Definition of Chronic Kidney Disease (CKD)

• CKD is characterized by either kidney damage or a decreased Glomerular Filtration Rate (GFR) less than 60 mL/min for at least 3 months.

• Kidney damage includes abnormalities in blood or urine tests, imaging studies, or a history of kidney transplants.

• Normal GFR is greater than 90 mL/min; stages of CKD range from Stage 1 (mild) to Stage 5 (severe).

Stages of CKD

• Stage 1: Mildest form, GFR is normal or slightly decreased.

• Stage 2: GFR decreases further.

• Stage 3 (divided into 3A and 3B): Moderately decreased GFR.

• Stage 4: Severely decreased GFR.

• Stage 5: End-stage renal disease (ESRD) with GFR less than 15 mL/min or on dialysis.

  • Synonymous with uremia, renal failure, ESRD.

  • Patients in earlier stages may be asymptomatic, while those in Stage 4 and 5 typically exhibit symptoms.

Causes of CKD

• The most common causes are:

  • Poorly controlled diabetes mellitus.

  • Poorly controlled hypertension.

• Importance of maintaining control over these conditions to prevent progression to CKD.

Symptoms of Stage 5 CKD

• Patients often experience:

  • Anemia due to lack of erythropoietin (EPO) production by dysfunctional kidneys.

  • Fluid retention leading to peripheral edema and possibly pulmonary edema due to decreased urine output.

  • Increased blood volume and hypertension.

  • Accumulation of toxins leading to systemic symptoms, including renal failure manifestations.

  • Fatigue and malaise requiring regular dialysis treatments (4 times a week, each lasting about 5 hours).

Complications in CKD Patients

• Anemia: Results from reduced erythropoietin (EPO) production.

  • EPO signals bone marrow to produce red blood cells.

  • Lack of EPO leads to decreased red blood cell production.

• Fluid Retention Symptoms:

  • Increased hydrostatic pressure, leading to edema.

  • Edema may occur in various body regions, including the lungs.

Urinary Tract Infections (UTIs)

• UTIs can affect any part of the urinary tract: kidneys, ureters, bladder, and urethra.

• More common in females due to shorter urethra.

• Common symptoms in non-elderly patients include:

  • Urinary urgency and frequency.

  • Dysuria (painful urination).

  • Possible cloudy urine or hematuria (blood in urine).

• Symptoms may differ in the elderly:

  • Confusion, irritability, and changes in mental status instead of classic symptoms.

Kidney Stones (Calculi)

• Kidney stones can lead to nephrolithiasis (stones in the kidney) or ureterolithiasis (stones in the ureter).

• They present as sharp, jagged formations leading to severe pain as they move.

• Hematuria may occur due to irritation or damage to the urinary tract lining.

• Stones can cause obstruction, leading to hydronephrosis (swelling of the kidney due to urine retention).

  • Increased risk of developing stones in individuals with a history of kidney stones.

Hematuria (Blood in Urine)

• Defined as the presence of blood in urine, which is abnormal.

• Can be classified as:

  • Microscopic Hematuria: Not visible without a microscope.

  • Gross Hematuria: Visible blood to the naked eye.

• Possible sources include any part of the urinary tract (kidneys, ureters, bladder, urethra).

• Causes can include infections, stones, trauma, or other underlying conditions.

Summary

• CKD is a progressive disorder categorized into stages based on GFR.

• The most common causes are uncontrolled diabetes and hypertension, leading to various systemic complications, including anemia and fluid accumulation.

• UTIs and kidney stones present distinctive risks and symptoms, particularly in different demographics, such as the elderly.