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Chronic kidney disease

CONTENTS 

1. Overview 

2. Risk factors 

3. Causes 

4. Signs and symptoms 

5. Investigations and evaluation 

6. Prevention 

1.OVERVIEW 

➔ As we know each kidney comprises about 2 million of nephrons with weight on an average of 160gm. 

➔ Apart from its size and weight it does its work meticulously without any sign of fatigue and gets rid off one to one and half liters of urine per day. 

➔ Moreover both kidneys combinely can filter up to 200 liters of fluid from the blood. Ironically due to failure of maintaining this function called filtration the waste piles up in the body, and also failure to release hormones (hypo or hyper) at required levels thus leading to severe kidney disease. 

➔ The long standing disease can lead to kidney failure. 

➔ By definition chronic kidney disease is defined as chronic, irreversible loss of kidney function can be accountable for the loss of nephron function. 

➔ There is a subtle loss in function and develop over 3 months can leads to chronic kidney disease 

➔ Other names of chronic kidney disease include chronic renal disease, chronic kidney failure or CKD in short 

2.RISK FACTORS 

There are several risk factors which adversely develop and spread the disease, of which 

primary risk factors which can be reversible includes 

➔ 1. Diabetes type I , with onset of age 20 

➔ 2.uncontrolled Hypertension 

➔ 3.obesity,due to production of inflammatory substance can cause renal tissue damage 

➔ 4.cigarette smoking further damages the tissues by constriction of blood vessels ➔ 5.fail to maintain glucose levels 

➔ 6.cardiovascular or heart diseases 

The risk factors which are irreversible includes

➔ As age increases the severity of developing CKD is more .people of age at 65years or above. 

➔ Gender studies shown that females are more prone to CKD than men because men are more likely to reach kidney failure sooner.Basically the proper reason for these gender differences are not known till date 

➔ Race according to few african Americans are affected more but talking about India, one in every ten are affected 

➔ Lower birth weight of the child born with kidney abnormalities like impaired kidney development resulting in smaller organs 

➔ Genetics it is said to be one of the major non modifiable risk factors due to its inheritance that runs down the entire family tree .non escapable risk factor .there is 3 to 9 times greater chances if family has an positive history . 

➔ Poor immunity as we know that immunity that comes by birth is more stronger than the one obtained after birth .As there is frequent exposure to the infections they had no space to escape the attack of chronic kidney disorders. 

These are some of the potential risk factors which on treatment can be controlled. 3.CAUSES OF CHRONIC KIDNEY DISEASE 

Diabetes 

● Often, the first sign of kidney disease from diabetes is protein in your urine. ● When the filters are damaged, a protein called albumin, which you need to stay healthy, passes out of your blood and into your urine. 

● A healthy kidney doesn’t let albumin pass from the blood into the urine. ❖ In diabetes,the excessive sugar in the blood sticks to protein in blood called as non enzymatic glycation this makes the efferent arteriole to get stiff and narrow leading to decrease in blood flow thus increases pressure as a result of this it further expand glomerulus causing diminishing of the nephron activity. 

Hypertension 

● The walls of the artery get thickened and that results in narrow lumen means less blood gets supplied to the kidney and oxygen leading to ischemic injury. 

● so that few inflammatory cells slips in to the glomerulu causing glomerular sclerosis ,results in decrease function 

❖ Other causes includes 

INFECTIONS long standing of these infection can cause CKD and if untreated can lead to death 

➔ HIV 

➔ Tuberculosis 

➔ Leptospirosis 

➔ Nematode infestations 

➔ Pyogenic infections

➔ MEDICATIONS 

➔ NSAIDS 

➔ OVER THE COUNTER medicines such as vitamins, antihistamines,antibiotics,common cough medications etc 

➔ TOXINS 

➔ Tobacco( nicotine and it’s products ) 

➔ Occupational over exposure to certain heavy metals such as cadmium and lead are also known to cause toxic injuries to kidney leading to its failure 

SYSTEMIC DISEASES 

➔ lupus nephritis 

➔ Rheumatoid arthritis 

➔ Liver disease 

➔ Diabetic nephropathy 

➔ Congestive heart failure 

➔ Dysproteinemias 

The chief causes of Chronic kidney disease in children includes 

● Obstructive uropathy 

● Focal segmental glomerulosclerosis 

● Polycystic kidney disease(hereditary) 

SIGNS AND SYMPTOMS 

Signs and symptoms indicate that there is some abnormality happening in the body . One of the first possible signs is….. 

DIZZINESS & FATIGUE 

➔ Due to weakening of the kidneys it affects the overall health of the body. ➔ If you are tired for a day or two don’t panic, sometimes it may be due to stress or overwork and you face trouble concentrating. 

➔ But if u find it weak Even after taking good rest and healthy food it’s time to visit a specialist immediately without any delay 

SWELLING OR EDEMA 

➔ Swelling or edema is known as retention of water caused by electrolyte or other nutritional abnormalities 

➔ The lower extremities like legs,ankles,around eyes edema is noted and it is a primary sign to detect that there is any heart or kidney disorder. 

