Blog

September 19, 2016

CKD Mangement

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.
Health, Kidney Disease, Risk Factors
About Kundan Kidney Care

At Kundan Kidney Care Centre we believe that kidneys can recover. We been helping kidney patients for the last three decades and have helped thousands of patients.