders or (in addition) may need to reduce weight before receiving a kidney transplant.

Hemodialysis

During hemodialysis, blood passes from your body, around a dialysis machine, via a dialyser (artificial kidney), and back into your body. A little procedure will be required to construct a 'fistula,' which is where an artery connects to a vein, so that the vein may be expanded larger to allow dialysis needles to reach your circulation.

This is normally done six months before starting dialysis to allow it to expand, although they may usually be used safely after approximately six weeks if necessary. If you require dialysis before a fistula is created, a temporary dialysis line (a short plastic tube) may be inserted into a big vein in your neck.

The standard duration of hemodialysis is four hours, three times a week on alternate days. A rising number of patients are choosing self-care dialysis within the facility as well as home hemodialysis, which can provide greater independence, either with daily nocturnal dialysis or traditional three times weekly home dialysis.

The renal care team prepares patients for home hemodialysis so that they may manage their own treatment, and technical assistance is always accessible if needed. Patients who get home hemodialysis either insert the dialysis needles themselves or have a spouse/relative/partner trained to do so.

Peritoneal dialysis

This method of dialysis involves inserting a short, soft, plastic tube called a catheter into your abdomen (tummy area), allowing dialysis fluid to be emptied into and out of your peritoneal cavity. Waste materials from your blood are excreted and absorbed by the dialysis fluid. When the fluid is drained, it removes waste and excess fluid from your body.

This can be done by hand four times a day as part of a technique known as CAPD (continuous ambulatory peritoneal dialysis), or by machine overnight as part of APD (automated peritoneal dialysis). CAPD takes around 20-30 minutes to drain the fluid in and out and must be performed four times each day. APD lasts eight hours and requires 30 minutes to set up and clean the unit before and after each session.

The best method to decide whether dialysis therapy is right for you is to chat to staff and other patients about their decisions and what they like and dislike about their treatment options. If you plan ahead of time, you should be able to alter your kind of dialysis.

No treatment

Some patients may prefer not to receive any treatment for renal failure, and many units now have a specialized team of nurses who can give support and care to these patients and their families. It is critical to remember that dialysis and transplantation are not for everyone and that patients have the freedom to refuse treatment.

Patients who refuse dialysis are normally handled in the same way as other CKD patients until the kidney fails, at which point the goal of treatment shifts to treating the symptoms of renal failure and managing its consequences.

Preventing or slowing down the progression of chronic kidney disease

There are treatments to prevent chronic kidney disease from worsening or to reduce its course. Your GP or practice nurse should examine your kidney function on a regular basis using the eGFR test. They will also treat you and advise you on how to avoid or delay the course of CKD. This often includes:

Blood pressure control. The most critical therapy for chronic kidney disease, regardless of the underlying reason, is to keep your blood pressure under control. Most persons with CKD will need medication to keep their blood pressure under control. Depending on the quantity of albumin in your urine, your doctor may advise you to strive for a blood pressure level of less than 140/90 mm Hg or 130/80 mm Hg, or even lower in certain cases. Blood pressure should be kept lower than usual for their height in children and adolescents with CKD and high amounts of albumin in the urine.
Review of your medication. Certain medications can have an adverse effect on the kidneys, worsening CKD. For example, if you have CKD, you should not use anti-inflammatory medications unless your doctor has prescribed them. If your CKD worsens, you may need to change the dose of some medications you're taking.
Diet. if you have more advanced CKD (stage 4 or 5) then you will need to follow a special diet.

Medication to protect your kidneys

ACE inhibitors and ARBs. Even if your blood pressure is normal, you may be advised to take medication if you have excessive levels of protein in your urine. Two forms of medicine that are linked have been demonstrated to be effective for many persons with CKD. This is because they can prevent future deterioration of your renal function. These medications are known as:
Angiotensin-converting enzyme (ACE) inhibitors (for example, captopril, enalapril, ramipril, lisinopril); and
Angiotensin receptor blockers (ARBs), such as losartan, valsartan, candesartan, telmisartan).
SGLT2 inhibitors. SGLT2 inhibitors (such as canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) were originally used to control blood sugar levels in type 2 diabetes. However, newer research indicates that some of these can dramatically slow the deterioration in kidney function. These may be advised whether or not you have type 2 diabetes. The National Institute for Health and Care Excellence (NICE) has published new recommendations advising that they be made available to, or considered for, the majority of persons with type 2 diabetes and CKD.

Conclusion

Chronic renal disease indicates that your kidneys are no longer functioning as effectively as they once did. Chronic kidney disease can be caused by a variety of illnesses. The severity of the condition varies, but most instances are mild or moderate, occur in elderly individuals, do not cause symptoms, and worsen gradually over months or years. The rate of advancement differs from case to case and is frequently influenced by the severity of any underlying illness. Treatment in the early stages of chronic renal disease can prevent or reduce the development to kidney failure.