Chronic kidney disease (CKD)

Chronic kidney disease also known as chronic kidney failure is the gradual loss of kidney functions due to various reasons. Kidneys are a pair of bean-shaped organs situated more posteriorly on both the sides of the spine just below the ribcage. They are one of the most important organs in the body that helps in maintaining blood pressure, electrolytes and water balance, excretion of toxins or drugs, reabsorption of nutrients, and maintaining the pH of the body.


CKD or chronic kidney disease is more commonly seen in people above 65 years of age and has a slightly higher occurrence in women. The two most frequently seen risk factors associated with CKD are uncontrolled diabetes mellitus and hypertension. The other factors associated are

  • Race: African American, Hispanics, and American Indian populations have a higher risk
  • Smoking or alcohol consumption
  • Obesity
  • Kidney infection or inflammation like glomerulonephritis
  • Cardiovascular disease or people with a history of heart problems
  • Prolonged backlog of urine like enlarged prostate, kidney stones
  • Structural abnormalities of the kidney like horseshoe kidney, polycystic kidneys, etc
  • Family history of kidney disease
  • Babies of premature births have a higher risk of CKD later in life
  • Long term use of certain drugs harmful to the kidney like pain killers, NSAIDs

    Depending on the severity and duration of loss of kidney function, a person can present with a number of symptoms or signs such as

  • Symptoms associated with diabetes mellitus like elevated sugar levels, increased risk of infections, etc
  • Nausea or vomiting due to accumulation of toxins
  • Persistent fatigue or tiredness
  • Loss of appetite
  • Generalised edema or swelling of face, arms, and legs
  • Shortness of breath due to accumulation of fluid in the lung or around the heart
  • Symptoms of anemia like dizziness increased sensitivity to cold, etc due to reduced production of erythropoietin
  • Increased blood pressure
  • Altered bladder habits like reduced urine output or increased urination at night, change in color of urine due to blood or proteins, pressure on passing urine, etc
  • Altered mental sharpness due to accumulation of toxins
  • Muscle cramps or twitches due to abnormalities in electrolytes
  • Reduced calcium levels resulting in an increased risk of fractures
  • Sexual dysfunction in both men and women
  • Persistent itchy dry skin
  • Sleep disturbances

    Signs and symptoms of chronic kidney disease are very nonspecific and may mimic symptoms of other illnesses and also usually only present at advanced irreversible stages of kidney damage. The different stages of CKD are classified based on the loss of filtration capacity (GFR) of the kidney

  • Stage I(GFR>90): very mild kidney damage, generally no significant symptoms present
  • Stage II(GFR 60-89): usually no symptoms but may rarely have symptoms of anemia or increased blood pressure
  • Stage III(GFR 30-59): have symptoms of generalized swelling, anemia, tiredness, electrolyte disturbances
  • Stage IV(GFR 15-29): severe kidney damage resulting in symptoms that require immediate treatment
  • Stage V(GFR <15>


    As with most diseases, the diagnosis of a kidney disease starts with a detailed discussion of the symptoms, personal, family, or medication history, and physical examination by your doctor. The other tests that are frequently recommended are

  • Blood investigations to look at the kidney functions like urea and creatinine, blood albumin, electrolyte levels, and a complete blood count.
  • Urine evaluation for proteins, and blood in urine, and for the calculation of glomerular filtration rate and creatinine clearance.
  • Ultrasound abdomen and pelvis to look at the structural changes of the kidney, ureter & bladder or associated infection, inflammation, or stones.
  • Other imaging studies like CT abdomen, MAG 3 nuclear scans, and DMSA scan may be done in some patients to determine the blood flow, and filtration capacity or to differentiate between functions of each kidney.
  • Rarely is kidney biopsy may be done in patients with atypical symptoms, or for the evaluation of the exact cause.

    Initial management of chronic kidney disease focuses on controlling the symptoms of CKD along with prevention of further progression or worsening.

  • Blood pressure control along with strict monitoring of blood sugar levels and regular intake of medications for diabetes and hypertension is one of the most important ways in the management of CKD.
  • Maintaining a healthy weight, anti-lipid medications in case of elevated cholesterol levels
  • Quit smoking and reduce alcohol consumption
  • Dietary changes: low salt, low fat, low protein diet is recommended
  • Treatment of symptoms like anemia, and electrolyte abnormalities with medications
  • Adequate sleep and healthy lifestyle practices
  • Late stages of CKD generally require dialysis on a regular basis depending on the severity
  • Renal transplant may be the final resort in patients with end-stage renal disease

    Chronic kidney disease cannot always be prevented, however, there are many simple ways in which we can reduce the risk of kidney disease such as

  • Follow proper compliance to medications under the guidance of your doctor for diabetes and hypertension.
  • Maintain a healthy lifestyle and optimal weight for age and height.
  • Quit smoking and alcohol consumption
  • Regular exercise and healthy food intake
  • Avoid over the counter medications especially pain medications that may be harmful to your kidneys
  • Regular visits to the doctor or kidney specialist especially when there is a family history of kidney disease.