Chronic Kidney Disease (CKD)

What is chronic kidney disease (CKD)?

Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function that are present for more than 3 months, irrespective of the cause. This leads to a gradual loss of kidney function. Kidney failure, also known as end-stage renal disease (ESRD), is the last stage of chronic kidney disease which occurs when the kidney function has declined to a point that they can no longer function on their own.

Why are healthy kidneys important?

  • They filter the blood by removing waste and excreting it via urine.
  • They help keep a stable balance of fluids in your body.
  • They help maintain electrolyte concentrations by filtering electrolytes and water from blood, returning some to the blood and excreting any excess in the urine.
  • They help maintain the acid-base balance in your body.
  • Kidneys help keep your blood pressure at a normal level.
  • Kidneys produce hormones that aid in the production of red blood cells.
  • They produce active vitamin D.

What are the risk factors for CKD?

  • Hypertension.
  • Diabetes Mellitus.
  • Cardiovascular disease.
  • HIV and other chronic viral infections, for example hepatitis C.
  • Autoimmune disease.
  • Glomerular Diseases (primary and secondary).
  • Tubulointerstitial diseases.
  • Urinary tract obstruction, for example, kidney stones or prostatic hypertrophy.
  • Recurrent urinary tract infections.
  • Congenital diseases.
  • Family history of kidney disease.
  • Chronic use of nephrotoxic drugs, for example, NSAIDs.
  • Obesity, which increases the risk of developing Family history of kidney disease.
  • Chronic use of nephrotoxic drugs, for example, NSAIDs.
  • Obesity, which increases the risk of developing hypertension and diabetes. Obesity may cause secondary glomerular disease.
  • History of kidney transplantation.

What are the symptoms of chronic kidney disease?

Patients with mild to moderate chronic kidney disease (CKD) are generally asymptomatic, as symptoms tend to develop only during the later stages of CKD.

Kidney disease is therefore sometimes referred to as a ‘silent disease’.

Patients with kidney failure may present with signs and symptoms of the following:

1. Abnormalities in salt and water handling:

  • Hypertension – swelling of the lower limbs, generalized body swelling and pulmonary oedema (accumulation of fluid in the lungs) with resultant shortness of breath.
  • Changes in the frequency and volume of urination.
  • Dark or foamy/frothy urine.

2. Metabolic acidosis:

  • Protein – energy malnutrition.
  • Loss of lean body mass and muscle weakness.
  • Shortness of breath.

3. Anaemia:

  • Fatigue.
  • Impaired cognitive function.
  • Impaired immune function.
  • Reduced quality of life.
  • Development of cardiovascular disease.

4. End Stage Renal Disease – manifestations of uremia:

  • Peripheral neuropathy (pins and needles, burning sensation or numbness in the fingers and toes).
  • Restless leg syndrome.
  • Bad breath or metallic taste in the mouth.
  • Muscle cramps.
  • Dermatological symptoms (dry skin, itchiness, bruising).
  • Increased somnolence.
  • Malnutrition.
  • Gastrointestinal symptoms (anorexia, nausea, vomiting, diarrhoea).
  • Erectile dysfunction, decreased libido, menstrual abnormalities.

When should one seek medical intervention relating to kidney disease?

Screening in patients at risk for developing CKD is important for early detection so that therapeutic interventions can be implemented early, to prevent or delay progression of disease.
Make an appointment with your doctor if:

  • You have signs or symptoms of kidney disease.
  • If you have a medical condition that increases your risk of kidney disease.