Chronic kidney disease (CKD)

Overview – Chronic kidney disease is a condition wherein there is a gradual loss of kidney function resulting in the accumulation of waste.

Chronic kidney disease is diagnosed when there is kidney damage or decreased kidney function for three or more months, irrespective of the cause.

Symptoms and signs of chronic kidney disease

  • Edema (swelling)
  • Hypertension (high blood pressure)
  • Decreased urine output
  • Weakness, anorexia, vomiting, mental status changes, seizures. These symptoms depending on the duration and severity of CKD.

Conditions causing chronic kidney disease

  • Long-standing diabetes mellitus
  • Severe hypertension
  • Heart failure
  • Cirrhosis
  • Renal artery sclerosis
  • Polycystic kidney disease
  • Sarcoidosis,
  • Sjögren’s syndrome,
  • Reflux nephropathy
  • Retroperitoneal fibrosis
  • Recurrent kidney infection

Diagnosis of chronic kidney disease

  • Initial evaluation of chronic kidney disease include blood tests to look for serum creatinine levels, estimated glomerular filtration rate; urinalysis (dipstick) with urine microscopy; and the quantification of urine protein or albumin
  • A kidney ultrasound is performed in all people with increased serum creatinine levels of unclear duration.

Complications of chronic kidney disease

  • High blood pressure
  • High cholesterol levels and atherosclerotic heart disease
  • Anemia
  • Weak bones and increased risk of fractures
  • Swelling due to fluid retention
  • Sexual dysfunction
  • Progression to end-stage kidney disease when kidneys can’t keep up with waste and fluid clearance on their own.

Management of chronic kidney disease

Lifestyle management

  • Diet recommendations for patients with chronic kidney disease depend on the estimated glomerular filtration rate.
  • For patients with eGFR ≥60 mL/min/1.73 m2, the optimal diet is similar to the Dietary Approaches to Stop Hypertension (DASH) diet. This consists of low sodium, fruits, vegetables, legumes, fish, poultry, and whole grains.
  • Talk to your doctor and follow the dietary guidelines recommended by your doctor.
  • The following dietary guidelines for most patients with eGFR <60 mL/min/1.73 m2 who are not on dialysis are –

– A daily protein intake of 0.8 g/kg.

– A diet rich in vegetables.

– Sodium intake as suggested by your doctor. Among individuals who are hypertensive, volume overloaded, or proteinuric (proteins in the urine), the recommended sodium intake is <2 g/day

– For patients who are not hypertensive, volume overloaded, or proteinuric (proteins in the urine), the recommended sodium restriction is generally 2.3 g/day (5.75 g/day of salt [NaCl]

– The recommended potassium intake is based on serum potassium levels.

– The recommended maximum phosphorus intake is 0.8 to 1 g/day.

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