TROUBLE SLEEPING 

➔ sleep apnea is most commonly encountered in CKD affected persons 

DRY AND ITCHY SKIN

➔ As there is failure to balance right amount of mineral and nutrients levels in the blood the skin feels .reasons include high blood levels of phosphorus binds to calcium 

➔ Other few reasons include limited fluid intake,right amount of dialysis,Allergies etc ➔ Urenic frost on skin is seen where urea is deposited over skin 

OFTEN FEEL TO URINATE 

➔ There is an urge to urinate due to failure of kidneys especially during nights. ➔ This may be indication of Urinary tract infection or prostate enlargement 

BLOOD IN URINE 

➔ Due to failure of filtration the severed kidneys leaks blood cells out into urine ➔ This is an indicative of obstruction,tumors or infections to kidneys 

➔ Foamy urine this is because of protein albumin which excretes through urine,which doesn’t happen in healthy kidneys 

➔ MUSCLE CRAMPS 

➔ Electrolyte imbalance (Low calcium levels and poor controlling of phosphorus) can cause severe cramps 

Nausea ,loss of appetite happens due to increased urea in the blood known as (Azotemia) ENCEPHALOPATHY 

➔ This causes flapping of hands in persons with kidney disease further If untreated may lead to coma /death 

PERICARDITIS 

➔ Due to buildup of toxins there is increasing chances of infection to heart tissues BLEEDING TENDENCIES (COAGULOPATHY) 

➔ Increased bleeding tendency due to failure to clot 

ANEMIA 

➔ Due to decrease in erythropoietin hormone which is responsible for signaling bone marrow 

HYPERKALEMIA 

➔ Increase in phosphorus causes cardiac arrhythmias 

HYPOCALCAEMIA 

Decrease in calcium levels can lead to renal osteodystrophy 

INVESTIGATIONS & EVALUATION

1.Blood test is done based on the age ,gender,weight of the patient,can be done by estimating glomerular filtration rate(GFR) and calculated by a specific formula according to the gender and race. 

THE NORMAL RANGE OF GFR IN A HEALTHY KIDNEY 60 or above mL/min/1.73m^2,below 60mL/min/1.73 m^2 causes kidney disease and still lower i;e <15 mL/min/1.73m^2 cause kidney failure. 

Staging of the disease according to the glomerular filtration rate 

Stage. Description. GFR 

I. Increased GFR. 90(CKD+ 

riskfactor) 

II. Mild decrease in GFR. 60_89 

III. moderate decrease. 30_59 

IV. Severe decrease. 15_29 

V. Renal failure. <15/ dialysis 

2.Modification of diet in renal disease is calculated by following formula 

eGFR (mL/min/1.73 m2) = 175 x (creatinine, mg/dl)-1.154 x (Age, years.)- 0.203 (x 0.742 if female). 2.Urine analysis 

Dipstick test for albumin _ the less albumin in urine the less chances of CKD 

This causes foamy urine 

Urine albumin-to-creatinine ratio (UACR)_ the range 30mg/g is normal ,more than 30 mg/g is indicative of kidney disease 

blood urea nitrogen (BUN), electrolytes, glucose, calcium, phosphorus, albumin complete blood count (CBC) 

Other tests included to evaluate further are 

Renal ultrasound shows change in size and shape of kidney or any constrictions Renal sonogram shows same as renal ultrasound 

Monitoring levels of electrolytes such as ca, phosphorus,alkaline phosphatase,iron Levels of hormones such as renin, angiotensin, erythropoietin 

Rh factor in case of positive family history

To evaluate CKD 

the phosphorus levels are higher 

Calcium levels are lower 

GFR is lower 

Renal ultrasound and sonogram show change in size and shape 

Hormonal activity decreases 

Complete blood count shows decrease in red blood cells,white blood cells and platelets Urine analysis shows more than 30 mg/g of UCAR. 

Treatment and management 

Management 

Stage I 

Eating healthy diet 

Maintaining healthy routine 

Keep checking over blood pressure and diabetes 

Stop smoking 

Continue using prescribed medications 

Stage II 

Eating healthy diet 

Maintaining healthy routine 

Keep checking over blood pressure and diabetes 

Stop smoking 

Continue using prescribed medications 

*Regular visits to check up on Glomerular filtration rate 

Stage III 

Maintaining healthy routine 

Keep checking over blood pressure and diabetes 

Stop smoking

Continue using prescribed medications 

*Regular visits to check up on Glomerular filtration rate *Using other imaging techniques to rule out any spread of disease Eating According to the changed diet plan with low protein diet Stage IV 

Eating healthy diet containing enough iron , vitamin C,D,proteins Maintaining healthy routine 

Keep checking over blood pressure and diabetes 

Stop smoking 

Continue using prescribed medications 

*Regular visits to check up on Glomerular filtration rate Limiting diet which are high in phosphorus,sodium, carbohydrates Stage V 

Eating healthy diet containing enough iron , vitamin C, D,proteins Maintaining healthy routine 

Keep checking over blood pressure and diabetes 

Stop smoking 

Continue using prescribed medications 

*Regular visits to check up on Glomerular filtration rate Limiting diet which are high in phosphorus,sodium, carbohydrates Treatment 

iron supplements for anemia 

calcium/vitamin D supplements to prevent bone fractures, vitamin C cholesterol-lowering drugs in case of overweight 

diuretics to treat edema 

Hypoglycemic drugs in case of diabetes 

Antihypertensive drugs for lowering blood pressure

bone marrow stimulants for production of red blood cells 

Hemofiltration 

Dialysis/peritoneal dialysis 

Kidney transplantation 

Prevention 

Conscious decision making while considering health habits is prerequisite for leading a healthy life as mentioned above following 

strict diet plan 

Physical exercises like running,walking,cycling 

Quit smoking and alcohol consumption 

Management of underlying conditions through help of specialists 

Standard life habits 

Control over situations to reduce stress or workover load can be helpful mentally and improves good rest Following an expert advised prescription cannot harm. 

In a nutshell,your overall health of the body depends on the kidney’s health.

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