Chronic Kidney Disease (CKD) and its causes.

Nephropathy is any disease of the kidneys caused by damage to the small blood vessels of the kidneys or to the glomeruli that filter the blood. Ultimately, these disorders may result in reductions in renal function i.e. Glomerular Filtration Rate (GFR), such that the ability of the kidneys to adequately filter the blood is reduced.

Diabetic nephropathy is a very specific disorder of the kidney caused by diabetes and is a major cause of kidney failure. There are number of other disorders that cause nephropathy, including hypertension and atherosclerosis.

Ultimately, any of these disorders may result in reductions in Glomerular Filtration Rate (GFR). Depending on the extent that the decrease in renal function occurs, one may see abnormalities in the ability to properly regulate the levels of waste products, solutes such as sodium and potassium, and certain drugs.

What is Chronic Kidney Disease (CKD)?

Chronic Kidney Disease refers to a variety of conditions that damage the kidneys to such an extent that they cannot adequately filter the blood to keep fluid, solutes, and waste products in a healthy range.

As kidney disease gets worse, wastes build to high levels in the blood and make an individual feel sick. In association with chronic kidney disease, one can develop complications such as high blood pressure, anemia (low blood count), weak bones, poor nutritional health, and nerve damage. Also, kidney disease increases the risk of having heart and blood vessel disease. These problems may progress slowly over a long period of time.

Chronic kidney disease may be caused by diabetes, high blood pressure, and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse or slowing the rate of progression. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

Causes

Two main causes of chronic kidney disease are diabetes and high blood pressure. These two diseases are responsible for up to two-thirds of the cases of kidney failure. The high blood sugar of diabetes contributes to damage to the kidneys and heart, as well as blood vessels, nerves, and eyes.

High blood pressure (or hypertension) occurs when the pressure of your blood against the walls of your blood vessels increases above normal. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes, and chronic kidney disease. Conversely, chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are;

  • Glomerulonephritis. A group of diseases that cause inflammation and damage to the kidneys filtering units. These disorders are the third most common type of kidney disease.
  • Inherited disease, such as Polycystic kidney disease, cause large cysts to form in the kidneys and damage the surrounding tissue.
  • Anatomic malformations that occur as a baby develops in the mother’s womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
  • Lupus and other diseases that affect the body’s immune system.
  • Obstructions caused by problems like kidney stones, tumors, or an enlarged prostate gland in men.
  • Repeated urinary infections.

The following table is provided as background on the five stages of chronic kidney disease from the national Kidney Foundation;

Stage Description GFR
At increased
risk
Possible risk factors for kidney diseaseMore than 90
1Kidney damage (Protein in the urine) and normal GFRMore than 90
2Kidney damage and mild decrease in GFR60 to 89
3Moderate decrease in GFR30 to 59
4Severe decrease in GFR15 to 29
5Kidney Failure (Dialysis or kidney transplant needed)Less than 15

The renal insufficiency is classified as mild, moderate, and severe.

Mild

  • Roughly corresponds to include stage 1 and 2
  • Creatinine Clearance: more than or equal to 50 mL/min
  • Serum creatinine (Cr) levels (mg/dL): Men – Less that or equal to 1.7, Women – Less than or equal to 1.5

Moderate

  • Roughly corresponds to include stage 3
  • Creatinine Clearance: more than or equal to 30 mL/min to Less than or equal to 50 mL/min
  • Serum creatinine (Cr) levels (mg/dL): Men – More than 1.7 to Less than or equal to 3.0 Women – More than 1.5 to Less than or equal to 2.5

Severe

  • Roughly corresponds to include stage 4 and 5
  • Creatinine Clearance: Less than 30 mL/min
  • Serum creatinine (Cr) levels (mg/dL): Men – More than 3.0 or on dialysis, Women – More than 2.5 or on dialysis

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