Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a long-term condition characterized by gradual loss of kidney function over time. CKD is a worldwide public health problem. There is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost in the United States. There is an even higher prevalence of earlier stages of chronic kidney disease. The outcomes of CKD are adverse, and include, s kidney failure, cardiovascular disease, and premature death, and to prevent these outcomes, it becomes necessary to understand the function of the Kidney and Chronic Kidney Disease.

How does our Kidney function?

The function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals. The critical regulation of the body’s salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism. Kidney also helps to produce a substance called erythropoietin, which stimulates production of red blood cells.

The kidneys are powerful chemical factories that perform the following functions:

• remove waste products from the body
• remove drugs from the body
• balance the body’s fluids
• release hormones that regulate blood pressure
• produce an active form of vitamin D that promotes strong, healthy bones
• control the production of red blood cells

What is Chronic Kidney Disease (CKD)?

CKD includes conditions that damage the kidney and decreases its ability to keep the body healthy by doing its usual job. CKD is usually asymptomatic, but it is detectable, and tests for CKD are simple and freely available. When the kidneys do not work properly, they leave behind waste in the blood. The waste can build up and make the person feel sick. It can cause problems with the heart and can increase the risk of bone loss, broken bones, anemia (a low number of red blood cells, which carry oxygen throughout the body), complete kidney failure, and other serious problems. It can also lead to death. Chronic kidney disease is also called chronic renal failure or chronic renal insufficiency.

One way to measure how well the kidneys are working is to figure out the glomerular filtration rate (GFR). The GFR is usually calculated using results from the blood creatinine test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.

How is GFR calculated? Doctor can estimate the GFR from the results of a simple blood test for creatinine. Creatinine is a waste product of the body’s muscle activity. Kidneys usually keep the level of creatinine just right. The creatinine result is used in a math formula with the age, race and gender to determine your GFR.

A GFR of 90 or above is considered normal. Even with a normal GFR, you may be at increased risk for developing CKD if you have diabetes, high blood pressure, or a family history of kidney disease. The risk increases with age: People over 65 are more than twice as likely to develop CKD as people between the ages of 45 and 65. The 5 stages are:

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 symptoms as stage 1
3	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

 

Causes of CKD

CKD is usually caused by conditions that put strain on the kidneys. The two main causes are:

• Diabetes – Diabetes is a condition in which the body produces no – or too little – insulin (type 1 diabetes) or has become unable to make effective use of insulin (type 2 diabetes). If diabetes is poorly controlled, too much glucose can build up in your blood. The glucose can damage the tiny filters in the kidneys, which affects the ability of your kidneys to filter out waste products and fluids. The first sign of diabetic kidney disease is the appearance of low levels of protein in the urine.
• High Blood Pressure – High blood pressure puts more stress on blood vessels throughout the body, including the kidneys filters called the nephrons. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other causes are:

