Chronic Kidney Disease (CKD) is caused by
a wide variety of pathologic processes, including diabetes, hypertension, and autoimmune diseases.
The stages of CKD, from stage 1 to stage 5, reflect progressive loss of function as quantified
by the glomerular filtration rate or GFR. GFR is commonly estimated using serum creatinine
levels, which increase as renal function falls. In early CKD, patients are frequently asymptomatic
due to the large amount of “backup function” in the kidneys. However, as more function
is lost, this ability to compensate is overwhelmed. Fluids, electrolytes, minerals, and acids,
which are usually flushed out of the body, begin to accumulate, and patients develop
anemia and bone/mineral disorders. While we cannot undo this damage, we can prevent
the complications of chronic kidney disease. Dietary restrictions to lower sodium and potassium
intake can prevent electrolyte abnormalities and diuretics can remove excess fluid.
We can also prevent progressive damage from hypertension and proteinuria, using medications
that target the renin-angiotensin-aldosterone axis. In some, GFR may continue to fall despite
intervention, especially when the underlying disease is poorly controlled or chronic damage
is extensive. Patients subsequently develop symptoms of uremia, including persistent fatigue,
nausea, vomiting, anorexia, and confusion. Treatment includes dialysis – through a
variety of methods – to remove toxins and prolong life.
However, the best option for uremic patients is renal transplantation. With a carefully
supervised anti-rejection regimen, these patients can again enjoy life with a new kidney.