Prevention and Early detection Chronic Kinsey disease for a healthy nation

Chronic diseases also known as Noncommunicable diseases have become the main threat to human health, leaving behind diseases infectious such as malaria and tuberculosis. They characterized by being diseases of few symptoms in their early stages and high cost in their treatment..The CKD has not played a leading role because it accounts for only about 2% of global deaths compared to 30% of cardiovascular diseases. This leads the CKD to belong to the group of Forgotten Incommunicable Diseases, significantly limiting the development of treatment and advances in adequate diagnoses. This, coupled with a growth of about 6% per year of patients rings alarms worldwide especially when taking into account the high cost of renal replacement therapy in its advanced stages.

The CKD affects developing countries more, places where access to health systems is insufficient. The growth of the disease and its causing pathologies generates great pressure for the health systems, more so when, due to the difficulties in the diagnosis, the majority of people identified with the disease are already in the most advanced stages.

The treatment of CKD then presents two fundamental challenges: To improve diagnostic techniques in the early stages and to increase access to patients in advanced stages.Within renal replacement therapy, in most countries of the world, the preferred therapy is hemodialysis.  However both the categories  give a great financial social burn to the economy and it is an unbearable burden  for developing countries. Therefore early detection of renal impairment and avoid further deterioration is the only way to address this global issue.

Therefore it is important to identify the risk factors of kidney diseases. Diabetes, Hypertension , positive family history , obesity , smoking , aging over 60 , certain ethnic backgrounds , history of acute kidney injuries , certain medications and toxins heavy metal irons are the main identified  risk factors .

The definition of the chronic kidney disease according to the Australian Kidney association is

An estimated or measured glomerular filtration rate (GFR) < 60 mL/min/1.73m2 that is present for more than 3 months with or without evidence of kidney damage
with evidence of kidney damage with or without decreased GFR that is present for more than months as evidenced by the following, irrespective of the underlying cause:
– albuminuria
– haematuria after exclusion of urological causes
– structural abnormalities (e.g., on kidney imaging tests)
– pathological abnormalities (e.g., renal biopsy)

What are the causes of end stage kidney disease (ESKD)?

Diabetic kidney disease
hypertensive vascular disease
polycystic kidney disease (PKD)

Analgesic nephropathy , Heavy metal toxin

Symptoms does not appear until 90% of kidney function lost, so annual screening  of those at risk is essential. Hypertension, pruritus, pruritus, nocturia, restless legs, dyspnoea, lethargy, nausea/vomiting and malaise are the most common symptoms and presentation of end stage chronic kidney disease .

It is recommended to screen all the patients who has above risk factors with Urine albumin , estimated glomerular filtration rate and blood pressure every 1-2 years . If urine ACR positive
repeat twice over 3 months (preferably first morning void) and  If eGFR < 60mL/ min/1.73m2 repeat within 7 days in order to conclude the chronic kidney disease. Other investigations which needs to be done to assess common risk factors we needs to order Renal ultrasound scan , Full blood count, CRP, ESR, Fasting glaucose , fasting Lipid profile and urine microscopy for dysmorphic red cells cast and crystals.

If there is a history of connective disease or autoimmune disease Anti-glomerular basement membrane antibody Anti-neutrophil cytoplasmic antibody Anti-nuclear antibodies Extractable nuclear antigens and Complement studies are to be done.Based on the history and risk factors HBV, HCV, HIV serology  and people above the age of 40 Serum and urine protein electrophoresis to rule out multiple myeloma is recommended.

Excessive amounts of proteins in the urine are a key marker of kidney damage and of increased renal and cardiovascular disease risk.

It is important to review renally excreted medications, as well as avoid nephrotoxic medications in people with CKD. Dosage reduction or cessation of renally excreted medications is generally required once the GFR falls below 60 mL/min/1.73m2. Common medication which require dosage adjustment are Acarbose,  Fenofibrate, Metformin, Antivirals, Gabapentin,  Opioid analgesics,  Apixaban Glibenclamide, Rivaroxaban, Benzodiazepines, Gliclazide, Saxagliptin, Colchicine, Glimeprimide Sitagliptin, Dabigatran, Glipizide, Sotalol, Digoxin, Insulin ,Spironolactone ,Exanatide, Lithium Valaciclovir and Vildagliptin. It is very important not to prescribe renal toxic medication such as non steroid antiinflamatory medications for patients as well as people who have significant risk factors.

Hypertension has to be controlled with a targert blood pressure of 130/80 with help of angiotensin converting enzyme inhibitor or angiotensin receptor blocker. Calcium channel blockers and beta blockers are also helpful in case of ischemic heart disease. Both non-loop diuretics (e.g., thiazides) and loop diuretics (e.g., frusemide) are effective in all stages of CKD.

Commonly prescribed drugs that can adversely affect kidney function in CKD

Underline diabetes and its contributing factors should be controlled to avoid micro vascular and macro vascular complications including diabetic nephropathy.

Encourage to loose weight for overweight and obese people. Stopping smoking  and minimal alcohol intake as well as drink fresh water with out any toxin or heavy metals reduce the risk of developing renal failure or further deterioration of kidney function in the future .Active lifestyle with at least 30minnutes of moderate physical activity per days at least 5 days a week is safe for kidney ,  heart and general health as well.

People with CKD should be encouraged to eat a balanced and adequate diet according to energy requirements in line with the Dietary Guidelines. The salt intake should not be  greater than 100 mmol/day (or 2.3 g sodium or 6 g salt per day). If persistent hyperkalaemia is present, consult Dietitian regarding restricting intake in potassium. There is no need for restriction or increase water intake and drink water to satisfy the thirst. The most important thing is prevention of kidney disease followed by early detection and avoid further deterioration of kidney disease as once the kidney is damaged the treatment options are very limited . Reference – Australian kidney association guidelines

Pubudu Jayaweera




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