What is chronic kidney disease?
Chronic kidney disease is a progressive loss of kidney functions. The disease is chronic as the damage happens slowly, over some time.
Initially, it shows only biochemical abnormality but, eventually, loss of excretory, endocrine and metabolic functions of the kidney leads to the clinical signs and symptoms of renal failure.
What is the function of the kidneys?
The kidney’s main job is to filter wastes and excess fluids from hundreds of pints of blood per day. The waste and fluids become urine stored in the bladder until it is passed out of the body.
While cleaning the blood, they take or add chemicals, such as calcium and phosphorus, to maintain the body’s balance.
The kidneys also control blood pressure, tell the body to make red blood cells and help keep the bones strong.
Also Read: Myeloproliferative Glomerulonephritis
What are the stages of CKD?
There are 5 stages of CKD.
Stages depend upon the GFR (glomerular filtration rate) which means how well your kidneys function. Normal value of GFR 90 to 120 mL/min/1.73 m2.
| Stages | GFR | Description | Treatment stage |
| 1 | 90+ | Normal kidney functions but urine findings or structural abnormalities or genetic traits point to kidney disease | Observation, control of blood pressure |
| 2 | 60-89 | Mildly reduced kidney functions, and other findings (as for stage 1) point to kidney disease. | Observation, control of risk factors and BP |
3A 3B | 45-59 30-44 | Moderate reduced kidney function | Observation, control of risk factors and BP |
| 4 | 15-29 | Severely reduced kidney functions | Planning for end-stage renal failure |
| 5 | <15 or on dialysis | Very severe or end-stage kidney failure | Treatment choices |
What are the causes of CKD?
In many cases, the underlying diagnosis is very unclear, especially among the large number of elderly patients with moderate GFR reduction.
High blood pressure and diabetes are the most common cause of chronic kidney disease.
Many health conditions can cause CKD:
- Glomerulonephritis
- High cholesterol
- Autosomal dominant polycystic kidney disease
- Recurrent obstruction of the urinary tract
- History of long-term use of lithium and NSAIDs
- Polycystic kidney disease
- Nephrotic syndrome
- Recurrent pyelonephritis
- Autoimmune diseases like lupus, polyarteritis nodosa
- Vesicoureteral reflux
What are the signs and symptoms of CKD?
Most symptoms go unrecognized until the disease has progressed blood and urine tests are the quickest ways to diagnose the disease. The typical presentation is with a raised urea and creatinine found during routine tests. The rate of change in renal function varies from patient to patient but is relatively constant for an individual and provides useful prognostic information.
Clinic features:
- High blood pressure
- Reduced appetite
- Weight loss
- Retention of water
- Nausea and vomiting
- Changes in skin pigmentation
- Numbness in hands or feet
- Excessive thirst
- Easy bruising
- Blood in stool
- Drowsiness, fatigue
- Difficulty in thinking or concentration
- Confusion
- Swelling of hands and feet
- General ill feeling
- Dry itchy skin
- Chest pain can occur due to the accumulation of water in the heart lining
- Dyspnoea
- Insomnia
- Body pain or muscle cramps
- General debility
- Increased susceptibility to infection
- Increased bleeding tendency in advanced CKD
- Electrolyte abnormalities
- Hormonal abnormalities may be observed
- Generalized myopathy may occur due to a combination of poor nutrition, hyperparathyroidism
- Vitamin D deficiency
- Restless leg syndrome
- Cardiovascular diseases like ventricular hypertrophy secondary to hypertension
- pericarditis
What are the diagnostic criteria for CKD?
Documentation:
- Physical findings: description of urine, output, fluid balance, presence of pain or pruritus, vital signs, LOC (altered level of consciousness), GI status, skin integrity, condition of dialysis access site.
- Nutrition: response to dietary or fluid restrictions, tolerance to food, body weight
- Complications: impaired decision-making, uremia, CHF, HTN, rapid irregular heartbeat, hyperventilation, anemia, osteopenia etc.
