Tag: Nephrology

The progression of CKD varies for each individual and is influenced by factors like kidney function, underlying causes, and overall health. This article provides an informative overview of the stages of CKD, offering insights into the changes that occur as the disease advances. 

The 5 Stages of CKD: Tracking Kidney Function and Damage

Chronic Kidney Disease (CKD) is a long-term condition in which the kidneys gradually lose their ability to function correctly, leading to a decline in kidney function and potential complications. The stages of CKD are defined based on the estimated Glomerular Filtration Rate (eGFR), which is a measure of kidney function, and the presence of kidney damage. 

The 5 stages of CKD are as follows:

Stage 1: Kidney damage with normal or high eGFR 

• eGFR > 90 mL/min/1.73 m²
• Kidney damage is present, but kidney function is still considered normal.
• Proteinuria (abnormal amounts of protein in the urine) may be detected.
• Usually, there are no symptoms in this stage.

Stage 2: Kidney damage with mild decrease in eGFR 

• eGFR 60-89 mL/min/1.73 m²
• Kidney function is slightly impaired, but symptoms may still be absent. Fatigue
• itching, loss of appetite, sleep problems and weakness are initial and nonspecific symptoms.
• The kidneys are not working at full capacity, but the decreased function is mild.

Stage 3: Moderate decrease in eGFR

• eGFR 30-59 mL/min/1.73 m²
• Stage 3 is divided into two sub-stages:
• Stage 3a: eGFR 45-59 mL/min/1.73 m²
• Stage 3b: eGFR 30-44 mL/min/1.73 m²
• Kidney function is significantly reduced, and the following symptoms may start appearing:
• Back pain
• Fatigue
• Loss of appetite
• Constant itching
• Sleep problems
• Hands and feet might swell
• Too frequent or too rare urination
• Weakness
• Blood tests may show abnormalities related to kidney function.

• Complications associated with reduced kidney function may arise:
• Anaemia
• Bone disease
• High blood pressure

Stage 4: Severe decrease in eGFR 

• eGFR 15-29 mL/min/1.73 m²
• Kidney function is markedly reduced.
• Symptoms and complications become more pronounced. 
• While complications are the same as that in the case of stage 3 CKD, symptoms generally include: 
• Back pain
• Chest pain
• Decreased mental sharpness
• Fatigue
• Loss of appetite
• Muscle twitches/cramps
• Nausea and vomiting
• Persistent itching
• Shortness of breath
• Sleep problems
• Hands and feet might swell
• Too frequent or too rare urination
• Weakness
• Preparation for kidney replacement therapy (dialysis or transplantation) often begins at this stage.
• At this stage the possibility of a heart disease or even a stroke increases.

Stage 5: End-stage kidney disease 

• eGFR < 15 mL/min/1.73 m² or requiring dialysis
• This is the most advanced stage of CKD.
• Kidney function is severely impaired or completely lost.
• Symptoms that are usually severe and can affect overall health include:
• Back pain 
• Chest pain
• Breathing problems
• Decreased mental sharpness
• Fatigue
• Little to zero appetite
• Muscle twitches/cramps
• Nausea or vomiting
• Persistent itching
• Trouble sleeping
• Severe weakness
• Hands and feet might swell
• Too frequent or too rare urination
• Dialysis or kidney transplantation is necessary to sustain life.

Watch this video to learn more about the five stages of chronic kidney disease in detail: 

Managing and Treating Chronic Kidney Disease: Key Approaches for Optimal Care 

Here are some key points about the treatment and management of CKD:

• Blood pressure control: Maintain optimal blood pressure levels through lifestyle changes and medication to slow CKD progression.
• Medications: Take prescribed medications to manage symptoms and complications like anaemia or mineral imbalances.
• Kidney-friendly diet: Follow a diet that controls protein, sodium, potassium, and phosphorus intake to lessen kidney burden.
• Fluid intake monitoring: Keep track of fluid intake to prevent fluid retention and complications.
• Regular monitoring and tests: Attend regular check-ups, blood, and urine tests to monitor kidney function and adjust treatment plans.
• Healthy lifestyle: Adopt a healthy lifestyle with regular exercise, weight management, no smoking, and limited alcohol intake slow CKD progression.
• Manage underlying conditions: Treat and manage underlying conditions contributing to CKD like hypertension or autoimmune disorders, to minimise kidney damage.
• Dialysis or transplantation: In advanced CKD stages, you must consider dialysis or kidney transplantation. 

Conclusion 

Remember, the progression of CKD can vary for each person, and proper management is crucial to slow down its progression and prevent complications. Regular monitoring and guidance from medical professionals are important for individuals with CKD.

FAQs

Q1. How long does it take to go from stage 3 to stage 4 kidney disease?

Ans. Most patients transition from stage 3 to stage 4 kidney disease in 10 years or above.

Q2. What foods are good for stage 5 CKD patients?

Ans. Fruits and vegetables contain less amount of potassium including grapes, green beans, cucumber, pasta, noodles and rice.

What Is Pediatric Kidney Disease?

‘Pediatric kidney disease’ is a broad-spectrum term that covers a range of conditions affecting the kidneys in children. This article includes a detailed guide on its causes, types, diagnosis, symptoms, and the role of healthcare professionals in treating them. 

Types of Pediatric Kidney Diseases

Various types of pediatric kidney diseases can affect children. Here are some common types: 

1. Congenital Anomalies

• Congenital Hydronephrosis
• Polycystic Kidney Disease (PKD)

2. Glomerular Diseases
3. Inherited Disorders

• Alport Syndrome
• Nephronophthisis

4. Urinary Tract Infections (UTIs)
5. Renal Tubular Disorders
6. Acquired Kidney Diseases

• Acute Glomerulonephritis
• Hemolytic Uremic Syndrome

Pediatric CKD (chronic kidney disease)

Kidney diseases are relatively uncommon in children. Many children may not exhibit noticeable symptoms until the disease has progressed. As a result, it becomes difficult to recognize the true number of affected children. 

