Chronic Kidney Disease
CHRONIC KIDNEY DISEASE
We all live a happy life in a conducive environment but we forget, life is all about health. A conducive environment and domestic felicity are not enough for our body to work in the manner it should. In our busy lives, we neglect to focus on our health and unknowingly we make mistakes that lead to an unhealthy body. There are multiple processes that our body goes through daily. Our body has 11 organ systems, which help the body to perform multiple processes, including the urinary system. Among the 11 systems, we will dig into the function of the urinary system to understand the kidney.
What is a kidney?
The kidney is a bean-shaped pair of organs present in our abdomen which performs the function of the urinary system and helps to filter waste produced in our body. The urinary system is also known as the renal system or urinary tract and has multiple organs namely the ureters, renal pelvis, bladder, urethra and the main organ kidney. These organs are responsible for excretion in our bodies. They work together as a team and regulate the filtration of extra waste and accomplish the task daily without fail.
As we all know, we are blessed to have such a system full of wonders in our body that works involuntarily and does not need our manual efforts to perform their functions. The kidney is one of them which filters blood in our body every 30 minutes daily without letting us know. However, kidneys can also fall ill like we all do, when we do not take care of ourselves. There can be multiple reasons for kidney diseases. Commonly, our daily carelessness can lead to kidney disease.
Chronic kidney disease
Chronic kidney disease is a condition in which the kidneys do not perform their function well and are unable to filter the blood due to which extra waste does not exit the body and leads to accumulation of waste of blood in the body. This extra waste collected in The body is not life-threatening for kidneys only but overall health. The risk of heart disease can be the consequence of (CKD) chronic kidney disease.
Taking treatment in the early stage can be worthwhile but if you do not take treatment as soon as possible it may get worse and even life-threatening. Sometimes people may not feel ill and notice any sign, so it is important for everyone to get tested yearly. This can help to reduce the risk of severe conditions.
Stages of CKD
There are five stages in CKD. Each stage is determined on the basis of the eGFR test (Estimated glomerular filtration rate is a type of test which measures the level of kidney function and shows the stage of kidney disease). As stages go up the disease becomes more severe and risky.
Stage 1- The eGFR report under the rate of 90 or above is assumed to be the early or first stage of CKD. 90 determines the good health of the kidney. However, kidneys do not work at 100 percent. Stage 1 does not damage the kidney severely and most patients do not notice any symptoms. The patient can live many years in stage 1, and recover with little treatment. This stage of kidney disease is mostly diagnosed through a blood test and urine test. The life expectancy in this stage is likely above other stages.
Stage 2- If the eGFR report falls under 60 to 89, it determines the second stage of CKD. This means the function of kidneys have decreased and kidneys cannot remove waste properly. In this stage, you may notice some mild symptoms or signs which patients commonly ignore. You can notice darker urine with yellow, red or orange colour, urination can be increased or decreased, high blood pressure, insomnia and pain in the lower back. Patients mostly ignore it as they assume these symptoms might have been caused due to the busy life.
Stage 3- When eGFR decreases and falls under 30 to 44 it indicates the 3rd stage of CKD. This stage becomes more complicated than previous stages. Now, the patients can notice some complications with the body. The function of kidneys gets complicated and it declines the waste and the accumulated waste results in uremia. Uremia is a condition when the level of nitrogenous waste product rises in the blood. Kidneys do not filter properly. This is the dangerous stage of CKD. The patient can experience kidney pain in their back, darker urine with foam, fluid retention, swelling of extremities. It is strictly advised to see a nephrologist in this stage.
Stage 4 – Once you reach this stage it can be a bit difficult to make a kidney work like before. This stage is a severe loss of kidney function which increases the risk of kidney failure and should be taken seriously. The eGFR falls under 15 to 29 and the function of the kidney almost becomes stagnant. Damaged kidneys cannot filter blood properly. At this stage, the patient should be ready for a transplant or dialysis. The patient may experience swelling in the hands and feet, back pain and nausea.
Stage 5- This is the last stage of CKD when kidneys are almost failed or near to failure. The eGFR decreased to less than 15. The function of kidneys stops and they no longer filter any waste in the body. Symptoms can be worse than previous stages like itching, vomiting, trouble in breathing, abnormal urinating and muscle cramp. In this stage dialysis or transplant are the only options.
Causes of Chronic Kidney Disease
It is well said, “prevention is better than cure”. As now you know what CKD is and how every stage of it becomes worse as it goes up, you must be thinking if there’s any specific reason to get CKD. There are some common causes that increase the risk of getting CKD. And why is it important to know about it because if we know the causes, we will not let it happen and develop into the worse stage of CKD?
