Clinical Presentation of CKD
According to the National Kidney Foundation, chronic kidney disease refers to the structural and functional abnormalities of kidneys over a period of three months demonstrated by either the damage of kidneys or Glomerular filtration rate lesser than 60mL per minute per 1.73 meter square . The clinical presentation of CKD is difficult to detect due to the uncommon symptoms in patients with GFR greater than 35 percent. However, when the percentage of GFR is less than 35 percent, a variety of complications associate with the disorder, such as hematologic, metabolic, psychiatric and cardiovascular issues occur . In such situations, clinical presentation depends on the basis of underlying causes of kidney failure and related complications. In the case of acute renal failure, clinical presentation involves risk factors, which include liver disease, age, vascular diseases and diabetes . The early screening of chronic kidney disease prevents morbidity in most of the patients.
Diagnosis of CKD
The diagnosis of chronic kidney disease is essential to establish the cause of occurrence of renal failure and exclude the potentially reversible causes of chronic renal failure. One of the best diagnostics involved in the diagnosis of chronic kidney disease is dipstick urinalysis performed frequently. If the clinician identifies the presence of proteinuria in the urinalysis, it is essential to perform a 24-hour analysis to clear creatinine and protein. Microalbuminaria testing in the laboratory is necessary for diabetic patients with negative protein. Other tests required for the diagnosis of chronic kidney disease include the analysis of fasting blood glucose, liver enzymes, magnesium and phosphorus, complete blood count, lipid profile and serum albumin . Further tests involved in the diagnosis of the disease are nuclear imaging and renal biopsy. A renal scan through ultrasound helps to identify cysts and obstructions in the kidneys as well as determine the size of the kidneys.
Treatment of CKD
Evidence states that the treatment of chronic kidney disease delays and prevents the progression of the disease. It also reduces or prevents the development of complications and minimizes the risks for cardiovascular diseases. Since the symptoms of chronic kidney disease involve nausea, loss of appetite and worsening fatigue, following a stricter eating plan helps to lower the progression of the disease . The treatment of chronic kidney disease involves treating the pathologic manifestations of the disease. In patients with hypocalcemia, treating with calcium supplements, such as calcitriol is necessary. On the other hand, CKD patients with hyperparathyroidism require calcium, vitamin D and calcimimetics . Similarly, CKD patients with hyperphosphatemia require phosphate binders and restriction of diet that involves phosphate. The treatment for volume overload involves the administration of loop diuretics or techniques, such as ultrafiltration.
In the case of advanced chronic kidney disease, which eventually progresses to the stage where the remaining kidney function is insufficient to keep the patient out of symptoms of kidney failure, the replacement of kidney function by dialysis or transplantation is essential. Different forms of dialysis, haemodialysis and peritoneal dialysis . Active supportive care or conservative management is necessary for patients who are unsuitable for dialysis. The diet involved in the treatment of CKD includes restriction of proteins and salt. Other restrictions related to the diet are phosphate, potassium and water restrictions. On the other hand, inclusion of higher amounts of fruits and vegetables helps to reduce the injury of the kidneys. The intake of fruits and vegetables also reduces the dietary acid, which in turn reduces the levels of urinary albumin. Consulting a nephrologist at the early stages of CKD helps to reduce morbidity and mortality. Following a multidisciplinary approach, which involves a nephrologist, dietician and general physician, helps to delay the complexities of the disease.
Patient Risk Factors Associated with CKD
Patient risk factors involved in the diagnosis and treatment of CKD are obesity, physical inactivity, poor diet, smoking and excessive alcohol consumption . Certain biomedical risk factors include impaired glucose regulation, increased blood pressure and cholesterol levels. Better diagnosis and treatment of CKD leads to the reduction of the prevalence of the diseases for which it is a risk factor. Furthermore, the risk of disease for an individual depends not only on the presence of a single risk factor, but also on whether multiple risk factors are present and the levels of each individual risk factor. Since uremia resulting from CKD is the notable cause for the multitude of cellular, humoral and systemic effects, it is important to assess the underlying risk factors in this area . Uremia also results in anemia due to impaired iron reutilization and erythropoietin deficiency, which is a risk factor for extreme fatigue.
Conclusion
Chronic kidney disease refers to the functional abnormalities of kidneys over three months due to renal damage or a reduction in Glomerular Filtration Rate (GFR) lesser than 60mL per minute per 1.73 m2 . The clinical presentation of CKD in patients whose GFR is less than 35 percent include hematologic, metabolic, psychiatric and cardiovascular issues. The clinical representation of acute renal failure involves various risk factors, such as liver disease, age, vascular diseases and diabetes. The diagnosis of CKD involves dipstick urinalysis. The presence of proteinuria in the urinalysis requires performing a 24-hour analysis to clear creatinine and protein. Other tests required for the diagnosis of chronic kidney disease include the analysis of microalbuminaria, fasting blood glucose, liver enzymes, magnesium and phosphorus, complete blood count, lipid profile and serum albumin. Further tests include nuclear imaging, renal biopsy and renal ultrasound. The treatment for CKD delays and prevents the progression of the disease. It involves following a stricter eating plan and treating the pathologic manifestations of the disease.
References
Bomback, A., & Bakris, G. (2011). Chronic Kidney Disease (CKD) and Hypertension Essentials. Sudbury, MA: Jones & Bartlett Learning.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice 4ed. St. Louis, MO: Mosby.
Lewis, D. R. (2012). Understanding Chronic Kidney Disease: A Guide for the Non-Specialist. M&K Publishing.
