CKD

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CHRONIC KIDNEY DISEASE

What is CKD?

The condition is also known as chronic renal disease, chronic renal failure, or chronic kidney disease (CKD). The symptoms deteriorating kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite. CKD is identified by a blood test for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate (the rate at which the kidneys filter blood), and as a result, a decreased capability of

In La Isla 70 % of men and 30% of women have chronic kidney disease

the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis shows that the kidney is allowing the loss of protein or red blood cells into the urine.

To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests, and often renal biopsy (removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms

. In developing countries, where dialysis access is limited, stage 3 and 4 will likely lead to stage 5. Without a transplant stage 5 is considered terminal.

There is no specific treatment unequivocally shown to slow the progress of chronic kidney disease. If there is an underlying cause of CKD in a particular case, such as vasculitis, this may be treated directly with treatments aimed at slowing the damage. In more advanced stages, treatments may be required for anemia and bone disease.

Prevalence Study of CKD (Chronic Kidney Disease)

Estudio de Prevalencia de IRC

Prevalence Study of Chronic Renal Insufficiency, conducted by UNAN-León for La Isla Foundation, November 2008.

In developed countries, the most common causes of CKD (Chronic Kidney Disease) are diabetic nephropathy and hypertension (high blood pressure). However, in Latin America there is a growing class of patients with CKD who do not have these conditions. The patients are described as young males who live close to riverbanks, have worked on large farms and have been exposed to pesticides, of whom the etiology in a high percentage of cases has yet to be determined. In Central America, CKD is more frequent among men, specifically agricultural laborers (who work with various crops, but predominantly sugarcane) who are exposed to large amounts of agrochemicals, and inhabitants of areas less than 100 meters above sea level.

Causes of CKD

Severe CKD requires one of the forms of renal replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant. Initially CKD present without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney function decreases:

Blood pressure is increased due to fluid overload and production of vasoactive hormones, increasing one's risk of developing hypertension and/or suffering from congestive heart failure.

Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy). Urea is excreted by sweating and crystallizes on the skin ("uremic frost").

Potassium accumulates in the blood (known as hyperkalemia, with a range of symptoms including malaise and potentially fatal cardiac arrythmias).

Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue).

Fluid volume overload -- symptoms may range from mild edema to life-threatening pulmonary edema.

Hyperphosphatemia -- due to reduced phosphate excretion, associated with hypocalcemia (due to vitamin D3 deficiency), the major sign of hypocalcemia being tetany. Later this progresses to tertiary hyperparathyriodism, with hypercalcaemia, renal osteodystrophy and vascular calcification that further impairs cardiac function.

Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid, etc. This may cause altered enzyme activity by excess acid acting on enzymes and also increased excitability of cardiac and nueronal membranes by the promotion of hyperkalemia due to excess acid (acidemia).

Health Implications

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