Department of

Nephrology

Chronic Kidney Disease and End-Stage Kidney Disease

In a human body, two kidneys are placed at the back of the upper abdominal area. They are the blood purifiers of our body. Their job is to eliminate toxins from the body which are generated in our day-to-day life. However, kidney functions are many more ways than just purifying the blood. They contribute to the production of hemoglobin, regulation of blood pressure, synthesis of active vitamin D which assists in the strengthening of bones. Thus, kidneys are very important and multi-purpose organs of our body.

Chronic Kidney Disease (CKD) and End-Stage Kidney Disease (ESKD)

It is the most common kidney disease. In case of a progressive decline in a kidney function over a period of 3 months, then the patient is said to have chronic kidney disease. The incidences of this disease have risen rampantly in the last decade. In India, around 7.85 million people suffer from various stages of chronic kidney disease. Around 35 million which is 1/10th of the American population is affected by the disease. This increase in a number of people suffering from the disease is largely owing to the rise in diabetes and hypertension.

Symptoms of CKD  and End-Stage Kidney Disease (ESKD)

The symptoms of a kidney disease are not noticeable in the early stages, therefore there is a high chance of the disease being detected in later stages which can be detrimental to the patient.

The symptoms of CKD are as follows:

  • Swelling of hands, face and legs
  • Difficulty in breathing
  • Loss of appetite
  • Vomiting
  • Itching
  • Non-specific body pain.

Some patients may also complain about frequent urination in the night. After observing the symptoms further investigations are conducted on the patient. Serum creatinine is normally excreted through kidneys, when there is an impairment to the kidneys, there is a rise in the accumulation of creatinine in the blood. So this is an important marker used to quantify/ diagnose the disease or understand the extent of disease. Urine examination is conducted to determine if the protein is being excreted out in urine. Ultrasound is used to understand the morphology of kidneys. Normal kidney size is 9 to 11 cm in length and 3 to 5 cms of width. If the size of kidney changes beyond these sizes, a person is said to be suffering from kidney disease.

What is the course of treatment for CKD  and End-Stage Kidney Disease (ESKD)?

Initially, the categorization of the disease is done into 1 to 5 stages on the basis of eGFR (estimated glomerular filtration rate) which is the filtration capacity of the kidney. The following are stages depending on eGFR:

eGFR (in millilitres) Stage
90 Stage I
60 – 90 Stage II
30 – 60 Stage III
15 – 30 Stage IV
> 15 Stage V (Advanced level)

The history of the patient is investigated to understand the status of pre-existing conditions like diabetes and hypertension if any. The pre-existing conditions are monitored and efforts are taken to bring them in control. Following suggestions are made to the patients to bring CKD in control:

  1. Exercise regularly
  2. Quit alcohol consumption
  3. Quit smoking
  4. Avoid over-the-counter medicines like painkillers
  5. Diet should have low potassium and phosphorus levels

When the patient reaches Stage V of CKD, they require renal replacement therapy along with other general care. The two renal replacement therapies available are dialysis and renal transplantation.