Chronic Kidney Disease
Summary/Definition
Chronic kidney disease (CKD) is a chronic condition in which the kidneys cease to perform physiological functions. Usually patients diagnosed with CKD have coexisting cancer, heart disease and other chronic conditions that increase the risk of complications. Treatment often involves the use of drug therapy, abdominal CT and MRI scans, general anesthesia and other medical procedures.
This disease can be diagnosed when there are possible symptoms of liver damage or decreased renalfunction for more than three months. The glomeruli have the function of filtering our body’s secretions, and if the glomerular filtration rate is less than 60 for more than three months, this may indicate a decline in renalfunction. CKD can also lead to the development of other diseases such as diabetes, high blood pressure, glomerulonephritis, polycystic renal disease, obstructive uropathy, etc.
Table 1. Criteria for diagnosing CKD
| Criteria for diagnosing CKD (for duration of 3 months or more) | |
| Markers of lesions (more than one marker) | Ratio of albumin to creatinine in a single urine sample Preliminary report of albuminuria/proteinuria, i.e. abnormal protein levels in urine, namely albumin 30mg and above = creatinine proportion 30mg/g and above Preliminary report on electrolytes and other abnormalities detected during renalduct function. Preliminary opinion on abnormal pathology detected by histological examination. Preliminary opinion on structural abnormalities detected using imaging diagnostic techniques. Medical history and information on renaltransplantation. |
| Renalglomerular filtration rate (kGFR) | kGFR <60ml/min/1.73m |
Table 2. Types of CKD
| Stage 1 albuminuria | Stage 2 albuminuria | Stage 3 albuminuria | |
| Stage 1 kGFR | low | normal | high |
| Stage 2 kGFR | low | normal | high |
| Stage 3а kGFR | normal | high | very high |
| Stage 3b kGFR | high | very high | very high |
| Stage 4 kGFR | very high | very high | very high |
| Stage 5 kGFR | very high | very high | very high |
Symptoms
In the absence of initial characteristic symptoms of disease at diagnosis, there is the possibility of abnormal liver function or late diagnosis due to the detection of abnormal abnormalities by creatinine blood tests prior to contrast-enhanced CT, and by urine protein excretion in 24 hours. As renal function deteriorates, the following complications may occur: oedema, hypertension, heart failure, uremia (uraemia), acid-base imbalance, anemia and other conditions.
Diagnostics
The majority of cases of Chronic kidney disease (CKD) can be detected relatively easily by blood and urine tests. Creatinine blood tests and clinical urinalysis are required to assess the glomerular filtration rate (GFR), which characterizes renalfunction. By measuring the creatinine concentration in the blood, the GFR can be calculated. The diagnosis of CKD can be made if the GFR remains below 60 ml/min/1.73 m² for more than three months and is accompanied by albuminuria or haematuria according to urinalysis, provided that the GFR is more than 60 ml/min/1.73 m². For a more accurate diagnosis, urine microscopic analysis and albumin biochemical tests are required, as well as abdominal CT and MRI and other imaging studies, analysis of blood electrolyte concentrations and, if necessary, renal tissue biopsy.
Treatment and course of the disease
In the presence of Chronic kidney disease (CKD), mortality is known to increase significantly due to cardiovascular complications. As is well known, albuminuria increases as the glomerular filtration rate (GFR) decreases.
The main treatment of Chronic kidney disease (“CKD”) is therapy aimed at treating the underlying causative diseases. In the case of high blood pressure (BP), specific treatment adapted to the type of glomerulonephritis is given. In the case of diabetes mellitus, measures are taken to control blood sugar levels and manage BP. In addition, an important aspect of therapy is to prevent deterioration of kidney function and to reduce the burden on the kidneys. This includes a range of nutritional measures, a low-protein diet, smoking cessation, increased physical activity, drug therapy and other preventive measures. In cases of critical renal failure, when kidney function drops below 25% despite continuous treatment, dialysis and kidney transplantation, including organ transplantation, may be required.
