Chronic Kidney Disease: All you need to know

Last Updated on December 5, 2023 by Shabnam Sengupta

In Chronic Kidney Disease (CKD) or chronic kidney failure, there is a gradual loss of functioning of the kidneys due to progressive damage to the functional units of the kidneys leading to complete failure in the end.

In a healthy person, the kidneys filter toxins, balance electrolytes and remove excess fluid from the body. This does not happen in a person with CKD, leading to toxin and fluid accumulation in the body causing various complications.

It is a gradually progressive disease, and the early signs and symptoms are usually mild, and therefore ignored by the patients resulting in diagnosis at a late stage. In this article, we will discuss the symptoms, causes, stages, diagnosis, complications, treatment and prevention of chronic kidney disease.

Symptoms of Chronic Kidney Disease

The early signs and symptoms of chronic kidney disease are mild as well as non-specific making the diagnosis very difficult. But as the disease progresses with an increasing amount of nephron damage and loss of function in the kidney, the symptoms become evident.

Usually, there are following visible symptoms:

1. Nausea and vomiting due to improper toxin clearance from the blood 
2. Loss of appetite 
3. Decreased frequency of urination due to decreased kidney function 
4. High blood pressure due to fluid accumulation 
5. Swelling in feet and ankles 
6. Shortness of breath due to fluid in the lungs 
7. Fatigue and weakness 
8. Dry and itchy skin 
9. Decreased mental functioning 
10. Poor sleep at night 
11. Muscle cramps 

Causes 

The most common causes of chronic kidney disease are diabetes and hypertension.

However, apart from these diseases, there are other causes that can also lead to kidney failure if not timely managed or controlled:

1. Glomerulonephritis: This is the inflammation of the filtering units of kidneys called glomerulus causing their damage and loss of function.
2. Polycystic kidney disease: This happens when multiple small to large cysts develop inside the kidney causing compression of the normal tissues and blood supply.
3. Renal stones
4. Repeated urinary infections: UTIs can spread further from the urinary tract to cause infection of the renal tissue causing its damage and destruction.
5. Chronic use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): When consumed for a very long period of time, NSAIDs decrease blood supply to the kidneys and cause ischemic damage and renal failure.
6. Obesity: Fat around the renal blood vessel decreases its blood supply and increases the chance of ischemic damage.
7. Fetal developmental defect leading to underdeveloped kidneys.
8. Substance abuse: Alcohol, heroin, cocaine
9. Physical damage due to trauma or surgery
10. Autoimmune diseases like SLE (Systemic Lupus Erythematosus) cause antibody-mediated tissue damage.

Stages of Chronic Kidney Disease

There are five stages of the disease depending on the level of kidney damage causing a proportionate decrease in the filtration ability of the kidney which is quantified as glomerular filtration rate (GFR).

1. Stage 1 

GFR is more than 90 which is normal but urine shows the presence of proteins which indicates early kidney damage

2. Stage 2

The GFR decreases to 60-89 with an increase in proteinuria

3. Stage 3

GFR ranges from 30 to 59 ml/min 

4. Stage 4

There is a severe loss in renal functioning with GFR ranging from 15-29 ml/min

5. Stage 5

This is the last stage with complete loss of renal functioning and GFR less than 15ml/min called end-stage renal disease.

The person with this stage of CKD either needs a transplant or dialysis to survive.

Complications of Chronic Kidney Disease

Due to defective fluid, electrolyte and toxin clearance, there can be the following complications:

1. Fluid retention causes oedema in the peripheral parts of the body involving the ankles and feet.
2. Hyperkalemia is the increased concentration of potassium ions in the blood causing problems in heart and muscle contraction.
3. Anaemia due to low amount of erythropoietin which is secreted from the kidneys
4. Weak bones due to an imbalance in calcium and phosphorus metabolism
5. Decreased libido due to defective steroid hormone metabolism 
6. Defective immune function
7. Seizures due to defective electrolyte balance in the body

Diagnosis 

There are various tests to evaluate the levels of toxins in blood and the filtration ability of the kidneys:

1. eGFR: This estimates the GFR by measuring the level of creatinine in the blood.
2. Increased levels of creatinine estimate a failing kidney with low GFR.
3. Urine tests: Shows presence of proteins 
4. Blood pressure: increased in the blood pressure 
5. Kidney scans: this helps in the evaluation of the shape and size of the kidney and the presence of any congenital or structural deformity 
6. Kidney biopsy: a small sample of kidney tissue is taken and observed under a microscope 
7. Chest X-ray: helps in evaluation if pulmonary oedema is present 

Treatment 

The aim of treatment of chronic kidney disease is to treat the underlying cause and stop the progression of kidney damage and management of symptoms. When the cause is diabetes, good control of blood sugar will stop the CKD from progressing. In hypertensive patients, blood pressure management will decrease progression of the disease.

Besides this, following are some measures for symptomatic management:

1. Anaemia: Erythropoietin stimulating agents are given to increase the haemoglobin and red cell count.
2. Skin itching: Moisturisers and antihistaminic medicines are given. 
3. Weak bones: Calcium and vitamin D supplements can be used. 
4. Fluid build-up: Low sodium diet along with diuretics are given. 
5. Diet: Low protein diet is given. 
6. Limited consumption of alcohol and smoking. 

But if the disease has already progressed to stage 4 or 5, then the patient will need regular dialysis to remove the toxic substances until they find a compatible donor for transplant.

Prevention

Some steps for prevention of chronic kidney disease can be as follows:

1. Don’t take over-the-counter medications injudiciously for too long, for example, aspirin, ibuprofen, etc.
2. Avoid smoking and alcohol.
3. Maintain a healthy weight by doing regular exercise and consuming healthy food.
4. Frequent health check-ups in case of genetic predisposition or an underlying disease.

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.