• Overuse of pain killers and allergic reactions to antibiotics – Heavy use of painkillers containing ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol) have been linked to interstitial nephritis, a kidney inflammation that can lead to kidney failure. Allergic reactions to or side effects of antibiotics like penicillin and vancomycin may also result in CKD.
• Drug Abuse – Use of certain non-prescribed drugs, such as heroin or cocaine, can damage the kidney.
• Inflammation – Glomerulonephritis, a group of diseases that cause inflammation and causes damage to the kidney’s filtering units. Some glomerulonephritis is inherited, and some may be an immune response to infections like strep throat. Sometimes, these are enough to cause CKD.
• Environmental Toxins – Exposure to various toxic agents and conditions in the natural and occupational environment such as heavy metals, industrial chemicals, elevated ambient temperatures, and infections can lead to CKD. Various toxins are derived from gut micro biota, and an imbalance of gut micro biota or dysbiosis is related to renal failure. However, the pathophysiologic mechanisms underlying the relationship between the gut micro biota and renal failure are still obscure. Toxics include –
  • Cadmium
  • Fluoride in drinking water
  • Combination of fluoride in drinking water and aluminum vessel
  • Arsenic
  • Hard Water
  • Cyanobacterial toxins
  • Bioaccumulation – pesticide residues, heavy metals and toxins in the plants and aquatic animals
  • Liquor – Illicit liquor is another probable cause
  • Pesticides
  • Lead
• Blockages – Infections or a malformed lower urinary tract system (birth defect) can force urine to back up into the kidney and damage it. Blood clots or plaques of cholesterol that block the kidney’s blood vessels can reduce blood flow to the kidney and cause damage. Repeated kidney stones can block the flow of urine from the kidney and are another kind of obstruction that can damage the kidneys.
• Family History – The person having one or more family members with CKD or on dialysis or kidney transplant may be at high risk of getting this condition. One inherited disease, polycystic kidney disease, causes large, fluid-filled cysts that eventually crowd out normal kidney tissue. Diabetes and high blood pressure can also run in families.
• Premature Birth – About one in five very premature infants (less than 32 weeks gestation) may have calcium deposits in parts of the kidney called nephrons. This is termed nephrocacinosis. Sometimes, individuals with this condition may go on to develop kidney problems later in life.
• Certain Diseases – Having certain diseases puts people at higher risk for kidney disease. These diseases include systemic lupus erythematosus (a connective tissue disease), sickle cell anemia, cancer, AIDS, hepatitis C, and congestive heart failure.

Symptoms

Many people who have chronic kidney disease don’t know it, because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Some people with CKD live out their lives without ever reaching kidney failure.

Symptoms include –

• Change in urination – Kidneys are responsible for making urine, hence, the when kidneys fail to function properly, the urine may change (color, difficulty in urinating, urine may be foamy or bubbly, increased need to urinate, especially at night)
• Swelling in the legs, ankles, feet, face and/or hands – Failing kidneys don’t remove extra fluid, which builds up in the body.
• Fatigue – Healthy kidneys make a hormone called erythropoietin that tells the body to make oxygen-carrying red blood cells. As the kidneys fail, they make less erythropoietin. With fewer red blood cells to carry oxygen, the muscles and brain become tired very quickly. This condition is called anemia, and it can be treated.
• Skin Rash – Kidney cleans the body by removing wastes from the body. When it fails in performing its functions, the waste called uremia, accumulates in the blood and causes severe itching.
• Ammonia Breath – The accumulation of waste in the blood can make the food taste different and cause foul breath.
• Nausea & Vomiting – A severe build-up of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.
• Shortness of breath – Due to extra fluid in the body and anemia
• Feeling Cold – Due to anemia

 Treatment

 Conventional Medicines

• Angiotensin receptor blockers (ARBs) – ARBs are drugs that block the action of angiotensin 2 on its receptors. These drugs, like ACE-I, have a protective effect on the kidneys and slow the progression of kidney failure. Drugs included in this category include losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), candesartan (Atacand) and olmesartan (Benicar).
• Angiotensin converting enzyme inhibitors (ACE-Is) – ACE-Is are drugs commonly used in the treatment of hypertension. The drugs include captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), ramipril (Altace), quinapril (Accupril), benazepril (Lotensin) and trandolapril (Mavik). These drugs decrease blood pressure by reducing production of angiotensin-II (a hormone that causes blood vessels to constrict) and aldosterone (a hormone that causes sodium retention).
• Diuretics – The doctor may prescribe diuretics (water pills) to control edema (swelling), blood pressure and/or potassium levels. There are several classes of diuretics, including loop diuretics (furosemide, ethacrynic acid, bumetanide, torsemide), thiazides (hydrochlorothiazide, chlorthalidone, indapamide), and potassium-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene). Diuretics differ in their potential to eliminate salt and water.
• Erythropoiesis-stimulating agents (ESAs) – Patients with chronic kidney disease often develop anemia due to a lack of erythropoietin produced by the kidneys. Anemia is a condition with too few red cells and is characterized by fatigue and tiredness. After excluding other causes of anemia, the doctor may prescribe erythropoiesis-stimulating agents (ESAs). This includes Procrit (erythropoietin), Aranesp (darbepoetin), or Omontys (peginesatide). ESAs also stimulate the bone marrow to produce red cells and reduce the need for blood transfusions.
• Phosphate binders – Binders are divided into large classes, including calcium-based binders such as Tums (calcium carbonate) and PhosLo (calcium acetate) and non-calcium based binders like Fosrenol (lanthanum carbonate), Renagel (sevelamer hydrochloride) and Renvela (sevelamer carbonate).
• Vitamin D -Vitamin D deficiency is very common in patients with chronic kidney disease. The first step in treating metabolic bone disease is to ensure that there are adequate reserves of vitamin D in the body.

