Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease.

Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy(removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also called established chronic kidney disease and is synonymous with the now outdated terms end-stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF).

There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated directly with treatments aimed to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease. Severe CKD requires one of the forms of renal replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant.

CKD is initially without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine.

Blood pressure is increased due to fluid overload and production of vasoactive hormones created by the kidney via the RAS (renin-angiotensin system), increasing one's risk of developing hypertension Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy).
Urea is excreted by sweating and crystallizes on skin in the Potassium accumulates blood (known as hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias)
Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue)
Fluid volume overload - symptoms may range from mild edema to life-threatening pulmonary edema

Hyperphosphatemia - due to reduced phosphate excretion, associated with hypocalcemia (due to 1,25 hydroxyvitamin D3]] deficiency), which is due to stimulation of fibroblast growth factor-23. Later this progresses to secondary hyperparathyroidism, renal osteodystrophy and vascular calcification that further impairs cardiac function.

Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc. This may cause altered enzyme activity by excess acid acting on enzymes and also increased excitability of cardiac and neuronal membranes by the promotion of hyperkalemia due to excess acid (acidemia)

People with chronic kidney disease suffer from accelerated atherosclerosis and are more likely to develop cardiovascular disease than the general population. Patients afflicted with chronic kidney disease and cardiovascular diease tend to have significantly worse prognoses than those suffering only from the latter.

Anyone can develop kidney disease but you are at a higher risk if you

Have diabetes

Have high blood pressure

Have a history of kidney disease in family

Over 60 years old


Diabetes and high blood pressure are the two leading causes of kidney failure. It is very crucial to keep a very close eye on blood glucose and blood pressure.


Regular check-ups with your doctor

Taking medicines that are only prescribed by your doctor

Exercise

A low-fat diet

Quit smoking

Drink alcohol in moderation

Tests for kidney disease

As indicated earlier that this disease rarely shows any symptoms. Tests are the only way to find out if you have this disease. The following tests may help uncover this disease:

How well your kidneys clean your blood
Value from creatinine will help calculate the estimated GFR
A normal GFR is between 90 – 130, it may drop as you get older.
A value below 60 suggests that there may be some kidney damage. GFR is an estimate of how well the kidneys are doing. The value over 60 does not mean the kidneys are perfectly fine, your doctor may look at other tests to find if you may have kidney disease.

Kidney damage can cause protein to leak into the urine. This protein is called “albumin” A 24 hrs urine test

High blood pressure can cause kidney disease
Kidney disease can also cause you to have high blood pressure

Diabetes is the leading cause of kidney failure – must have the test done If the blood sugar is too high - it may be a sign of diabetes

A tiny piece of kidney tissue is examined under a microscope

Examples are ultrasound scan, CT (computed tomography) scans and MRI (magnetic resonance imaging)

Kidney disease can sometimes leads to kidney failure (also known as end-stage renal disease). The three possible treatments offered by allopathy are:

A way to artificially cleanse wastes and extra fluid from the blood. Blood is pumped out of the body through a machine for cleansing and then returned back into the body
It is usually needed three or four times a week and each treatment may last up to 4 hours. A strict diet must be followed with a variety of medicines and supplements

A permanent soft tube called a catheter is used to fill the abdomen with a cleansing liquid called dialysis solution
The walls of the abdominal cavity are lined with a membrane called the peritoneum. The peritoneum lets waste and extra fluid pass from blood into the dialysis solution. Waste and fluid then leave the body when the dialysis solution is drained. This is called an exchange PD patients must also follow diet restrictions though it is not as strict as Hemodialysis diets

This is a process where a healthy kidney is placed from another person into the body The new kidney takes over the work of the two failed kidneys The donated kidney may come from a living donor or from someone who has just died

According to Ayurveda, the kidneys are made up of the "Rakta" and "Meda" dhatus. Treating these two dhatus is also an effective way to treat the kidneys.

The advantage of using Ayurvedic medicines in chronic renal failure is that in most patients, the kidney damage can be either partly or fully reversed, the frequency of dialysis can be reduced, and the increased risk of death from cardiovascular diseases can be significantly reduced. Thus, Ayurvedic medicines have the potential for an important therapeutic contribution in all the stages of this condition.

Prevention is always the goal with kidney failure. Chronic disease such as hypertension and diabetes are devastating because of the damage that they can do to kidneys and other organs. Lifelong diligence is important in keeping blood sugar and blood pressure within normal limits. Specific treatments are dependent upon the underlying diseases. Once kidney failure is present, the goal is to prevent further deterioration of renal function. If ignored, the kidneys will progress to complete failure, but if underlying illnesses are addressed and treated aggressively, kidney function can be preserved, though not always improved. A lot of herbal treatments are available for renal failure.

The goals of treatment for renal failure are to:

» Correct or treat the cause of kidney failure.

» Support the kidneys until they have healed and can work properly.

» Prevent or treat any complications caused by acute renal failure.

The damage done to the kidneys can be repaired using medicines like Punarnavadi Guggulu, Gokshuradi Guggulu, Gomutra Haritaki, Chandraprabha Vati and Punarnavadi Qadha (decoction). Herbal medicines useful in this condition are: Punarnava (Boerhaavia diffusa), Gokshur (Tribulus terrestris), Haritaki (Terminalia chebula), Neem (Azadirachta indica), Daruharidra (Berberis aristata) and Patol (Tricosanthe dioica).

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When kidneys are not working at optimum, wastes build up in blood instead of being removed by the kidneys. That is why a special diet is important to follow. Some foods may need to be changed in diet for a CKD patient. This may include limiting protein, carbohydrates, fat, fluid, sodium, potassium and phosphorous in diet.

Patient must watch his/her calories. A dietician can help design a meal plan for a CKD patient.

Urea is a waste product that comes from the breakdown of protein. Urea is removed from the blood by kidneys and leaves your body in your urine. Too much protein in diet makes the kidneys work harder and can cause more kidney damage.
Since protein is needed for body, a careful balance is needed to keep your nutrition at best.

It is very important to eat the right amount of calories. Calories come from carbohydrates, proteins, fats and alcohol. It is very important for a CKD patient to get enough calories. Your family and dietician can play an important role in helping you keep this under control.

Carbohydrates are found in breads, cereals, rice, potatoes, fruits and vegetables, sugar, honey, cookies, cakes, sweets and drinks. Again, follow the diet guidelines suggested by your dietician and doctor.

Fats include foods like meat, butter and oils. Fats contain twice the calories as carbohydrates or proteins. Polyunsaturated fats are better than saturated fats. High cholesterol can cause kidney damage and heart disease.

In the beginning there may not be a fluid limit for CKD patients. This is because the kidneys may still be able to make urine, although the urine may not have all the wastes that are in normal urine. The amount of urine may eventually decreases and then there may be need to restrict the fluid intake.

Sodium is a mineral found naturally in almost all foods. The most common form of sodium is table salt. Excess sodium can cause high blood pressure and swelling.

Potassium is a mineral also found in many foods. As the CKS gets worse, too much potassium can cause serious damage. Here is the list of foods that are rich in potassium. Bananas, Potatoes, Tomatoes, Beans, Chocolate, Nuts, Peaches, Oranges, Milk, Raisins etc.

With CKD, phosphorus may start to build up in blood. Here is the list of foods that are rich in phosphorus.
Milk, Chocolate, Beans, Cheese, Nuts etc.
Your doctor may prescribe a medicine called “phosphorus binder” to bind the extra phosphorus from food and removed in your bowel movements.