Chronic kidney disease

Chronic kidney disease (CKD) is a long-term condition characterized by the gradual loss of kidney function over a period of three months or more.<ref>Levey, AS,

 Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO), 
 Clinical Journal of the American Society of Nephrology, 
 2007,
 Vol. 2(Issue: 3),
 pp. 514-523,
 DOI: 10.2215/CJN.03951106,</ref> CKD represents a significant health concern globally due to its associated morbidity and mortality, often leading to end-stage renal disease (ESRD) and necessitating renal replacement therapies like dialysis or kidney transplantation.

CKD - Chronic kidney disease

CKD Logo

Pathophysiology of Chronic Kidney Disease

CKD involves progressive and irreversible damage to the nephrons, the functional units of the kidneys. Over time, this damage hampers the kidneys' ability to filter waste and excess fluid from the blood effectively. This leads to the buildup of toxins, an imbalance in electrolytes, and alterations in blood pressure regulation.

The kidneys also have roles in erythropoiesis (production of red blood cells) and bone health. In CKD, these functions are compromised, leading to anemia and bone diseases.<ref>Liyanage, T,

 Worldwide access to treatment for end-stage kidney disease: a systematic review, 
 Lancet, 
 2015,
 Vol. 385(Issue: 9981),
 pp. 1975-82,
 DOI: 10.1016/S0140-6736(14)61601-9,</ref>

Causes of Chronic Kidney Disease

Key causes of CKD include:

• Diabetes: High blood glucose levels can damage the nephrons over time.
• Hypertension: Uncontrolled high blood pressure can cause damage to the blood vessels in the kidneys.
• Glomerulonephritis: This group of diseases damages the glomeruli, the tiny filtering units in the kidneys.
• Polycystic kidney disease: An inherited condition causing numerous cysts to form in the kidneys.
• Long-term use of certain medications: Some drugs, including NSAIDs and certain antibiotics, can cause kidney damage.

Diagnosis and Staging of Chronic Kidney Disease

CKD is diagnosed through blood tests measuring serum creatinine (used to calculate the glomerular filtration rate (GFR)), urine tests looking for proteinuria or albuminuria, and imaging studies. In some cases, a kidney biopsy may be needed.<ref>KDIGO,

 KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease, 
 Kidney International Supplements, 
 2013,
 Vol. 3(Issue: 1),
 pp. 1-150,
 DOI: 10.1038/kisup.2012.73,</ref>

Stages of CKD are based on the GFR:

• * Stage 1: Kidney damage with normal or high GFR (>90 mL/min)
• * Stage 2: Mild reduction in GFR (60-89 mL/min)
• * Stage 3: Moderate reduction in GFR (30-59 mL/min)
• * Stage 4: Severe reduction in GFR (15-29 mL/min)
• * Stage 5: Kidney failure (GFR <15 mL/min)

Management of Chronic Kidney Disease

The primary goals of CKD management include slowing the progression of kidney damage, managing symptoms, and reducing the risk of cardiovascular disease.

• Lifestyle Modifications: Patients are advised to maintain a healthy diet, limit sodium and protein intake, maintain optimal body weight, and exercise regularly. Smoking cessation is also recommended due to its link to faster CKD progression.<ref>Levin, A,

 Controlling the epidemic of cardiovascular disease in chronic renal disease: where do we start?, 
 American Journal of Kidney Diseases, 
 1998,
 Vol. 32(Issue: 5 Suppl 3),
 pp. S5-13,
 DOI: 10.1053/ajkd.1998.v32.pm9820470,</ref>

• Medications: Control of blood glucose levels in diabetics, management of hypertension, and the use of certain drugs like angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can slow the progression of CKD.<ref>Jafar, TH,

 Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis, 
 Annals of Internal Medicine, 
 2003,
 Vol. 139(Issue: 4),
 pp. 244-52,
 DOI: 10.7326/0003-4819-139-4-200308190-00006,</ref>

• Management of Complications: This includes treatment for anemia, bone disorders, and electrolyte imbalances. Additionally, psychosocial support may be beneficial due to the impact of CKD on quality of life.<ref>Gorodetskaya, I,

 Health-related quality of life and estimates of utility in chronic kidney disease, 
 Kidney International, 
 2005,
 Vol. 68(Issue: 6),
 pp. 2801-8,
 DOI: 10.1111/j.1523-1755.2005.00752.x,</ref>

• Renal Replacement Therapy: For individuals with advanced CKD (Stage 5 or end-stage renal disease), renal replacement therapy, such as dialysis or kidney transplantation, may be required.<ref>

Treatment Methods for Kidney Failure(link). {{{website}}}. National Institute of Diabetes and Digestive and Kidney Diseases.

Accessed 2023-05-18.

</ref>

Prognosis and Public Health Impact

The prognosis of CKD varies widely and depends on the underlying cause, stage at diagnosis, patient's age, and comorbidities. Untreated or poorly managed CKD can lead to end-stage renal disease, cardiovascular disease, and increased mortality. The public health impact of CKD is significant due to its high prevalence and the associated health care costs.

See Also

• Kidney disease
• End-stage renal disease
• Renal replacement therapy
• Diabetes mellitus
• Hypertension
• Glomerulonephritis

References

<references />

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