- Diabetes – In diabetes, your body does not produce enough insulin. (Insulin is one of the main hormones which tends to regulate blood sugar) This condition determines that there is a high level of blood glucose or blood sugar in your body called hyperglycemia due to which blood vessels that filters the waste are clogged and the process of filtration stops working sooner or later. This can lead to kidney disease or even kidney failure. When diabetes causes harm to the kidney it is called diabetic nephropathy. So, controlling diabetes is not advised only to diabetic patients but to other people too.
- High blood pressure- there are 2 common causes of kidney diseases, diabetes and high blood pressure. High blood pressure constricts and narrows the blood vessels which damage or weaken vessels and kidneys which reduce the flow of blood. Damaged blood vessels are unable to perform their function due to which the kidney does not filter the waste and fluid and the extra fluid present in the blood vessels raise the blood pressure and lead to kidney disease and failure.
- Glomerular disease- glomeruli are the tiny filter network of blood vessels also known as cleaning units of kidneys. They are responsible for filtering waste and removing extra fluid from the blood. When glomeruli are damaged due to some reasons it is known as glomerular disease. In this condition, the waste accumulates in the blood and the danger of leakage of protein and red blood cells into the urine increases. Eventually, blood stops absorbing extra fluid which leads to swelling in the body especially in the hands and ankles. This affects the ability of kidneys’ filtration functions and can lead to kidney failure.
- Polycystic kidney disease(PKD)- this disease is believed to be a genetic disease. The cysts are likely to develop inside the kidney. These cysts are filled with liquid due to which the size of the kidney increases than their actual size and they lose the ability to work. Gradually, the cysts damage the kidney and lead it to failure.
- Vesicoureteral reflux- it is a condition in which urine opposes its natural direction of flow due to flap valve failure and starts flowing backwards and travels from bladder to ureter and then reaches the kidneys. As we all know urine is a waste product so it also contains bacteria that can reach the kidney and can cause kidney infections which damage the kidney. Another condition is a ureteral obstruction in which one or both ureters block which do not allow the urine to exit the body. ureters are the tubes that are responsible for carrying urine from the kidneys to the bladder. This can result in severe kidney damage.
Symptoms and signs of CKD
Symptoms get diversified from patient to patient. Sometimes patients notice severe symptoms and sometimes mild symptoms. As the stage of CKD goes up the symptoms are likely to get worse. It is advised to not trivialize any symptom even.
Here are some common symptoms:
- Muscle cramps
- Itchy skin
- High blood pressure
As patients reach the 3rd and 4th stages they notice some other symptoms:
- Darker urine (yellow, red and orange)
- Loss of appetite
- More or less urinating
- Swelling in feet and ankles
- Edema (fluid retention)
- Lower back pain
Diagnosis of CKD
As we read above, the early stage doesn’t show any symptoms, so it is better to get tested for it. When you visit your nephrologist and go for Chronic kidney disease tests, it can be diagnosed through blood and urine tests. However, most people unknowingly found CKD through routine tests. Diabetes patients are advised to get themselves tested regularly and also, it is important to tell your nephrologist if there’s any genetic problem regarding it. Patients with diseases like heart disease and high blood pressure are likely to have kidney disease so, it’s very important for those people to regularly contact their nephrologist so that they can diagnose CKD at an early stage and will be able to cure it with treatment, as it’s risky if you are having multiple diseases at a particular time.
- Blood test
The blood test is also known as (eGFR) estimated glomerular filtration rate is assumed to be the major test to diagnose chronic kidney disease. The level of a waste product called creatinine that comes from muscle tissue is measured in this test. After testing the blood, the result comes in a numerical formula that tells the GFR number. And the GFR number decides the health of the kidney if they are working well or not.
- Dipstick urine test– This test is one of the kinds of urine tests. It is used to detect kidney diseases and diabetes as well. Firstly, the urine sample is collected, then the urine is tested with chemical strips also known as a dipstick, which has 10 different chemical pads that react and show the result tested in the lab. The dipstick is dipped into the urine and then observed. If the colour changes it indicates the urine contains abnormalities or the level of substances is above the adequate level.
A dipstick check:
- pH level– the pH level determines the level of acid in urine. However, urine has an acidic nature but If the pH level is unusual, it can be a sign of kidney disease or urinary tract infection.
- Protein level– protein is an element that is present in urine at some amount but can become the reason to worry if it is in a high amount. A high level of protein in urine indicates kidney diseases. However, a low amount of protein in urine is not a matter of concern.
- Sugar– as protein, sugar (glucose) is also presented at a very small amount in urine. Commonly, the level of sugar is very low and cannot be detected but if the test detected sugar in the urine, it may indicate diabetes.
