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