Chronic Kidney Disease

Background

The human body has two kidneys which filter body wastes and excess fluids from the blood. The kidneys are bean-shaped organs, each weighing about 140 grams. They are located along the lower middle of the back on both sides of the spine. Each kidney has approximately one million filtering units (nephrons) which help in filtering wastes and fluids from the blood; these are then excreted as urine in the bladder. The kidneys are connected to the bladder through tubes called ureter and bladder is emptied by urinating through another tube called urethra (see inserted figure). Chronic Kidney Disease (CKD) refers to a gradual loss of kidney function, with duration usually greater than 3 months (an acute condition is less than 3 months). In this state, increasing amounts of fluids, electrolytes and wastes are retained in the body. As the condition worsens, the kidneys become damaged; wastes and fluids build up to high and dangerous levels in the body, and an overwhelming sickness often results. Complications like high blood pressure (and other heart and blood vessels (cardiovascular) conditions), low red blood cells, nutritional deficiencies, bone and nerve damage, among others may further set in. Eventually, kidney (renal) failure may develop- a condition where the kidneys can no longer perform its functions, with the body now requiring dialysis or kidney (renal) transplant to maintain healthy life.

The World Health Assembly already reported in 2008 that non-communicable diseases (NCDs) are now the most common cause of premature deaths worldwide, with CKD ranked 18th among the leading causes deaths globally (way up from 27th in 1990). In fact, the number of deaths from CKD has risen by over 80% during this period. Epidemiological reports show that Africa and many developing countries have experienced high burden of CKD mostly due to late detection of the disease and a prevalent burden of hypertension and diabetes, which are the two main risks of CKD. In a recent study by Stanifer and colleagues, published in the Lancet Global Health (March 2014), the prevalence of CKD in sub-Saharan Africa was estimated at 14%.

 

Risk factors

Diabetes, high blood pressure, and a family history of kidney disease increase the risk of having CKD. Increased risk has also been documented among Africans, African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians. Diabetes and hypertension are responsible for over 60% of cases of CKD globally. Hypertension is a leading cause of myocardial infaction, strokes and CKD (note that CKD can also cause hypertension!). Other risk factors include glomerulonephritis (inflammation and damage of the kidney’s filtering units), congenital and inherited diseases (e.g. polycystic kidney disease), diseases that affect the immune system, obstructions to the flow of urine (e.g. from kidney stones, prostate hypertrophy or tumours) and urinary tract infections.

 

Symptoms and stages of CKD

As with many chronic illnesses, a number of people may not have any symptoms and signs until advanced stages of the kidney disease. The main symptoms that may point to CKD include swollen feet and ankles, puffiness around the eyes (usually in the morning), muscle cramps especially at night, tiredness, poor appetite, dry skin, urine frequency at night, and general feeling of unwell. Please, report to nearest health facility if you are having some of these symptoms. A check of blood pressure, serum creatinine, urine albumin and glomerular filtration rate may point to diagnosis. The severity of CKD is now classified in 5 stages, mainly based on measured or estimated glomerular filtration rate (GFR), with stage 1 the mildest, and stage 5 a severe illness (end-stage renal disease). The Kidney Disease Outcomes Quality Initiative (KDOQI) stages of CKD as provided by the National Kidney Foundation, New York, USA, are shown in the table below.

Stage

GFR

Description

1

90+

Normal kidney function but urine findings or structural abnormalities or genetic trait point to kidney disease

2

60-89

Mildly reduced kidney function, and other findings (as for stage 1) point to kidney disease

3A
3B

45-59
30-44

Moderately reduced kidney function

4

15-29

Severely reduced kidney function

5

<15 or on dialysis

Very severe, or end-stage kidney failure (sometimes call established renal failure)

Available from: http://www.renal.org/information-resources/the-uk-eckd-guide/ckd-stages#sthash.qcj5G9AT.dpuf

 

Staying healthy

The aim of this write-up is to point us to the risks and symptoms of CKD in order to facilitate early detection of the disease, which obviously can ensure instituting early and appropriate management, and help prevent the progression of CKD to kidney failure. People with diabetes and hypertension should please manage these conditions well- maintain normal blood pressure and blood glucose levels. Please ensure you check with your family physician regularly. Anyone with the symptoms highlighted above should please present to a standard health facility for appropriate examination and investigations. GFR (glomerular filtration rate) has been described as the best way to measure the level of kidney function, which helps to determine the stage of a kidney disease (if present). Your family physician can easily calculate this from the results of the blood creatinine test, with reference to your age, race, gender and other medical conditions observed at the time of consultation. The earlier any sign of CKD is detected, the better the chances of a treatment option slowing down or stopping disease progression.

 

Conclusion

Chronic Kidney Disease is a major public health problem across many parts of Africa and the globe. This is just a brief review, please endeavor to read more on this topic and regularly seek advice from health experts.

Dr. Davies Adeloye is a medical doctor and epidemiologist. He currently lectures at Covenant University, Ota, Nigeria

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