Chronic Kidney Disease
Chronic kidney disease (CKD) is defined as the existence of a defect in the structure or function of kidney continuing for above 3 months. Following are the defects that may be observed: –
- GFR (Glomerular filtration rate) below 60 mL/min/1.73 m2
- Albuminuria (urine albumin more than 30 mg/24 hours or urine ACR [albumin-to-creatinine ratio] more than 30 mg/g)
- Renal tubular disorders
- Irregularities in urine sediment, imaging or histology
- History of kidney transplantation
Stages of CKD
- Stage 1 (GFR ≥90 mL/min/1.73 m2)- Kidney damage with normal kidney function
- Stage 2 (GFR 60–89 mL/min/1.73 m2) – Kidney damage with mild loss of Kidney function
- Stage 3 (30–59 mL/min/1.73 m2) – Moderate loss of Kidney function
- Stage 4 (15–29 mL/min/1.73 m2) – Severe loss of Kidney function
- Stage 5 (<15 mL/min/1.73 m2) – Kidney failure
Causes of CKD
CKD may occur due to disease processes in any of the three categories: prerenal, intrinsic renal or postrenal conditions. In prerenal conditions due to decreased plasma volume (dehydration) or due to decreased blood flow (excessive bleeding, shock, cardiac failure etc.) decrease in kidney function is observed. The renal causes for decreases kidney function are the conditions affecting the glomerular filtration rate, the tubular function and any changes in the renal vascular system that decreases the blood flow. A postrenal cause for decrease in kidney function is due to the obstruction of the urine flow, it may be caused by enlargement of the prostate, stones in the urinary tract or tumors of the bladder.
The most prevalent causes of CKD are Diabetes mellitus type 1 and type 2, High blood pressure, Primary and Secondary glomerulonephritis, Plasma cell neoplasm, Chronic Tubulointerstitial nephritis, Hereditary or cystic diseases and Sickle Cell Nephropathy.
Management of CKD
Following are the guidelines for management of CKD:
- Early detection and diagnosis: regular health check-ups and screening for individuals at risk (e.g., those with diabetes, hypertension or a family history of CKD) to detect CKD in its early stages.
- Medical Management: Consultation with a nephrologist for an accurate diagnosis and personalized treatment plan must be done. Medications to control underlying conditions such as blood pressure, diabetes, anaemia, hypercholesterolemia must be suggested.
- Lifestyle modifications: Restricted diet, exercise to maintain weight, restricting smoking and alcohol consumption and managing stress are required to be followed.
- Blood pressure management: Normal blood pressure should be maintained by regular blood pressure monitoring and antihypertensive medication.
- Monitoring and testing: Regular monitoring of patient by Kidney function test should be done.
- Medication Adherence: Prescribed medications should be taken as directed by the healthcare providers.
- Prevent complications: Vaccination against flu, pneumonia and hepatitis B will reduce infection risk. NSAIDs should be avoided. Any new medication or supplements should be taken after consulting healthcare providers.
- Manage cardiovascular health: This could be achieved by controlling cholesterol levels, maintain healthy diet, exercise regularly etc.
- Dialysis and Transplantation options: For advanced CKD, dialysis and kidney transplantation must be discussed with nephrologist.
- Regular Follow-ups: A consistent schedule of follow-up appointments with healthcare providers should be maintained.
- Education and Support: One should stay informed about CKD, its progression and management options. One must also join support groups or seek counselling to cope with the emotional and psychological aspects of CKD.
Dr. Pratyusha Kar