Chronic kidney disease

Kidney disease is no longer a rare condition, all thanks to our unhealthy eating habits and sedentary lifestyle that has increased our susceptibility to kidney problems.

According to the World Health Organization (WHO) Global Burden of Disease Project, kidney disease contributes to nearly 850,000 deaths per year, along with other urinary tract problems. In order to understand why the global burden of kidney disease is increasing, you need to understand its causes, risk factors, diagnosis, treatment and prevention.

Chronic kidney disease (CKD) is an age related progressive loss of kidney function. However, several conditions that can damage the kidneys and reduce their ability to filter wastes from the blood (glomerular filtration rate or GFR) are also included in chronic kidney disease. Once the kidneys start losing their ability to filter blood effectively, wastes start building up in the body resulting in many other complications. By definition, chronic kidney disease occurs when the glomerular filtration rate (GFR) is below 60 mL/min/1.73m2 for a period of 3 months or more.

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Causes

Diabetes and hypertension are the leading causes of kidney disease. As per the National Kidney Foundation (NKF), the following conditions can also cause kidney disease:


  • Recurring urinary tract infections.

  • Kidney stones

  • Polycystic kidney disease, where cysts formed in the kidneys result in damage to the filtering units called nephrons.

  • Glomerulonephritis or inflammation of the nephrons



‘External injury can also cause kidney disease by preventing the blood-filtering units (nephrons) from functioning properly. When the kidneys lose their functionality, fluids, salts and waste can build up in the bloodstream and lead to kidney failure,’ explains Dr Salil Jain, senior consultant, Nephrology and Renal Transplant.

Read about which of these kidney-damaging medicines are you on?

Risk Factors

Factors that put you at a higher risk of CKD include:

Symptoms

‘The most dangerous thing about CKD is that it progresses silently and is asymptomatic in the early stages. So, most patients will not develop any symptoms until kidney disease progresses to an advanced stage,’ says Dr Deepa Jayaram, consultant nephrologist and renal transplantologist. Here are some symptoms caused in the later stages of the disease.


  • Generalised fatigue and weakness

  • Pain while urinating

  • Swelling

  • Changes in frequency or urination

  • Pain in the lower back

  • Lack of appetite

  • Nausea and vomiting

  • Skin rashes or itching all over the body

  • Loss of concentration


Read in detail about various symptoms of kidney disease.

Diagnosis

About 10% of the general population suffers from kidney impairment of some kind, which if not diagnosed and treated at an early stage can lead to CKD, the prevalence of which is 1% in India, says Dr Saurabh Pokhariyal, director, Nephrology and Renal Transplant, FMRI.

According to Dr Jain, the problem lies in delaying regular health checkups. ‘Poor lifestyle practices increases the incidence of diabetes and high blood pressure,’ he says. If you know your risk factors and the status of your kidney function, you can make lifestyle and dietary changes early and save you kidneys from deteriorating completely.

When you go for an annual screening of your kidney function, you will have to undergo some or all of the following tests:

1. Blood tests:Several markers in the blood can help identify the actual kidney function. Urea and creatinine are the gold standards to detect kidney disease.

2. Urine tests: The ratio of values for blood and urine marker can give the actual rate of clearance of kidneys.

3. Estimated GFR: eGFR is the estimate of filtration rate of the kidneys based on a formula that include serum creatinine values along with correction factors like age, gender and race.

4. Imaging tests: Imaging test like renal ultrasound uses ultrasonic waves to analyse the size and shape of the kidneys to identify renal injury and changes in filtration capacity of the kidneys.

Read about 8 tests for checking if your kidneys are functioning fine.

Treatment

Most cases of CKD are diagnosed at a later stage when nothing much can be done about it. But when CKD is diagnosed at an early stage, further deterioration of kidney function can be prevented with appropriate treatment.

1. Medication: To prevent worsening of kidney function, medicines for controlling modifiable risk factors like high blood pressure, high cholesterol and triglyceride levels are prescribed.

2. Dialysis: ‘Dialysis is advised when the patient diagnosed with chronic kidney disease or CKD has glomerular filtration rate (GFR) less than 10 mL/min/1.73 m2. It is needed when the patient’s kidneys stop functioning and he experiences breathlessness due to excess water, increased acid level and high potassium level in the system,’ says Dr Harsh Dodeja, consultant nephrologist, Fortis Hospital, Mumbai. ‘These factors may result in heart rhythm abnormalities when left untreated. ‘But remember, dialysis cannot cure kidney disease. It is just supports the kidney function until the body may recover,’ he adds.

3. Kidney transplant: With kidney failure, regular dialysis may become difficult for both the patients and the staff. So, kidney transplant is the best option for such patients. But it is quite expensive. Only a few patients may afford it. Kidney transplant in India costs between 4 to 7 lakhs, in a private hospital in India.

Prevention

Chronic kidney disease can be prevented.  While nothing can be done about some factors like age, ethnicity or external injury to the kidneys, you can prevent a lot of other major risk factors leading to kidney disease. Also, minimizing stress on the kidneys right from the beginning can reduce your risk of developing CKD later in life. Here are 5 expert tips to keep your kidneys healthy

Dr Salin Jain offers some tips to prevent kidney disease:


  • People who have high BP should control it at the target set by their health care provider. This can delay or prevent kidney failure

  • If you have diabetes make sure you control your sugar levels with proper diet and regular exercise

  • Avoid excessive salt intake


Read more about10 tips to prevent kidney disease.

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