Others

• Dialysis – removes Dialysis helps to maintain your body’s balance by removing waste and extra fluid from the blood, keeping the blood’s chemical balance at a safe level and assisting with blood pressure control. Dialysis is a useful and important treatment.
  • Haemodialysis – Uses machine acting as an artificial kidney cleans the blood. Requires good access to your bloodstream, which may be an issue if you have diabetes. If you have heart problems, changes in blood pressure and waste levels associated with haemodialysis can cause problems.
  • Peritoneal Dialysis – Allows the blood to be cleaned inside the body and is usually done at home. PD may not be possible if you’ve had major abdominal surgery causing scarring. It may also be difficult to obtain the right amount of dialysis with PD if you are tall and muscular, or overweight.
• Transplantation – If you start dialysis you will also be assessed for your suitability for transplantation. Health issues may prevent this option.
• Conservative or Supportive Care – If you decide that dialysis or transplant is not for you, then your health-care team will support you to stay as healthy as possible without dialysis. Your life-span however will be limited.

Alternative Medicine

Environmental Medicine focuses on finding the causes of an illness rather than just treating the effects.

• Biodetoxification Prgramme – Safe, intensive treatment for the reduction of the body’s burden of toxic chemicals. Biodetoxification Program utilizes clinical procedures that safely reduce the body’s burden of toxic chemicals, including chemicals stored following occupational, accidental, and/or chronic airborne exposures. Chemicals bind to human tissues on the basis of their lipophilic properties — meaning literally “attracted to fats.” When our bodies absorb lipophilic toxins, they are deposited in the fat stores and released whenever those fatty tissues are broken down to provide energy. Thus, although a patient may initially be poisoned by an extrinsic (outside) source of toxicants, the patient may continue to be poisoned over a prolonged period of time by our own intrinsic (inside) body stores of those poisons.
• Fish Oils – Fish oils affect the progression of CKD. In one meta-analysis some studies indicate a negative effect on the progression of CKD
• Vitamin and mineral supplements – Replacement of certain vitamins and minerals that that the patient does not get in the diet or that are lost during dialysis.
• Avoiding IV Dye – Avoiding X-ray tests that require IV dye (contrast material), such as an angiogram, an intravenous pyelogram (IVP), and some CT scans. IV dye can cause more kidney damage.
• Diet – This may include – Avoid products with added salt, lower potassium foods, limited amount of protein in the diet.
• Chinese Herbal Medicine – Acupuncture, Lei Gong Teng, Micro-Chinese Medicine Osmotherapy are the natural alternative treatments for kidney failure which is used externally.
• Ayurveda – Gokshura and Mutrakrichantak Churna which contains herbs like Punarnava, Varuna, Shigru, Apamarg etc. maintain effective kidney functioning by promoting proper urination, reducing kidney discomforts and removing stones and helps to reduce accompanying fluid accumulation and kidney tissue inflammation.
• Herbal treatment – Cornsilk, dandelion, astragalus, basil etc. helps to cleanse and strengthen the kidney.