Chronic Kidney Disease (CKD)
Definition: Chronic Kidney Disease is a progressive, irreversible deterioration of renal function lasting >3 months, leading to reduced ability to maintain fluid, electrolyte, and waste balance.
Epidemiology
- Global prevalence ~10–15%
- More common in elderly, diabetics, hypertensives
- Increased risk in African-American, Hispanic, and South Asian populations
Stages of CKD (Based on GFR)
| Stage | GFR (ml/min/1.73 m²) | Description |
|---|---|---|
| 1 | ≥90 | Kidney damage with normal function |
| 2 | 60–89 | Mild decrease in GFR |
| 3a | 45–59 | Mild to moderate decrease |
| 3b | 30–44 | Moderate to severe decrease |
| 4 | 15–29 | Severe decrease |
| 5 | <15 | Kidney failure (End-Stage Renal Disease) |
Etiology
- Diabetes mellitus (leading cause)
- Hypertension
- Glomerulonephritis
- Polycystic kidney disease
- Reflux nephropathy
- Obstructive uropathy
Clinical Features
- Fatigue, weakness
- Anorexia, nausea
- Pruritus
- Nocturia, polyuria → Oliguria in late stages
- Edema, hypertension
- Metallic taste in mouth, uremic breath
- Peripheral neuropathy, restless legs
- Anemia, bleeding tendency
Laboratory Investigations
- Serum creatinine & estimated GFR (eGFR)
- Blood urea nitrogen (BUN)
- Urine analysis: Proteinuria, hematuria
- Urine albumin-to-creatinine ratio
- Electrolytes: Hyperkalemia, hypocalcemia, hyperphosphatemia
- Hemoglobin: Anemia of chronic disease
- Renal ultrasound: Small echogenic kidneys
Management
General Principles:
- Treat underlying cause (e.g., diabetes, hypertension)
- Slow progression and delay ESRD
- Prevent and manage complications
Medical Management:
- Blood pressure control: Target <130/80 mmHg (use ACE inhibitors or ARBs)
- Glycemic control: Maintain HbA1c ~7%
- Dietary: Low protein, sodium, potassium, and phosphate diet
- Anemia: Treat with iron and erythropoiesis-stimulating agents
- Bone mineral disorders: Control calcium, phosphate, vitamin D
- Dialysis: Indicated in ESRD (Stage 5)
- Renal transplant: Definitive treatment in eligible patients
Complications
- Cardiovascular disease (leading cause of death)
- Electrolyte imbalances (e.g., hyperkalemia)
- Renal osteodystrophy
- Uremia
- Malnutrition
- Infections
Prognosis
- Depends on stage, etiology, and comorbidities
- Better outcomes with early detection and management
- Increased mortality in late-stage CKD without dialysis or transplant
Patient Education
- Importance of blood pressure and glucose control
- Adherence to low-protein, low-sodium diet
- Regular monitoring of renal function
- Vaccination: Hepatitis B, pneumococcal, influenza
Conclusion
Chronic Kidney Disease is a major public health issue with rising global burden. Early diagnosis, lifestyle changes, optimal control of comorbid conditions, and timely referral to nephrology are essential for slowing progression and improving quality of life.
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