Chronic Kidney Disease: An Overview

Chronic kidney disease (CKD, also called renal failure or renal failure) is a condition in which the kidneys lose some of their ability to remove waste and excess water from the bloodstream. body systems can be affected and can harm human health. , requiring a kidney transplant or dialysis to survive.
cause
The most common causes of CKD are diabetes and high blood pressure. In the early stages of CKD, there are no symptoms. The disease can progress to complete renal failure, also called end-stage renal disease. It occurs when kidney function deteriorates and requires dialysis or a kidney transplant to maintain health and even life. This is usually when renal function is about 10% or less of normal renal function.
symptoms
Most people may not have severe symptoms until kidney disease is advanced. However, you may notice:

• Increased fatigue and decreased energy
• have trouble concentrating
• Anorexia
• have trouble sleeping
• have muscle spasms at night
• swollen feet and ankles
• Puffiness around the eyes, especially in the morning
• dry skin, itchy
• Need to urinate more often, especially at night

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Chronic Kidney Disease: Risk Factors
Many factors can increase the risk of developing CKD, including:

• Diabetes
• high blood pressure
• family history of kidney disease
• African Americans and Other Minorities
• obesity
• smoking
• older age
• protein in urine
• have an autoimmune disease such as lupus

Evaluation and diagnosis
Health care providers may use several tests to diagnose CKD and determine if there is a treatable underlying cause. These include:
Renal function test – Glomerular filtration rate (GFR) provides an approximate measure of the overall filtering capacity of the kidney. Measuring true (actual) GFR is difficult and impractical in most patient care. Instead, her GFR is usually estimated. The most common method of estimating her GFR in adults is to measure creatinine levels in the bloodstream and use this value in a mathematical formula to calculate estimated GFR (eGFR) levels. eGFR provides an estimate of renal function, but actual renal function may be higher or lower than this estimate.

• A decrease in GFR signifies exacerbation of the underlying kidney disease or the development of another, possibly reversible, kidney problem.
• On the other hand, increased GFR indicates improved renal function.
• Stable GFR in CKD patients means stable disease.

Urinalysis – The presence of albumin or protein in the urine (called albuminuria or proteinuria) is a marker of kidney disease. Even small amounts of albumin in the urine can be an early sign of CKD in some people, especially those with diabetes and high blood pressure.
Imaging Research – Imaging tests (computed tomography, etc.) [CT] When ultrasonography is recommended to determine whether there is a blockage (blockage) in the urinary tract, kidney stones, or other abnormalities, such as the many large cysts seen in a genetic disorder called polycystic kidney disease there is.
Renal biopsy – A kidney biopsy is the removal of a small piece of kidney tissue for examination under a microscope. A biopsy helps identify abnormalities in kidney tissue that cause kidney disease.
Management of CKD patients
The main goal of treatment is to prevent progression of CKD to complete renal failure. The best way to do this is to diagnose CKD early and control the underlying cause.
Reduces risk of cardiovascular disease: The prevalence of cardiovascular disease is significantly higher in people with CKD than in those without CKD. Therefore, a major component of CKD management is cardiovascular risk reduction. Her CKD patients over the age of 50 are recommended to be treated with low- to moderate-dose statins regardless of low-density lipoprotein cholesterol levels. Smoking cessation should also be encouraged.
Management of high blood pressure: Many guidelines provide algorithms detailing which drugs should be used to treat hypertension in CKD patients. The presence and severity of proteinuria should be assessed. Blockade of the renin-angiotensin-aldosterone system with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) is recommended for adults with diabetes and urinary albumin/creatinine ratio (ACR). Adults with a urinary ACR of at least 30 mg per 24 hours, or at least 300 mg per 24 hours.
Diabetes management: Optimal management of diabetes is also important. First, glycemic control may slow progression of CKD, and most guidelines recommend a target hemoglobin A1c of approximately 7.0%. Second, dose adjustment of oral hypoglycemic agents may be required. In general, drugs that are largely cleared by the kidney (eg, glyburide) should be avoided, but drugs that are metabolized by the liver and/or partially excreted by the kidney (eg, metformin and some dipeptidyls) should be avoided. peptidase 4 [DPP-4] and sodium-glucose cotransporter-2 [SGLT-2] Dose reduction or discontinuation may be necessary, especially if eGFR is below 30 mL/min/1.73 m². Third, the use of specific drug classes such as SGLT-2 inhibitors should be considered in patients with severely increased albuminuria.
Nephrotoxin: All CKD patients should be counseled to avoid nephrotoxins. A complete list is beyond the scope of this review, but a few should be mentioned: Routine administration of NSAIDs in CKD is not recommended, especially among individuals on her ACE-I or ARB therapy. not.Diet management: KDIGO guidelines recommend reducing protein intake to less than 0.8 g/kg per day (with appropriate education) for adults with CKD stages G4-G5. proceed. Reducing the acid load in the diet (eg, eating more fruits and vegetables and less meat, eggs, and cheese) may also help prevent kidney damage.low-sodium diet (generally Pages labeled “Brand Connect” are advertising equivalents and are not created and produced by Forbes India journalists.