- Blood- if the test detects blood in your urine, it can be a sign of many diseases like kidney disease, bladder cancer and blood disorder, that is why it needs some additional testing to detect the actual reason for blood in the urine.
- (UACR) Urine albumin-to-creatinine ratio- this determines whether there is albumin in your urine that is present or not. Albumin is one of the kinds of protein that is found in our blood. As we all know, protein is an important nutrient that our bodies need. However, it is good for the body but harmful if present in the blood. The condition in which urine contains albumin is known as albuminuria or proteinuria. UACR is a urine test in which a little amount of urine is needed which gets examined in the lab to observe the result. It identifies the presence of blood and protein in the blood. As a result, if the amount of albumin is present more than 3g, it indicates kidney disease. In fact, kidney function is to filter the blood and help the waste to exit our body. Healthy kidneys work exactly as I said and let only a low amount of protein go into the urine but due to kidney damage, protein gets leaked out into the urine which can increase the risk of chronic kidney disease and sometimes kidney failure can also happen. UACR can be an early sign of kidney sign so it is advised to not to ignore the signs.
Treatment for chronic kidney disease
Treatment for Chronic kidney disease varies upon complications. Mild complications can be cured with medication and the other severe complications have their different cures.
CKD complications that can be cured are:
- Swelling– CKD can be responsible for retaining fluids which can lead to swelling in ankles, legs and hands. This can be controlled with diuretics, a type of medication that can cure this complication by balancing the fluids.
- High blood pressure- it can be controlled with (ACE) angiotensin-converting enzymes, a medication that can balance high blood pressure. However, they can slow down the function of the kidney for which the patient needs to see the nephrologist.
- High cholesterol level- There is bad cholesterol called (LDL) cholesterol present in the blood. Kidney patients are likely to experience high cholesterol. Statins, a kind of drug which helps to reduce the bad cholesterol in the blood. Nephrologists suggest it lowers your cholesterol level.
- Amount of waste products in the body- when we consume food, our body produces protein from the food and then the waste is filtered by kidneys. Patients having kidney diseases need to reduce the protein diet so that it does not pressurize kidneys to filter. A dietician suggests to the patient the ways to reduce protein intake.
These complications can be cured with the help of medications but when a patient reaches stages 4 and 5 the complications become severe and life-threatening, so for these stages, there are other treatments: Dialysis and Kidney transplant
Dialysis- The process in which toxic wastes get filtered through mechanical equipment when our kidneys no longer filter the accumulated liquid waste present in our body.
Dialysis becomes essential when one of the kidneys of a human being fails to filter. In this process, several needles and pipes are inserted into our body so it can direct the blood through the pipes and needles to the dialysis machine in which blood-filled with toxic nutrients gets intoxicated. Then it flows back to the body.
- Types of dialysis
● Peritoneal dialysis
Hemodialysis – In this process, an artificial kidney is taken in order to remove the waste and extra chemicals and fluid from our body. To do this process the patient has to go into minor surgeries so that the nephrologist can get access to the vessels and the process can be carried out smoothly.
Peritoneal dialysis- In this type of dialysis, the toxic blood accumulated in our body gets filtered inside of our body. During this, a plastic tube gets inserted in our abdomen called a catheter and a cleansing fluid goes from the catheter to the abdomen. The lining presented in our abdomen known as the peritoneum helps to remove the waste from the blood. After some time the fluid flows outside the body and gets disposed of. This can be carried at home as well as at the hospital or whilst working. To get through this dialysis we have to need a special caregiver.
TRANSPLANTATION OF KIDNEY
The transplantation of a kidney is a procedure in which the patient has to undergo surgery so that a healthy kidney can be placed inside the body of the patient. A kidney transplant is one of the best options during kidney failure. kidney transplantation is more beneficial as compared to lifetime dialysis. There is a lower risk of death. Usually, the patient who gets a kidney transplanted lives 10 to 15 years longer than the person who would live on dialysis.
Family history – family history is very important in order to know the risk of kidney disease. Because kidney disease has been in your family history, then it is very likely that you have been inherited by your family. Kidney disease can be genetic and it is important to let your nephrologist know if there is any family history regarding kidney disease.
Diabetes and high blood pressure– it is proven that diabetes and high blood pressure are the biggest and two most common causes of kidney disease and kidney failure. It does not harm the kidney only but the heart and overall health.
Age– Age matters in kidney disease. Because if the patient’s age is above 60 years, then it increases the risk factor a lot. As we grow older our kidney becomes weaker naturally. People above 60 are likely to have diabetes and blood pressure. As we see in the article above, high blood pressure and diabetes are two common causes of chronic kidney disease.