Chronic Kidney Disease & End Stage Kidney Disease

What is Chronic Kidney Disease (CKD)?  What is End Stage Renal Disease (ESRD)?

Chronic kidney disease (CKD) refers to a gradual loss of kidney function over time. CKD is an irreversible condition that can progress to End Stage Renal Disease, at which time the patient will require kidney replacement therapy.

Symptoms

CKD in early stages often asymptomatic. Patients may not be aware that they have a kidney problem. In more advanced stages, patients may develop leg swelling, fatigue, worsening hypertension (high blood pressure). As a patient reaches ESRD, he/she may develop shortness of breath, poor sleep, poor sleep, poor appetite and even nausea and vomiting.

Causes

There are many causes of CKD. The most common include:

• Diabetes Mellitus (high sugar): Longstanding Diabetes can damage many different organ systems including the kidneys. Poor control of blood sugars will lead to CKD faster than if blood sugars are well controlled. This is the most common cause of End Stage Kidney Disease world-wide.

• Hypertension (high blood pressure): Poorly controlled high blood pressure can strain the kidneys, causing damage over time. Alternatively, kidney disease in itself can cause high blood pressure.

• Glomerulonephritis: Inflammation of the kidney’s filtering units from various different conditions can result in CKD. Examples of diseases that result in this condition include Systemic Lupus Erythematosus (SLE), IgA Nephropathy, Membranous Nephropathy amongst others.

• Polycystic Kidney Disease: This is an Inherited disorder causing cysts to develop in the kidneys, which leads to kidney enlargement and chronic damage. Screening of family members and close monitoring of those with the condition should be done.

• Chronic use of Kidney Toxic Medications: Examples of kidney toxic medications include certain painkillers (Non-Steroidal Anti-inflammatory Drugs), gastritis medications (ex. pantoprazole, esomeprazole), ayurvedic medications.

• Repeated Infections of the Kidneys: Also known as Pyelonephritis. Repeated infections can occur in patients with poorly controlled diabetes or with enlarged prostates.

• Obstructive Kidney Disease: repeated episodes of obstructive kidney stones or repeated episodes of urinary obstruction from an enlarged prostate can results in chronic kidney damage.

Treatment

Unlike AKI where injury usually reverses, CKD is irreversible damage to the kidneys that usually progresses over time.  Therefore, CKD is not curable and treatment focuses on slowing progression to more advanced stages and management of other conditions that arise due to kidney dysfunction. This involves management of the following:

• Blood pressure with dietary modifications and medications
• Blood sugar in diabetic patients with dietary modifications and medications
• Anemia with optimization of iron, vitamin b12 and folate levels and the use of certain injections in more advanced stages of CKD to help boost blood counts.
• Acid-base levels with the use of certain medications
• Electrolyte levels with dietary modifications and occasionally medications
• Water levels in the body with dietary modifications and occasionally medications
• Mineral bone health with diet and medications
• Protein losses with the use of certain medications

When a patient reaches ESRD, kidney replacement therapy in the form of dialysis or transplantation will be required.