HEALTH TIPS: Chronic kidney disease (renal failure) Part- 1

Dr Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

Chronic kidney disease (CKD) is a slow and progressive loss of kidney function over a period of several years, eventually leading to permanent kidney failure. Chronic kidney disease, also known as chronic renal failure, chronic renal disease, or chronic kidney failure, is much more widespread than people realise; it often goes undetected and undiagnosed until the disease is well advanced. It is not unusual for people to realise they have chronic kidney failure only when their kidney function is down to 25 per cent of normal. As kidney failure advances and the organ’s function is severely impaired, dangerous levels of waste and fluid can rapidly build up in the body. Treatment is aimed at stopping or slowing down the progression of the disease by controlling its underlying cause.
* Over 10 per cent of the population worldwide is affected by chronic kidney disease, and millions die each year because they do not have access to affordable treatment.
* In people aged 65 through 74 worldwide, it is estimated that one in five men, and one in four women, have CKD.
* According to the latest WHO data published in 2018, kidney disease deaths in Guyana reached 147 or 2.47 per cent of total deaths and the 10th leading cause of death.
* Over 2 million people worldwide currently receive treatment with dialysis or a kidney transplant to stay alive, yet this number may only represent 10 per cent of people who actually need treatment to live.
* It is estimated that the number of cases of kidney failure will increase disproportionately in developing countries, where the number of elderly people is increasing.
* In middle-income countries, treatment with dialysis or kidney transplantation creates a huge financial burden for the majority of the people who need it. In another 112 countries, many people cannot afford treatment at all, resulting in the death of over 1 million people annually from untreated kidney failure
* Chronic kidney disease can be treated. With early diagnosis and treatment, it is possible to slow or stop the progression of kidney disease.

RISK FACTORS
The following conditions or situations are linked to a higher risk of developing kidney disease:
* A family history of kidney disease
* Age – chronic kidney disease is much more common among people over 60
* Atherosclerosis
* Bladder obstruction
* Chronic glomerulonephritis
* Congenital kidney disease (kidney disease which is present at birth)
* Diabetes – one of the most common risk factors
* Hypertension
* Lupus erythematosus
* Overexposure to some toxins
* Sickle cell disease
* Some medications

CAUSES
Kidneys carry out the complex system of filtration in our bodies – excess waste and fluid material are removed from the blood and excreted from the body. In most cases, kidneys can eliminate most waste materials that our body produces. However, if the blood flow to the kidneys is affected, or they are not working properly because of damage or disease, or if urine outflow is obstructed, problems with filtration and excretion can occur.
In most cases, progressive kidney damage is the result of a chronic disease (a long-term disease), such as:
* Diabetes – chronic kidney disease is linked to diabetes types 1 and 2. If the patient’s diabetes is not well controlled, excess sugar (glucose) can accumulate in the blood. Kidney disease is not common during the first 10 years of diabetes; it more commonly occurs 15-25 years after diagnosis of diabetes.
* Hypertension (high blood pressure) – high blood pressure can damage the glomeruli – parts of the kidney involved in filtering waste products.
* Obstructed urine flow – if urine flow is blocked it can back up into the kidney from the bladder (vesicoureteral reflux). Blocked urine flow increases pressure on the kidneys and undermines their function. Possible causes include an enlarged prostate, kidney stones, or a tumour.
* Kidney diseases – including polycystic kidney disease, pyelonephritis, or glomerulonephritis.
* Kidney artery stenosis – the renal artery narrows or is blocked before it enters the kidney.
* Certain toxins – including fuels, solvents (such as carbon tetrachloride), and lead (and lead-based paint, pipes, and soldering materials). Even some types of jewellery have toxins, which can lead to chronic kidney failure.
* Fetal developmental problem – if the kidneys do not develop properly in the unborn baby while it is developing in the womb.
* Systemic lupus erythematosus – an autoimmune disease. The body’s own immune system attacks the kidneys as though they were foreign tissue.
* Malaria and yellow fever – known to cause impaired kidney function.
* Some medications – overuse of, NSAIDs (Ibuprofen, aspirin, diclofenac, etc), some antibiotics,
* Illegal substance abuse – such as heroin or cocaine.
* Injury – a sharp blow or physical injury to the kidney(s).

STAGES OF KIDNEY DISEASE
Changes in the glomerular filtration rate (GFR) can assess how advanced the kidney disease is. In the UK, and many other countries, kidney disease stages are classified as follows:
Stage 1 – GFR rate is normal (>90ml/min). However, evidence of kidney disease has been detected, such as protein in the urine, blood, and other biological markers.
Stage 2 – GFR rate is lower than 60-89ml/min, and evidence of kidney disease has been detected.
Stage 3 – GFR rate is lower than 30-59ml/min, regardless of whether evidence of kidney disease has been detected. It can have 2 subtypes of 3A and 3B
Stage 4 – GRF rate is lower than 30ml/min, regardless of whether evidence of kidney disease has been detected.
Stage 5 – GFR rate is lower than 15ml/min. Renal failure has occurred.
The majority of patients with chronic kidney disease rarely progress beyond Stage 2. It is important for kidney disease to be diagnosed and treated early for serious damage to be prevented. Patients with diabetes should have an annual test, which measures microalbuminuria (small amounts of protein) in urine. This test can detect early diabetic nephropathy (early kidney damage linked to diabetes). Along with frequent check of GFR every 6 months.

SYMPTOMS
Chronic kidney disease rarely shows symptoms until the later stages, so screening is recommended for those who are at risk. Chronic kidney failure, as opposed to acute kidney failure, is a slow and gradually progressive disease. Even if one kidney stops functioning, the other can carry out normal functions. It is not usually until the disease is fairly well advanced and the condition has become severe that signs and symptoms are noticeable; by which time most of the damage is irreversible. It is important that people who are at high risk of developing kidney disease have their kidney functions regularly checked. Early detection can significantly help prevent serious kidney damage.
The most common signs and symptoms of chronic kidney disease include:
*
* Anaemia
* Blood in urine
* Dark urine
* Decreased mental alertness
* Decreased urine output
* Oedema – swollen feet, hands, and ankles (face if oedema is severe)
* Fatigue (tiredness)
* Hypertension (high blood pressure)
* Insomnia
* Itchy skin, can become persistent
* Loss of appetite
* Male inability to get or maintain an erection (erectile dysfunction)
* More frequent urination, especially at night
* Muscle cramps
* Muscle twitches
* Nausea
* Pain on the side or mid to lower back
* Panting (shortness of breath)
* Protein in urine
* Sudden change in bodyweight
* Unexplained headaches
Patients with chronic kidney disease generally experience progressive loss of kidney function and are at risk for end-stage renal disease. The rate of progression depends on age, the underlying diagnosis, the implementation and success of secondary preventive measures, and the individual patient. Timely initiation of chronic renal replacement therapy is imperative to prevent the uremic complications of CKD that can lead to significant morbidity and death.
Next week’s article will discuss how someone can be diagnosed with CKD, treatment options and possible complications