What Causes Chronic Kidney Disease?
The most common causes of kidney failure are diabetes and unregulated hypertension. Both cause kidney damage after many years of presence (at least 10-15 years). Other causes such as glomerulonephritis, polycystic kidney disease, chronic pyelonephritis, obstructive nephropathy, etc. Most kidney diseases develop silently and may go unnoticed for many years. Therefore, there are patients with CKD who do not visit a nephrologist until an advanced stage of the disease.
What are the clinical symptoms of Chronic Kidney Disease?
CKD is a silent disease. When clinical symptoms begin then the disease is at an advanced stage.
The clinical symptoms are as follows:
- Increase in the blood of various metabolic products such as urea, creatinine, uric acid and elements such as potassium (dangerous for the heart) and phosphorus (causes itching). This increase in the early stages (early years) causes no symptoms.
- Payment and weakness due to anemia.
- Fluid retention resulting in increased pressure, peripheral edema, and even pulmonary edema – dyspnea.
- Anorexia, nausea, vomiting, malnutrition (there is a significant increase in urea).
- Due to vitamin D deficiency, hormonal disorders and calcium and phosphorus disorders, kidney patients develop a special form of bone disease (such as osteoporosis)
What is eGFR (estimated glomerular filtration rate) and why is it important in kidney disease?
EGFR is the estimated glomerular filtration rate. This is a value that shows how well the kidneys filter waste products from the blood and helps to determine the presence of damage in them. The higher the filtration rate, the better the kidneys function. The normal filtration rate is about 90-120 ml / min / 1.73m2. Another key function of GFR is that it participates with the albumin in the urine in the staging of kidney disease.
What Are The Stages Of Chronic Kidney Disease?
Chronic Kidney Disease (CKD) is divided into 5 stages as follows:
Stage 1: Normal GFR equal to or greater than 90 ml / min / 1.73m2
Stage 2: Slightly reduced GFR between 60-89 ml / min / 1.73m2. If renal function is in stage 1 or 2, chronic kidney disease only exists if albuminuria, hematuria, pathological or structural abnormalities coexist.
Stage 3: Distinguished in 3a (slight or moderate reduction of GFR between 45-59 ml / min / 1.73m2 and in 3b (moderate or severe reduction of GFR between 30-44 ml / min / 1.73m2)
Stage 4: Severe reduction of GFR between 15-29 ml / min / 1.73m2
Stage 5: Renal insufficiency at GFR of 15ml / min / 1.73m2 and initiation of dialysis at GFR <15ml / min / 1.73m2.
Treatment of CKD
When the renal failure “progresses” enough (stage 3-4), the nephrologist can only slow down the progression of the disease with frequent monitoring and instructions given in the outpatient clinic. When the 5th stage occurs, the patient’s stay outside of extrarenal dialysis not only does not help, but also burdens the health of the kidney patient. It is not uncommon for patients to present to the emergency department of on-call hospitals, already in the final stages of renal failure. They have severely affected laboratory values and fluid overload where in most cases it is life threatening. Regular monitoring by a specialized nephrologist can not only delay the patient’s integration into extrarenal dialysis, but also make the patient transition safely and in an organized manner. Replacement of renal function is achieved in 3 ways:
- Dialysis
- Peritoneal dialysis
- The transplant
Types of treatment of CKD
Both dialysis and peritoneal dialysis, replace the basic functions of the kidneys and thus protect the patient from fluid overload, hyperkalemia, acidosis, cachexia, bone disease. Both methods ensure the continuation of patients’ lives, in contrast to what happens with severe heart or liver failure. However, renal failure snaps back by kidney transplantation, which is very successfully applied in the transplant centers of our country. Unfortunately, the lack of implants does not allow its quick application, while in some cases of patients, it is impossible to apply it for medical reasons.