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Patient Review Highlights
What is Chronic Kidney Disease?
Chronic Kidney Disease (also known as Chronic Renal Failure) is the progressive loss of kidney function occurring over a span of several months to several years and is characterised by the replacement of kidney architecture with interstitial fibrosis.
Chronic kidney disease is classified into five stages on the basis or proteinuria (presence of protein in large amounts in the urine) or Glomerular Filtration Rate (GFR) - 1 being the mildest with no distinct symptoms and 5 being end stage renal failure.
Causes and Risk Factors of Chronic Kidney Disease-
The various reasons (called risk factors) that can increase chances of Chronic Kidney Diseases are:
- Diabetes mellitus, hyperlipidemia (excess fat proteins in the blood)
Family history heritable renal disease
Older age, smoking
Past episodes of acute renal disease
The direct causes of Chronic Kidney Diseases are-
Diabetic nephropathy (leading cause)
Glomerulonephritis (swelling of the glomerulus in the kidneys)
Reno-vascular disease (ischemic nephropathy)
Polycystic kidney disease
Transplant allograft failure
Exposure to drugs and toxins
Diet that you must maintain in Chronic Kidney Disease-
It is essential to make dietary as well as lifestyle amends once you are diagnosed with CKD. The main purpose of this diet is to maintain the levels of carbohydrates, fluids and minerals. This is done to prevent the buildup of waste products in the body as the kidneys are unable to fulfil its function properly.
It is recommended to refer a dietician who can make you a diet chart that helps you adhere to your diet.
Here is a list of food items that you may avoid or may consume if you are suffering from Chronic Kidney Disease:
Carbohydrates : Carbohydrates are a good source of energy. If the intake of protein has been restricted, then it is recommended to replace that with carbohydrates as a source of energy. Fruits, vegetables, grains and bread can be consumed as they are rich source of fibres, minerals and various types of vitamins. You can indulge in some hard candies or sweets as well.
Fats: Fats can provide a good amount of calories as well. Ensure that you only stick to healthy fats such as the monounsaturated and polyunsaturated fats that are good for your cardiac health.
Reduce your phosphorus intake: A diet with no more than 800 mg of phosphorus can help reduce the risk of too much phosphorus building up in your blood. Limit intake of foods with high levels of phosphate or phosphate additives such as organ meats, whole grain breads, processed foods, cola beverages, cheese, dried beans, liver, peanut butter, dairy products and chocolate. Many beverages and processed foods have these additives. Other high-phosphorus foods to limit include:
- Ice cream
- Monitor your potassium levels: Usually, potassium is not restricted in stage 3 CKD unless lab tests show potassium is too high. Your doctor may make medication changes or prescribe a low-potassium diet. Reduce an elevated potassium level by limiting some high-potassium foods and potassium chloride (found in salt substitute and many low-sodium processed foods), such as avocado, bananas, cantaloupe, honeydew, legumes, milk, nuts, potatoes, seeds, tomato products and yogurt. Some high-potassium foods to limit or avoid include:
- Cantaloupe and honeydew melon
- Dried fruit
- Nuts and seeds
- Oranges and orange juice
- Pumpkin and winter squash
- Tomato products (juices, sauces, paste)
- Proteins: Usually, before undergoing dialysis, it is recommended to adhere to a low-protein intake diet. However when you are undergoing dialysis, it is necessary to consume a certain amount of protein. This detailed information can be obtained from your dietician.
Fluids: In the early stages of CKD, your fluid intake is not monitored. But as the disease progresses, you need to check your intake of fluids as too much fluids may accumulate in your body and create pressure on your kidneys.
- Sodium Or Salt Intake: Keeping a check on your salt intake reduces the risks of high blood pressure. Also, having food low on salt can reduce your thirst and prevent fluid retention in your body. If you wish to discuss about any specific problem, you can consult a nephrologist.
Glomerulonephritis is a disease that is caused due to inflammation of the small filters that are present within the kidneys or glomeruli. Glomeruli eliminate the excess waste, electrolytes and fluids from the blood, discharged through urine. A glomerular disease can be either acute or chronic. If the condition arises without a combination of any other disease, it is termed as primary glomerulonephritis. Secondary glomerulonephritis is characterized by diabetes or lupus (an auto-immune disorder) being at the root of the disease. Prolonged or severe inflammation can take a toll on the kidneys.
Nephrotic syndrome can be primary, being a disease specific to the kidneys, or it can be secondary, being a renal manifestation of a systemic general illness. In all cases, injury to glomeruli is an essential feature. Kidney diseases that affect tubules and interstitium, such as interstitial nephritis, will not cause nephrotic syndrome.
Primary causes of nephrotic syndrome include the following, in approximate order of frequency:
Secondary causes include the following, again in order of approximate frequency:
Viral infections (e.g., hepatitis B, hepatitis C, human immunodeficiency virus [HIV] )
Amyloidosis and paraproteinemias
Allo-antibodies from enzyme replacement therapy
Nephrotic-range proteinuria may occur in other kidney diseases, such as IgA nephropathy. In that common glomerular disease, one-third of patients may have nephrotic-range proteinuria.
