LOU PART 2

Chronic Kidney Disease

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Chronic Kidney Disease

One of the key and increasing health issues worldwide is chronic kidney disease (CKD) among the adult population. CKD is characterized by enduring impairment of kidney structure or function over three months or longer, which is most often identified by either a progressive decline in estimated glomerular filtration rate (eGFR) or albuminuria(Yan et al., 2021). In addition to progressive renal failure, CKD has a significant impact on cardiovascular risk, difficulties in medication management, and impaired physical functioning, as well as poor quality of life among patients and their family members. Early diagnosis and regular, evidence-based treatment are essential to delay the progression, minimize complications, and maintain patient-centered outcomes.

Global burden of disease — description, signs/symptoms, diagnosis, treatment

Chronic kidney disease is a progressively heterogeneous disorder that is brought on by several etiologies. In adults, leading drivers worldwide are type 2 diabetes mellitus and long-standing hypertension; other etiologies are glomerulonephritis, inherited disorders (e.g., autosomal dominant polycystic kidney disease), chronic urinary obstruction, autoimmune illness, and recurrent nephrotoxins or environmental toxins exposure. Asymptomatic CKD occurs in earlier stages, deferring presentation. When it occurs, symptoms are commonly non-specific and can be as follows: dullness or lethargy with occasional nausea and loss of enthusiasm for food with poor hunger; pruritus; agitation with nighttime disturbances; intellectual impairment; shortness of breath when fluid accumulation ensues; peripheral swelling; and breath odor with uremia fetor (Aeddula & Vaidya, 2024). The physical examination can be positive for hypertension, obtundation in advanced stages of illness, fetor uremia, or signs of volume overload.

Diagnosis is based on absolute laboratory and imaging criteria. The essential features are sustained reduction of eGFR < 60 mL/min/1.73 m² or evidence of kidney damage, most typically albuminuria as urine albumin-to-creatinine ratio (ACR ≥ 30 mg/g on at least 3 consecutive months. The additional assessment is urinalysis, repeated serum creatinine and eGFR determinations to document chronicity, renal ultrasound examination to determine anatomy and obstruction, and selective serologic examination when systemic or glomerular disease is suspected. Staging according to GFR category (G1–G5) and albuminuria category (A1–A3) determines prognosis and aggressiveness of therapy.

Treatment aims are to retard progression, lower cardiovascular risk, control complications (anemia, mineral bone disorder, acidosis, electrolyte imbalance), and ready patients for renal replacement therapy in case progression to kidney failure is inevitable. Some of these essential interventions are optimal control of blood pressure on topographic therapy with renin-angiotensin system antagonists in patients with nephropathy proteinuric, tight glycemia control in diabetic patients, lipid control, removal of nephrotoxins, immunization, not smoking, life style change, medication reconciliation, and referral to nephrology as necessary. Patient education as well as a team approach are also associated with greater likelihood of better outcomes.

References

Aeddula, N., & Vaidya, S. (2024, July 31). Chronic kidney disease. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535404/

Hood, C., Sikka, N., Manaoat Van, C., & Mossburg, S. (2023). Remote Patient Monitoring. Patient Safety Network. https://psnet.ahrq.gov/perspective/remote-patient-monitoring

Paneerselvam, G. S., Lua, P. L., Chooi, W. H., Rehman, I. U., Goh, K. W., & Ming, L. C. (2025). Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review. Journal of Medical Internet Research, 27, e53144. https://doi.org/10.2196/53144

Yan, M.-T., Chao, C.-T., & Lin, S.-H. (2021). Chronic Kidney Disease: Strategies to Retard Progression. International Journal of Molecular Sciences, 22(18), 10084. https://doi.org/10.3390/ijms221810084