CHRONIC KIDNEY DISEASES [CKD].

CHRONIC KIDNEY DISEASES [CKD]

NB: This article is aimed at General Public for awareness against CKD, as CKD affects OUR relatives, Friends, Children, Colleagues, Mates etc. This article is NOT for Academic purpose or Clinical Discussions.

A REVIEW OF KIDNEYS FUNCTIONS:

kidneys received about 25% of blood pumped from the heart [1.2-1.3L/min]. It filtered about 180L of water per day, which is reabsorb back to the body and makes about 1L of urine in a day.

1. formation and concentrations of urine.

2. Regulation Blood pressure and Blood volume.

3. Acid base balance in the blood.

4. Elimination of Most Drugs and toxic substances.

5. Erythropoietin secreation : A hormones helps in productions of Red blood cells.

6. Vitamin D Metabolism: which helps in Bones formation.

CHRONIC KIDNEY DISEASES [CKD].

Is a progressive, irreversible, deteriorations of kidney functions for more than 3 months.

It is a worldwide public health problem with poor outcome and HIGH COST. It is 3-4 times more common in BLACKS than in whites and HYPERTENSION is much more frequent cause of ESKD [End Stage Kidney Diseases] in Blacks.

much studies in Nigeria are hospital based. However, the prevalence of CKD is high but variable. A systemic review of populations based studies by Innocent I. Chukwuonye et-al observed the prevalence of CKD between 12.3% to 26% in Nigeria.

WHAT CAUSES CKD?

The causes are too numerous to mention here but i will mention most commonly seen in our Hospitals. The causes depends of part of kidney affected.

1. Hypertension: most common cause in Black Africans.

2. Diabetes : Most common cause among Asians but also seen in Blacks.

3. Glomerular Diseases: It is caused by Many Diseases, Glomerulo-Nephritis [mostly seen in children and young adults], Nephrotic syndrome, Accelerated Hypertensions, Malaria, Hepatitis B & C, Sickle cell Diseases.

4. Poly-cystic kidney Diseases: This is sponge like enlargement of the kidneys depending on the number of cysts. It is inherited disease and runs in family, 50% of these patient must under go Dialysis at the age of 60yrs. 

5. Tubulo-Interstitial Diseases: Drugs [NSAIDs or Pain killers & Traditional Medicine especially Chinese Herbs], Tuberculosis, Exposure to heavy metals like Mercury, Lead, Cadmium and Arsenics.

6. Obstructions of Urinary Track: Kidney stones, BPH, Cancer of bladder or in the pelvis, Schistosomiasis and Urethral stricture.

HOW DOES CKD MANIFEST?

The symptoms can varied depending on accumulations of Urea and electrolytes in the blood. The duration of symptom has to be more than 3 month.

1. Decrease in daily Urine volume. In end stage can be total loss of urine [Anuria]

2. Body swellings that usually not always start with face then legs and abdomen.

3. Decrease in Red blood cells count.

4. High blood pressure: Hypertension and CKD are vicious cycle, that each can be a cause of one another.

5. Generalized body weakness and loss of Energy.

6. Hiccups, Nausea and persistent vomiting.

7. Body dryness and itching, in end stage with Uremic frost [salt like deposition on the skin]

8. Pulmonary Edema: Accumulation of water in the lungs due to water and salt retention.

9. Bones pains due to abnormal Bone metabolism {Renal Osteodystrophy}.

10. Irrational talk, convulsion and loss of consciousness [uremic encephalopathy] End stage.

11. Others.

CKD STAGING  

Established by Kidney Disease Outcome Quality Initiative [k/DOQI] of National kidney foundation USA in 2002 and Endorsed by International Kidney Disease: Improving Global Outcome [KDIGO]. Staging use GFR [Glomerular Filtration Rate] or ACR [Albumin Creatinine Ratio] obtained using either of the 3 equations. 

STAGING GFR (mL/min/1.73 m²)  

  Stage 1. ≥90                                   

  Stage 2. 60-89

  Stage 3..(a&b) 30-59

  Stage 4. 15-29

  Stage 5. <15

MANAGEMENT/TREATMENT.

Management of CKD is exclusively is done in a special centers by a Nephrologist. Depending on the stage of CKD it ranges from Conservative management to Renal Replacement therapy [Dialysis and Kidney Transplantations].

Conservative involve control of blood pressure, Corrections of Low blood count, corrections electrolytes derangements, Calcium and Vitamin D supplementations among others.

 DIALYSIS: 

It is either peritoneal dialysis or Hemodialysis. Most centers use Hemodialysis.

HEMODIALYSIS: patient blood pass through a machine that has a Bio-compatible semi permeable membrane called Dialyzer ‘artificial kidney’. A dialysate fluids pass in opposite directions with blood so that, the accumulated Urea and electrolyte will diffuse from the blood through dialyzer in to dialysate. 

In a standard 4 hours session, about 80 liters of blood will pass through dialysis machine continuously at a rate of 300mls/min. with a target to remove 1-2L of fluids per session depending on fluid overload.

Dialysis is a very expensive procedure even in developed countries. It cost USA Government about $114 Billion per year, about $72,000 [N 25, 000 000] for a single patient in a year. In Nigeria it cost about N15,000 to N40,000 per session and patient requires minimum of 2-3 session per week in an End stage CKD.

KIDNEY TRANSPLANT.

It is the treatment of choice in patient with CKD. It cost between 5 million to 10 million Naira in Nigeria depending on the center.

PRECAUTIONS AGAINST CKD. 

{mostly for Hypertension and Diabetes as they pose major threats to kidney in Blacks}

1. Treat your hypertension ‘Religiously’ in Hospital NOT in chemist.

2. Control your blood sugar optimally.

3. AVOID excessive SALT intake, Excessive SUGAR [soft drinks] intake and High fat diets as they can predispose to hypertension and diabetes. 

4. DO NOT abuse NSAIDs [Feldine, Diclofenac, Ibuprofen etc.], Gentamycine, Tetracyclnes, and TRADITIONAL MEDICINES.

5. STOP smoking and Alcohol.

6. Treat Sore-throats in children and young adults promptly in hospital NOT in chemist or street medicine vendors. It can cause Post streptococcal glomerulonephritis that can progress to CKD.

7. DO NOT JOKE with any form of Urinary Tract infections, Urinary Tract Obstructions like BPH, Urethral stricture, Cancer of the bladder.

8. PROMPTLY treat Schistosomiasis {Bloody Urine} in your children as It is a major cause of CKD and cancer of the bladder in riverine areas at old age. 

9. AVOID skin contacts with chemicals that contained Heavy metals like Paints, Old Batteries, Legal and Illegal Mining impurities.

10. Routine Hospital check ups to detect any illness at early stage.

11. Government need to do much more on Healthcare of it is citizen [Universal Health coverage for all].