- Activity tolerance: level of fatigue, ability to perform, mobility.
Lab tests:
- Blood urea nitrogen (BUN): BUN indicate the renal clearance of waste products. A high level indicates the inability to excrete water.
- Serum creatinine: it is an end product of protein and muscle metabolism. A high level of it can indicate renal disease and when 50%> of renal function is lost.
- 24-hr urine creatinine: <95% decrease that may indicate acute damage limits the ability to clear creatinine.
- Glomerular filtration rate: this tells the amount of filtrate formed by the kidneys each minimum.
- Complete blood count: RBC, WBC, and platelets.
Also Read: BUN
How common is CKD?
The social and economic consequences of CKD are considerable. In most countries, estimates of the prevalence of CKD stage 3-5 are around 5-7%, mostly affecting people aged 65 years and above.
Also Read: Homeopathy A Safe And Effective Cure For Kidney Stones
Is kidney disease hereditary?
Yes, CKD can run in the family. Hypertension and diabetes are the most common cause of CKD that always runs in the biological family.
What are the risk factors of CKD?
Factors that can increase your chances of getting CKD include:
- Hypertension
- Diabetes
- Family history of CKD
- Prolong use of NSAIDs
- Smoking
- Obesity
- Abnormal structures of the kidney
- People above 60 years
Also Read: Foods to prevent Kidney disease
What are the complications of CKD?
- Retention of fluid in the body can lead to swelling in the limbs
- Dyspnea due to fluid accommodation in the lungs
- Pericarditis
- Weak bone and muscle due to vitamin D deficiency or calcium absorption
- Uncontrolled high blood pressure
- Anemia
- Generalized myopathy
- Difficulty in conception
- Decreased libido
- Electrolyte imbalance
How to manage CKD?
There is no cure for CKD but there are several ways that can prevent further damage to the kidney:
- Take proper medications
- Quit smoking
- Control parameter of DM
- Treat Hypertension
- Treat anemia
Regulate diet:
- Fluid restrictions
- High calories, high carbohydrate
- Maintain healthy weight
- Low protein, low sodium
- Reduce intake of dark leafy greens, salmon, beans
- Reduce intake of chicken, milk, carbonated drinks
- Dialysis when indicated
- Transplantation when available
What are the contraindications?
- Alka seltzer or baking soda
- Milk of mag or another antacid
- Aspirin
- NSAIDs
- Enemas or laxatives
- Supplements
- OTC meds: consult PCP before using
- Herb meds: consult PCP before using
What are the allopathic treatments for CKD?
- BP meds (ACE or ARB) help protect the kidneys and lower heart disease risk.
- Diuretics: controls fluid overload
- Supplements: Vit D, Ca, Phosphorus Binder, sodium bicarb, and kayexalate should be taken with meals or snacks.
- Meds to Increase RBCs
- Immunosuppressants
- Corticosteroids to decrease pain and inflammation
- Cholesterol reducing medicines
- antibiotics.
What are the homoeopathic medicines for CKD?
- Arsenicum album- It is used in the later stages of chronic kidney disease where the patient’s skin becomes pale, and he develops a waxy appearance, excess thirst and diarrhoea. The patient also experiences dyspnea with urinary troubles.
- Apis mellifica- Works well in cases where the patient has edematous swelling on the face, and paleness with pain in limbs and back. It is used when there are dull aches in the kidney, reduced urination, and micturition
- Belladonna- It helps in treating inflammation of kidneys with shooting, piercing pain in the lumbar region of kidneys. The pain relapses every now and then with increasing intensity.
- Cantharis- Suited best where there is a cutting pain in the lumbar region, the urine contains blood and the flow is in the form of drops with difficulty in passing urine.
- Conavallaria- It is used in case of nephritis occurring with heart affections. It is also beneficial in cases with dropsy and anasarca.
