Mon | Aug 21, 2017

Chronic kidney disease posing a serious challenge

Published:Wednesday | March 23, 2016 | 3:00 AMCharmaine Watson-Brown
If it is not treated, progression of chronic kidney disease can lead to end stage renal disease, that is, the need for renal replacement therapy – dialysis or transplantation.
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Chronic kidney disease is a condition characterised by the gradual loss of kidney function for a period of longer than three months.

The kidneys are two bean-shaped organs lying at the back of the abdomen whose primary function are to filter the blood of wastes that accumulate from normal metabolism. The kidneys also function to maintain water balance, regulate the body's electrolyte balance, regulate the body's acid-base balance, regulate the body's blood pressure, maintain bone health and produce certain important hormones and enzymes.

Studies have shown that each year in Jamaica, several hundred people are diagnosed with chronic kidney disease. The management of chronic kidney disease presents a significant challenge, both as a public-health care concern and a financial burden.

Some of the causes of chronic kidney disease are hypertension, diabetes mellitus, glomerulonephritis or inflammation of the kidney caused by such diseases as lupus, cystic disease and sickle cell disease.

The diagnosis is usually made by blood tests, urine tests and other tests that the doctor orders.

Once the diagnosis of chronic kidney disease is made, the stage of the disease is determined based on the level of kidney function. The level of kidney function is determined by the rate at which the kidney excretes a substance called creatinine, with stage one being the mildest stage and stage five the most severe.

There may be no symptoms in the early stages of the illness, but as the disease progresses, patients present with fluid retention, hypertension, lung congestion with difficulty breathing, heart failure, electrolyte imbalances, bone disease with bone pain and fractures, loss of appetite, vomiting, diarrhoea, anaemia, impaired growth and development, sexual dysfunction, skin changes, fatigue, lack of concentration, seizures and coma.

If it is not treated, progression of chronic kidney disease can lead to end-stage renal disease, that is, the need for renal replacement therapy - dialysis or transplantation.

It should be noted that chronic kidney disease is also an independent risk factor for heart disease.

The aim of monitoring is to prevent or delay the progression of chronic kidney disease to end-stage renal disease. The factors that must be treated or controlled are hypertension, diabetes, protein in the urine, obesity, high cholesterol and cessation of smoking.

It is important to screen for the causes of chronic kidney disease, namely, hypertension and diabetes mellitus, and to treat them so that chronic kidney disease may be prevented or delayed.

- Dr Charmaine Watson-Brown is a nephrologist; email: yourhealth@gleanerjm.com