CHRONIC KIDNEY DISEASE
Helen T. Ocdol, MD, FPCP, FPSN
Chronic Kidney Disease (CKD) is a dreaded condition . CKD includes a continuum of kidney dysfunction from mild kidney damage to end-stage renal disease (ESRD). Chronic renal disease is interchangeably used for CKD but to be unifom in usage, we will use the term Chronic Kidney Disease or CKD. In the U.S., there are 20 million adults who have chronic disease and over 400,000 persons have ESRD and require dialytic or transplantation therapy. In the Philippines, annually we have about 6,ooo patients started on dialysis most of which are caused by diabetis mellitus. Complications of this condition have also made this the 9th cause of death ...view middle of the document...
73m3. This should be calculated on two occasions, with an interval of at least two weeks, before a diagnosis of CKD is considered. The disease domains of hypertension (high blood pressure), proteinuria (excretion of protein in the urine) and hyperlipidemia (increased blood level of cholesterol and/or triglyceride) may occur at any stage so these should be treated to slow down the progression of the disease. Anemia (low red blood cell count not to be confused with low blood pressure) appears at Stage 3, and hypertension may become less controlled during Stage 3-4. The bone disease of CKD or renal dystrophy, malnutrition and decreasing immune status typically appear during early Stage 4 and worsen rapidly as kidney failure (Stage 5) approaches. It is also necessary to adjust the dosage of the medicines depending on the kidney function particularly after reaching Stage 4.
There are risk factors for CKD, the two most important of which are diabetes mellitus and hypertension. The former is the greatest contributor to the ESRD population. Other risk factors are: positive family history of kidney disease, urinary tract obstruction, urolithiasis (stones in the urinary tract), reduced kidney mass (solitary kidney) or size, exposure to nephrotoxins (drugs or chemicals that damage the kidneys like pain killers, antibiotics or radio-contrast dye), autoimmune disorders (like systemic lupus erythematosus), and low birth weight. Socio-demographic risk factors include low income level, low educational level, exposure to chemical or environmental hazards, male gender, and advanced age. Certain ethnic groups have a higher risk of developing CKD including Asians, African-Americans, Hispanics, and American Indians. These groups should be screened for kidney disease from time to time.
One of the strongest predictors for worsening kidney function is the degree of protein excretion in the urine specially Asian and American-Indian patients with Type 2 diabetes mellitus . Other risk factors for the progression of CKD include: morbid obesity, hypercholesterolemia, the metabolic syndrome (a form of type 2 diabetes mellitus due to resistance to insulin, obesity, hypertension and high cholesterol level), heavy consumption of non-narcotic pain medication (like ibuprofen, mefenamic acid, diclofenac, naproxen, etc.) and cigarette smoking. These risk factors for the progression of the the kidney disease are particularly seen among patients with diabetes, glomerular disorders and Adult Polycystic Kidney Disease (an inherited disease where both kidneys have cysts). Strategies to delay the progression of CKD should include: controlling high blood pressure, compliance with dietary protein restriction, stringent control of the blood sugar among diabetics, the use of medications to lower cholesterol, and preventing the occurrence of acute renal failure (as what happens in patients with dehydration, infection, and urinary tract obstruction from stone).
What does one feel when...