Chronic Kidney Disease (CKD) is often described as an insidious condition that creeps in slowly and quietly, often going unnoticed until significant damage has already occurred. CKD is a progressive loss of kidney function over months or years, and it holds the potential to culminate in end-stage renal disease, requiring dialysis or transplantation.
The kidneys do far more than just produce urine. They regulate electrolytes, filter waste, balance fluids, and produce hormones that control blood pressure and red blood cell production. In CKD, this system starts to falter.
CKD is defined as either a reduced glomerular filtration rate (GFR) of less than 60 ml/min/1.73 m² or evidence of kidney damage (like proteinuria) that persists for more than three months. This chronicity differentiates it from acute kidney injuries, which occur abruptly and may be reversible.
At the microscopic level, CKD is marked by irreversible changes in the kidneys: glomerular sclerosis, tubulointerstitial fibrosis, and progressive loss of nephrons—the functional units of the kidney. These changes not only impair filtration but also initiate a malicious cycle of inflammation and further damage.
While CKD can arise from a range of underlying conditions, diabetes mellitus and hypertension account for the majority of cases. In diabetic nephropathy, persistent hyperglycemia damages the glomeruli. In hypertensive nephrosclerosis, elevated pressures scar and thicken the small renal arteries.
Some other culprits include:
● Glomerulonephritis – immune-mediated damage to the glomeruli
● Polycystic kidney disease – a genetic disorder marked by fluid-filled cysts
● Obstructive uropathies, such as kidney stones or an enlarged prostate
● Long-term use of nephrotoxic drugs, like NSAIDS or certain antibiotics
CKD is often asymptomatic in the earlier stages. As function declines, patients may experience:
● Fatigue and generalized weakness
● Swelling in the legs or around the eyes due to fluid retention
● Increased urination, particularly at night
● Loss of appetite, nausea, and weight loss
● High blood pressure that’s difficult to control
More advanced stages may present with anemia, bone pain, and severe electrolyte imbalances like hyperkalemia or acidosis.
Early detection is crucial to slowing the course of CKD. Routine screening in high-risk individuals—particularly those with diabetes, hypertension, or a family history of kidney disease—can catch the disease before it progresses.
Key diagnostic tools include:
● Serum creatinine and egfr to estimate kidney function
● Urinalysis to detect proteinuria or hematuria
● Albumin-to-creatinine ratio (ACR) to quantify protein leakage
● Imaging studies, like renal ultrasound, are used to assess kidney size and structure
CKD is classified into five stages based on GFR, with Stage 5 (GFR <15) indicating kidney failure.
There is no cure for CKD, but early intervention can significantly slow progression and prevent complications. Treatment involves both managing the underlying cause and mitigating the consequences of declining kidney function.
● ACE inhibitors or ARBS are used to reduce proteinuria and protect kidney function.
● Diuretics may help manage fluid overload.
● Statins reduce cardiovascular risk, which is significantly elevated in CKD patients.
● Erythropoiesis-stimulating agents are used for anemia in advanced stages.
● Monitor Sodium and Protein intake.
● Control blood glucose and blood pressure.
● Smoking cessation and weight management.
In later stages, planning for renal replacement therapy becomes necessary. Options include hemodialysis, peritoneal dialysis, or kidney transplantation—each carrying its benefits and challenges. Early detection, proactive management, and patient education are the key tools we have to reduce its burden.
References:
National Kidney Foundation. "About Chronic Kidney Disease."
https://www.kidney.org/atoz/content/about-chronic-kidney-disease
World Health Organization (WHO). "Global status report on noncommunicable diseases 2020."
https://www.who.int/publications/i/item/9789240001501
Centers for Disease Control and Prevention (CDC). "Chronic Kidney Disease Initiative."
https://www.cdc.gov/kidneydisease/index.html
National Institute for Health and Care Excellence (NICE). "Chronic kidney disease in adults: assessment and management." NICE guideline [NG203], 2021.
https://www.nice.org.uk/guidance/ng203