This article can help in understanding some general issues and the management of Chronic Kidney Disease:

Issues:

• It is important to understand that CKD is a spectrum of disease. Mild CKD is common and rarely progresses to a more severe form and it does not necessarily equate to renal dialysis.
• Understand eGFR and monitor it on a regular basis to ensure that the condition is not deteriorating.
• Understand the link between diabetes and hypertension – maintaining a tight control can limit the damage of the kidneys.
• People with CKD should exercise, achieve a healthy weight and must stop smoking.
• A good glycaemic control should be achieved in patients with diabetes mellitus and CKD.
• Review all prescribed medicines regularly.

Already Diagnosed: eGFR is less than 60

• Review GFR and assess the rate of deterioration.
• Review all medication including the over-the-counter drugs.
• Haematuria and proteinuria suggest glomerulonephritis, this may progress rapidly.
• Look for sepsis, heart failure, hypovolaemia, palpable bladder.
• Repeat serum creatinine measurement to exclude rapid progression.
• Seek professional help – there are safe and natural options to address this disease.

Monitoring:

• Based on the severity of the disease, eGFR should be monitored regularly.
• Have the level of proteinuria assessed at least annually.
• Proteinuria should be assessed by measurement either of the PCR or ACR, ideally on an early-morning urine specimen.
• An abnormal eGFR should prompt a clinical assessment and a repeat test within two weeks should be done to assess the progression.
• Patient with CKD should have an annual assessment of their cardiovascular risk factors, lipid profile, BMI, exercise, alcohol and smoking habits.
• Keep the systolic blood pressure below 140mm Hg and the diastolic blood pressure below 90mm Hg.
• Routinely measure calcium, phosphate, parathyroid hormone (PTH) and vitamin D levels.
• Renal dietitian should be consulted to carry out a dietary assessment and give individualized information and advice on diet.

Complications:

•  Anemia: left ventricular hypertrophy, fatigue, impaired cognitive functioning.
•  Coagulopathy.
• Hypertension: left ventricular hypertrophy, heart failure, stroke, CVD.
• Calcium phosphate loading: cardiovascular and cerebrovascular disease, arthropathy, soft tissue calcification.
• Renal osteodystrophy: disorders of calcium, phosphorus and bone, most commonly osteitis fibrosa cystica.
• Bone changes of secondary hyperparathyroidism: bone pain and fractures.
• Neurological: uraemic encephalopathy, neuropathy including peripheral neuropathy.
• Dialysis amyloid: bone pain, arthropathy, carpal tunnel syndrome.
• Fluid overload: pulmonary oedema, hypertension
• Malnutrition: increased morbidity and mortality, infections, poor wound healing.
• Glucose intolerance due to peripheral insulin resistance.