Pediatric CKD is one of the most commonly occurring types of kidney disorders in [1] boys over the age of 6 years when compared to girls.

The disease results in long-term kidney damage or kidney dysfunction. While complete recovery is not possible, your healthcare professional can help you and your child to manage it effectively for a healthy lifestyle. 

Pediatric CKD progresses in 5 stages and is dependent on GFR (i.e. glomerular filtration rate).

Pediatric Renal Tumors

Pediatric renal tumours refer to the development of abnormal growths or tumours in the kidneys of children. They are relatively rare but represent a significant proportion of childhood malignancies. 

The most common types of renal tumours in children include—

• Wilms tumour
• Clear cell sarcoma of the kidney
• Renal cell carcinoma 

Wilms tumour (Nephroblastoma):

Wilms tumour is the most common renal tumour in children. It usually affects children between the ages of 2 and 5. Imaging studies like ultrasound, CT scan, and MRI are used to evaluate the tumour and determine its extent.

Treatment typically involves a combination of surgery, chemotherapy, and sometimes radiation therapy. 

Clear Cell Sarcoma Of The Kidney (CCSK):

Clear cell sarcoma of the kidney is a rare malignant tumour that primarily affects young children. Treatment typically involves surgical resection of the tumour, sometimes followed by chemotherapy or radiation therapy depending on the specific case.

Renal Cell Carcinoma (RCC):

RCC is extremely rare in children.

Children with RCC often present with symptoms such as:

• abdominal pain
• hematuria (blood in urine)
• or a palpable mass.

Treatment for pediatric RCC usually involves surgical removal of the tumour, followed by additional therapies if needed.

Imaging studies, such as ultrasound, CT scan, and MRI, help evaluate the tumour and determine its characteristics in all the above 3 cases. 

Pediatric Acute Kidney Injury

Pediatric acute kidney injury (AKI) refers to a sudden and sharp decline in kidney function in children. It is a serious condition that requires prompt recognition and the right actions to be taken at the right time to improve it. 

AKI can result from various causes, including dehydration, sepsis, medication toxicity, urinary tract obstruction, and certain medical procedures. 

Treatment may involve fluid resuscitation , optimizing hemodynamics , addressing the underlying cause, and providing renal support as necessary. 

Acute Renal Failure In Pediatrics

Renal failure refers to the inability of the kidneys to adequately filter waste products and maintain fluid and electrolyte balance. It can be acute or chronic, and it can result from various underlying causes or certain medications. 

Common symptoms may include—

• Decreased Urine Output
• Fluid Retention
• High BP
• Fatigue
• Abnormal Electrolyte Levels 

Common Symptoms Of Kidney Disease In Children 

Most pediatric kidney diseases show little to no symptoms in the early stages and that is why their detection is not possible. However, when the disease gets worse following general symptoms are seen:

• oedema
• a significant increase or decrease in the production of urine. Some children might have the need to urinate more frequently sometimes resulting in wetting the bed.
• proteinuria
• hematuria
• decreased appetite
• feeling tired
• fever
• high blood pressure
• itchy skin
• nausea 
• vomiting
• shortness of breath
• trouble concentrating
• weakness
• weight loss
• stunted growth 

Diagnosis Of Pediatric Kidney Disease

The diagnosis of Children’s kidney diseases like pediatric renal tumours, pediatric acute kidney injury, acute renal failure in pediatrics, etc. is done using two types of methods: 

• Non-invasive Methods
• Invasive Methods

The non-invasive methods include:

1. Physical Exam 
2. Medical History
3. Urinalysis
4. Microalbuminuria
5. Creatinine Clearance 
6. Imaging studies

• Standard X-rays 
• Angiography 

7. Intravenous Urography
8. Ultrasounds
9. CT Scans 
10. Magnetic resonance imagery (MRI)

The invasive methods: 

1. Blood Tests
2. Serum creatinine 
3. Blood Urea Nitrogen 
4. GFR
5. Voiding cystourethrogram (VCUG)
6. Kidney Biopsy 

Treatment Approaches for Pediatric Kidney Disease

In order to treat and manage pediatric kidney diseases with maximum efficiency, it is very important to consider both: a pediatrician & a nephrologist. 

Your healthcare professional might start by prescribing antibiotics (in case of an infection) to treat the underlying cause of the specific type of disease. 

Treatment options depend on the type and severity of the kidney disease. They may include:

 Medications

Doctors may prescribe medications to control blood pressure, reduce inflammation, manage proteinuria (excessive protein in urine), or treat underlying causes such as infections or autoimmune conditions.

 Dietary Modifications

A balanced diet with appropriate restriction of certain nutrients, such as sodium and potassium, may be recommended to manage pediatric kidney disease. 

Dialysis

In cases of advanced kidney failure, dialysis may be necessary to filter waste products and excess fluid from the blood. Pediatric patients may undergo either hemodialysis or peritoneal dialysis, depending on individual circumstances.

Kidney Transplant

When kidney function is severely compromised, a kidney transplant may be considered. Transplantation offers the potential for long-term improvement in kidney function, providing a better quality of life for children with end-stage renal disease.

In addition to these treatments, healthcare professionals will also suggest regular monitoring, follow-up visits, and strict commitment to prescribed medications and lifestyle changes.

They work closely with pediatric nephrologists to develop a detailed care plan that addresses the unique needs of each child. 

Conclusion

All in all, when it comes to keeping your child healthy, the more you delay, the more complicated the disease gets. Therefore, it is essential to call the doctor at the right time regardless of whether your child is an infant or older.