Chronic Kidney Disease

Chronic Kidney Disease (CKD) Overview:

Chronic kidney disease, or CKD, is defined as eGFR of less than 60 mL/min/1.73 m2 for 3 months or more. Kidney failure is considered when eGFR becomes less than 15 mL/min /1.73 m2.

 

Aetiology:

CKD involves a loss of nephron function, and deterioration of glomerular filtration, tubular reabsorption, and endocrine capability of the kidneys over time. 

Risk factors include; proteinuria, congenital defects, polycystic kidney disease (PKD), obesity, diabetic nephropathy, hypertension, IgA nephropathy, chronic, polynephritis, vasculitis, systemic inflammation, systemic lupus erethematosus.

5 Stages of CKD:

Stage GFR Range Concern Treatment Considerations
1 > 90 Normal Determine underlying conditions
2 60 - 89 Mild Estimate the rate of progression
3 30 - 59 Moderate Evaluate and treat complications
4 15 - 29 Severe Prepare for renal replacement therapy
5 < 15 Kidney Failure Dialysis or kidney transplantation required
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  • ADD BUN TEST RESULTS
  • DIPSTICK TESTING
 

Complications Of Chronic Kidney Disease:

CKD brings a major risk for developing cardiovascular disease especially atherosclerosis and left ventricular hypertrophy. This will be exacerbated by any existing hypertension that may be present. 

Other complications includes metabolic acidosis, hyperkalaemia, vitamin D deficiency, hyperparathyroidism, and anaemia. 

 

Uremic Complications:

  • Impaired immune function
  • Inability for vitamin D to activate, resulting in hypertension and osteotrophy
  • Chronic GIT symptoms (such as nausea and vomiting) due to nitrogen buildup in bloodstream
  • Increased intravascular volume, left ventrical needs to pump harder and often atrophies
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Symptoms:

Fatigue

Swelling in the face, wrists, or abdomen

Foamy urine

Dark colored urine

Burning sensation on urination

Urinary frequency

Mid back pain

Hypertension

Itchy sensation

Loss of appetite

Poor concentration

Darkened skin

Muscle cramps

Uremic frost

Nausea/Vomitting

Osteodystrophy

Lowered Immune Function

 

Diagnostic Considerations:

May be indicated by increased creatinine lab results in combination with hypertension, proteinuria, and anaemia.

Serum eGFR, urinary albumin:creatinine ratio (UACR), and blood pressure should all be considered. 

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Kidney Function Testing:

Test Reference Range Increased Decreased
ACR insert insert insert
eGFR >90 insert insert
Urea 3-8 mmol/L High protein, renal failure, kidney stones, CHF, enlarged prostate, GIT bleeding, diarrhea or vomiting, dehydration, excessive sweating Low protein, water retention, urea cycle defects, poisoning, severe liver damage
Urate 0.17-0.45 mmol/L (Males)

0.12-0.4 mmol/L (Females)
Gout, pregnancy induced HTN, renal failure, fasting, excess lactate or ketones, diuretics, salicylates Protein insufficiency, poor nucleotide synthesis
Creatinine 0.04-0.13 mmol/L (Males)

0.04-0.1 mmol/L (Females)
Decreased filtration conditions such as hypovolemia or hypotension, renal or post-renal obstruction. Low muscle mass, pregnancy.
Urea:Creatinine Ratio 70-90 Excess protein tissue breakdown Protein deficiency
Calcium 2.1-2.6 mmol/L Hyperparathyroidism, malignancy, sarcoidosis, vitamin A toxicity, vitamin D toxicity. Hypoparathyroidism, renal failure, osteomalacia, rickets, recent thyroid or parathyroid surgery, calcium deficiency, phosphate deficiency.
Phosphate 0.90-1.35 mmol/L Hypoparathyroidism, hypercalcemia due to malignancy, renal failure. Hyperparathyroidism, magnesium or aluminum antacid use.
Calcium:Phosphate Ratio 1.0-2.4 --- ---
 

Therapeutic Aims:

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Differential Diagnosis:

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Cautions:

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Treatment Of Chronic Kidney Disease:

herbal medicine approaches not recommended as first line of treatment for chronic kidney disease past stage 2. The introduction of more metabolites into the bloodstream may increase the rate of damage to the basement membrane of the kidneys. 

 

Author:

Justin Cooke

The Sunlight Experiment

Updated: October 2017


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References:

  1. National Kidney Foundation. (2015, December 24). Glomerular Filtration Rate (GFR). Retrieved from https://www.kidney.org/atoz/content/gfr
  2. Sarris, J., & Wardle, J. (2014). Clinical naturopathy: an evidence-based guide to practice. Elsevier Health Sciences.
  3.