What is Chronic Kidney Disease?

Slow and progressive damage to the kidneys and gradual decrease in their functioning is Chronic Kidney Disease (CKD). If kidney disease gets worse, wastes can build up to high levels in our blood. We may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases the risk of having heart attack and blood vessel disease. These problems may happen slowly over a long period of time. Early detection and treatment can often keep chronic kidney disease from getting worse. As kidney disease progresses it eventually leads to kidney failure thus requiring dialysis or kidney transplantation.

The working of the kidneys is measured by a simple blood test called creatinine. In normal adults the serum creatinine is below 1mg/dl. This corresponds to 100% functioning of the kidneys. The functioning is usually talked about in terms of GFR (glomerular filtration rate). A normal adult male will have a kidney function of about 125ml/min of GFR. A female of the same age and weight will have about 15% lesser i.e. 110 ml/min of GFR (due to lesser muscle mass). As kidney function or GFR decreases, the creatinine increases. Surprisingly, a creatinine of just 1.5 mg/dl corresponds to a GFR of about 60, a loss of 50% function!! A creatinine of 2 mg/dl is about GFR 30, creatinine of 3 mg/dl is about GFR 20, a creatinine of 4 mg/dl is about GFR 15 and a creatinine of 5 mg/dl is about GFR 10. If a patient’s GFR falls below 10, the excretion of toxic wastes is no longer adequate to maintain life and should be considering dialysis.

What are the Causes of Chronic Kidney Disease?

The common causes of CKD are

• Diabetes (up to 50% have diabetes as a cause of CKD)
• Hypertension
• Medications (like chronic pain killer usage, other kidney toxic medications)
• Nephrotic syndromes (loss of proteins in urine)
• Glomerulonephritis (loss of blood and proteins in urine)
• Hereditary conditions (like polycystic kidneys)
• Obstruction to kidneys (stones, cancers, strictures etc)
• Chronic kidney infections
• Unknown causes

What are the symptoms of Chronic Kidney Disease?

Most organs in our body, including the kidneys do not cause any symptoms till more than 80 – 90% of the organ is damaged. Hence waiting for symptoms to check oneself maybe too late to detect treatable conditions. However the following symptoms may herald CKD

• Breathlessness upon walking short distances
• Breathlessness upon lying down
• Frothy or foamy urine
• Blood in urine
• Swollen feet and ankles
• Puffiness around eyes, especially in the morning
• Need to urinate more often, especially at night.
• Passing less urine especially less than 500 ml in a day

Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:

• have diabetes
• have high blood pressure
• have a family history of kidney failure
• are older
• Taking pain killers often
• Diagnosed with chronic disease conditions like Rheumatoid arthritis, SLE

How is Chronic Kidney Disease detected?

1. A test for protein in the urine. Albumin to Creatinine Ratio (ACR), estimates the amount of albumin lost in your urine per day. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. A positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.

2. A test for blood creatinine. The serum creatinine, along with age, race, gender and other factors, is used to calculate the Glomerular Filtration Rate (GFR). GFR calculator, click here.

How is Chronic Kidney Disease treated?

Strict control of diseases like diabetes, high blood pressure, cholesterol along with the required fluid intake, therapy for anemia, therapy for acidosis can help to prevent kidney disease from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. The exact causes of some kidney diseases are still unknown and specific treatments are not yet available for them. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs) helps to slow the progression of chronic kidney disease. The Nephrologist will help to tailor your therapy as the case maybe. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation.

How is Kidney Failure Treated?

Kidney failure may be treated with hemodialysis, peritoneal dialysis or kidney transplantation. Treatment with hemodialysis may be performed at a dialysis unit or at home. Hemodialysis treatments are usually performed three times a week. Peritoneal dialysis is generally done daily at home. Automated Peritoneal Dialysis requires the use of a machine while Continuous Ambulatory Peritoneal Dialysis does not. The Nephrologist will explain the different therapies and help individual patients make the best treatment choices for themselves and their families.

Kidney transplants have high success rates. The donor kidney could be from someone who is brain dead (termed Deceased Donor or Cadaver) or from a living donor, who may be a relative or is unrelated.

Facts about Chronic Kidney Disease (CKD)

• One out of every 9 adults have CKD
• Early detection can help prevent the progression of kidney disease to kidney failure
• Heart disease is the major cause of death for all people with CKD
• Hypertension causes CKD and CKD causes hypertension.
• Persistent proteinuria (protein in the urine) means CKD is present
• High risk of kidney failure includes those with diabetes, hypertension and family history of kidney failure
• Two simple tests can detect CKD: Urine protein and serum Creatinine
• Glomerular filtration rate (GFR) is the best estimate of kidney function