Nephrotic syndrome may occur in persons with sickle cell disease and evolve to renal failure. From a therapeutic perspective, nephrotic syndrome may be classified as steroid sensitive, steroid resistant, steroid dependent, or frequently relapsing.
Whether one is suffering from acute or chronic nephrotic glomerular , with symptoms moderate or severe, the treatment lies in treating high blood pressure and other underlying conditions of the disease.
Water pills help control sweating, thus increasing the fluid flushed from the kidneys.
Statins reduce cholesterol level.
Blood thinners such as anticoagulants lower the risk of blood clots.
Corticosteroids regulate the immune system and ease the inflammation that results from kidney disorders.
Incorporating certain lifestyle changes such as opting for lean proteins, cutting on the intake of fat in the diet and consuming lesser amounts of salt can treat inflammation and swelling.
For kidney failure, dialysis can come to the aid in eliminating excess fluids and regulating hypertension.
What is Diabetic Nephropathy?
Diabetic nephropathy (Diabetic Kidney Disease) is defined as the progressive damage to the kidneys caused by diabetes. It is characterised by the scarring of the glomeruli in the kidneys due to prolonged diabetes mellitus.
What Causes Diabetic Nephropathy?
Diabetes is a condition characterized by high concentration of blood sugar. Although the cause of Diabetes Nephropathy is not yet well defined, it is likely that the high sugar levels in the blood damage the blood vessels present in the kidneys that help to filter waste products, thus resulting in decreased kidney function and ultimately, kidney failure.
Not everyone with diabetes suffers from diabetic nephropathy. Although, factors that can increase your chances of getting diabetic neuropathy are-
Poor control of blood glucose
High blood pressure
History of kidney diseases
What are the symptoms of diabetic nephropathy?
In the early stages, there may be no symptoms at all, but as the disease progresses, you may notice swelling in the extremities like your feet. Thus it is recommended to get your blood albumin levels tested on a regular basis. If it is diagnosed in early stages, the damage can be reversed. Other symptoms that can indicate damage to the kidneys are-
Lack of appetite
Itchiness of skin
General feeling of illness
Diagnostic tests that can confirm diabetic nephropathy are-
Routine urine test (urinalysis) - Kidney diseases are detected by the presence of a protein in the urine called albumin and this condition is called albuminuria. Other parameters that must be regularly monitored are-
Cholesterol levels in your blood
How can you treat/ manage diabetic nephropathy?
If this type of nephropathy is diagnosed in the early stages, the damage to the kidneys can be reversible. The key to managing diabetic nephropathy are-
Diet: Reduce the dietary intake of salt, phosphorous and potassium in the advanced stages.
Glycemic Control: Monitor your blood glucose levels regularly
Management of Hypertension: It is important to manage your blood pressure as it can have a direct effect on the coronary blood vessels which in turn pump blood to the various blood vessels of the body
Renal Replacement Therapy: In chronically ill patients, renal replacement therapy is the best option. This can include haemodialysis (a procedure to flush out toxins from the blood, such as urea), peritoneal dialysis or ultimately renal transplantation.
Diabetes is a lifestyle disease that is very prevalent in the current generation. According to a report by the World Health Organisation (WHO), the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% to 8.5% from 1980 to 2014. Diabetes should not be taken lightly as it can affect other body organs besides the pancreas, such as the kidneys. Diabetic nephropathy refers to damage to your kidneys caused by diabetes, and may also lead to kidney failure in various cases.
Causes of diabetic nephropathy
Not everyone who suffers from diabetes will suffer from diabetic nephropathy. The main function of the kidneys is to filter waste from your blood. However, this is not always the case. Due to high a concentration of blood sugar caused by diabetes, several blood vessels in the kidney are destroyed, thereby, preventing the kidneys from carrying out its job. Over time, the kidneys may stop working altogether, resulting in kidney failure. If you are diabetic, the probability of you suffering from diabetic nephropathy will increase if you smoke or have high blood pressure or high cholesterol.
Catching it early
Today, diabetic nephropathy is the leading cause of chronic kidney disease in the US and other western countries. Since the symptoms of this condition aren’t visible in its early stages, you need to undergo urine tests on a regular basis. If detected early, the effects of diabetic nephropathy can be reversed. Common symptoms of this disease include the following:
- Swelling in legs and feet
- Detection of albumin in urine
- Decline in glomerular filtration rate (GFR)
- Elevated arterial blood pressure
What are the treatment options?
Medication to lower the blood pressure is the most commonly prescribed form of treatment suggested by doctors to prevent or slow the damage to your kidneys. There are other lifestyle changes that you may have to undertake in order to keep a check on the condition:
- Limit sugar intake and keep blood sugar levels within the target range
- Exercise regularly and work towards keeping your heart healthy
- Limit protein intake, as it could put extra pressure on your kidneys
- Limit salt intake to control blood pressure
- Quit smoking and drinking
Diabetes is an unfortunate condition to have to live with. But don’t let it bog you down! With these simple lifestyle changes and taking care of your general well-being, you can beat the disease and emerge a winner!