Chronic kidney disease
Also known as: CKD, kidney failure, renal failure
Persistent reduction in kidney function (a filtration rate below 60 ml/min) or evidence of kidney damage such as protein in the urine, for more than three months.
Overview
The kidneys lose nephrons slowly and silently, most often from diabetes and high blood pressure. Symptoms appear only when function is severely reduced, so CKD is found by blood and urine tests in at-risk people. Progression can be slowed for years; a minority reach kidney failure needing dialysis or transplantation.
Causes
- Diabetes
- High blood pressure
- Glomerulonephritis
- Polycystic kidney disease
- Obstruction (prostate, stones)
- Recurrent infection, drugs (NSAIDs, lithium), reflux
Risk factors
- Age
- Cardiovascular disease
- Obesity, smoking
- Family history
- Black, South Asian and Indigenous ancestry
- Episodes of acute kidney injury
Symptoms
What a clinician may find
- High blood pressure
- Oedema
- Pallor from anaemia
- Late: itching, muscle twitching, drowsiness
Complications
- Cardiovascular disease (the leading cause of death in CKD)
- Anaemia
- Bone disease and fractures
- High potassium, acidosis, fluid overload
- End-stage kidney failure
Diagnosis
Estimated GFR from blood creatinine and the urine albumin-to-creatinine ratio, repeated over three months; ultrasound of the kidneys; tests for the cause. CKD is staged G1 to G5 and A1 to A3.
Treatment
Blood pressure control with ACE inhibitors or ARBs, SGLT2 inhibitors, statins, glucose control, salt restriction, stopping smoking, avoiding NSAIDs, dose adjustment of medicines; treating anaemia and bone disease; preparing for dialysis or transplantation as function declines.
Prevention
Control diabetes and blood pressure, keep a healthy weight, do not smoke, avoid regular NSAIDs, stay hydrated during illness, have kidney checks if at risk.
When to seek care
Urgent care for breathlessness, chest pain, severe drowsiness, or a sudden fall in urine output; routine review for swelling, frothy urine or persistently high blood pressure.