Diagnosis, Treatment and Remedies of Chronic Kidney Disease.

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According to the National Kidney Foundation, tests are recommended for testing for kidney disease:

  • Measuring blood pressure. (Blood pressure levels are not only a factor in causing kidney disease, but indicate the presence of kidney disease.)
  • Measuring serum creatinine levels to provide for a calculation of glomerular filtration rate (GFR).
  • Testing urine is very important for the presence of albumin or other proteins.

If these tests show an indication of kidney disease, your health care provider may order additional testing. These include imaging tests like magnetic resonance imaging (MRI), ultrasound tests, and CT scans etc.

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How the  tests are done:

  • Blood test
  • This test measures the levels of a waste product called creatinine in the blood.
  • The doctor uses your blood test results to calculate how many ml of waste your kidneys should be able to filter per minute.
  • This calculation called as your estimated glomerular filtration rate (eGFR).
  • A pair of Healthy kidneys must filter more than 90ml/min.
  • eGFR (estimated glomerular filtration rate)

    The eGFR indicates how well your kidneys are cleaning your blood.

    The main function is that your body makes waste all the time and this waste goes into your blood. Healthy kidneys usually take the waste out of your blood. One type of waste is creatinine. When you have too much level of creatinine in your blood, it might be a sign that your kidneys are having trouble filtering your blood.

    The blood test is done to find out how much creatinine is in your blood. If your eGFR is less than 60 for 3 months or more, you might have kidney disease.

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Urine test

This test is performed to check if there is blood or protein in your urine.
If your urine contains blood or protein, it may be a sign that your kidneys are not working well.

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  • Blood pressure

    High blood pressure can cause kidney disease, but at the same time kidney disease can also cause high blood pressure. For most people, normal blood pressure should be or less than 120/80.

Who should be tested for CKD?

You must visit a nephrologist or a general doctor at least if you have persistent symptoms of CKD, such as:

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  • weight loss
  • poor appetite
  • swollen ankles, feet or hands
  • shortness of breath
  • tiredness
  • blood in urine
  • peeing more than usual, particularly at night
  • Your GP can check for other possible causes and arrange tests accordingly

Because CKD often has no symptoms in the initial stages, some people at a higher risk should be checked on a regular basis.

Precautionary measures:

Regular testing is important and should be done  if you have:

  • Heart diseases
  •  kidney stones, enlarged prostate or lupus
  • a family history of advanced CKD plus You’re also more likely to develop kidney disease if you’re black or of south Asian origin.
  • high blood pressure
  • diabetes
  • acute kidney injury 
  • protein or blood in your urine.
  • People taking long-term medicines that can affect the kidneys, such as lithium,  or non-steroidal anti-inflammatory drugs (NSAIDs), should also be tested regularly.

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Treatment for chronic kidney disease

It focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause.

Chronic kidney disease can gradually progress towards end-stage kidney failure, which is fatal without dialysis or a kidney transplant. Damage to your kidneys is usually permanent. But you can take important steps to keep your kidneys healthy r as long as possible by

  • Controlling your blood sugar level
  • Keeping a healthy blood pressure.
  • Following a low-salt and low-fat diet.
  • Keeping a healthy weight.
  • Restrict your smoking
  • Limiting alcohol.
  • Light to moderate exercising at least 30 minutes 5days a week
  • Talking to your doctor
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Treating complications

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Treatments may include:

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  • High blood pressure medications. People with kidney disease experience high blood pressure. Your doctor may recommend medications to lower your blood pressure like angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers and to preserve kidney function.
  • Medications to treat anaemia.  the doctor might recommend supplements of the hormone erythropoietin with added iron as these help in the production of more red blood cells, which relieve fatigue and weakness associated with anaemia.
  • Medications to relieve swelling.  DIURETICS helps to maintain fluid balance in your body.
  • Medications to lower cholesterol levels.  People with chronic kidney disease experience high levels of LDL or bad cholesterol, which can increase the risk of heart disease.
  • Medications to protect your bones. Your doctor will prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fractures.
  • Low protein diet
  • The body processes protein from foods, it creates waste products that your kidneys must filter from your blood. You must visit a dietitian who can suggest remedies and ways to lower your protein intake.
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Treatment for end-stage kidney disease

When your kidneys are unable to keep up with the wastes and fluid clearance on their own and you develop complete kidney failure, you have end-stage kidney disease. Then you need

  • Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer functional to do this.
  •  In haemodialysis, a machine is used which filters waste and excess fluids from your blood.
  •  In peritoneal dialysis, a thin tube inserted into your abdomen and then fills your abdominal cavity with a dialysis solution that absorbs the wastes as well as fluids. Then the dialysis solution drains from your body, carrying the waste along with it.
  • Kidney transplant -It involves surgically placing a healthy kidney from a donor man into your body.
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Potential future treatments

Regenerative medications have the potential to fully heal damaged tissues and organs, and provide hope for people who have worse conditions.

Regenerative medicine approaches include:

  • Powering up the body’s natural ability to heal itself
  • Using the body’s healthy cells, tissues or organs from a living or a deceased donor to replace the damaged ones

Lifestyle changes

  • Try to do   exercise for at least 30 minutes  5 days a week
  • manage your alcohol intake  like no more than the recommended limit of 14 units of alcohol a week
  • lose weight if you’re overweight or obese 
  • stop smoking 
  • eat a healthy, balanced diet
  • restrict your salt intake to less than 5-6 g/ day – that’s around 1 teaspoon
  • try to avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, except when advised to by a medical professional 
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Medicine

There’s no such medicine specifically for CKD, but medicine can help control many of the problems that cause the condition. You may need to take medicine to treat or prevent the different problems caused by CKD under nephrologist’s advice.

Controlling of High blood pressure

There must be a good control of blood pressure to protect the kidneys. People with kidney disease should usually aim to get their blood pressure down to below 130/80mmHg if you also have diabetes.

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There are many types of blood pressure medicines available prescription wise, but medicines called angiotensin-converting enzyme (ACE) inhibitors are often used.

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But here are certain side effects of ACE inhibitors :

  • persistent dry cough
  • dizziness
  • tiredness
  • headaches

If the side effects of ACE inhibitors are troublesome, you can be given a medicine called an angiotensin-II receptor blocker (ARB) only under doctors advice.

Controlling of High cholesterol

People with CKD have a  risk of cardiovascular disease, including heart attack. You might be prescribed some medicines called statins to reduce your risk of developing cardiovascular disease.

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Water retention

You may get swelling in your ankles, feet and hands if you have kidney disease as your kidneys are not as effective at removing fluid from your blood, causing it to build up in body tissues (oedema).

Doctor and nutritionist will advise to reduce your daily salt and fluid intake, including fluids in food such as soups and yoghurts, to help reduce the swelling.

Anaemia check

Some people  with advanced-stage CKD develop anaemia

Symptoms of anaemia include:

  • tiredness 
  • shortness of breath
  • a pounding, fluttering or irregular heartbeat (palpitations) 

If you have anaemia, you may be given erythropoietin injections as a medicine. It’s a hormone that helps your body produce more red blood cells.

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Have a healthy diet

  • A healthy, balanced diet can help improve your overall health
  • Try to Cook foods from scratch instead of eating fast processed commercial prepared foods, as that is higher in sodium. When you prepare your own food, you control what goes into it.
  • Use spices, various herbs, and of course sodium-free seasonings in place of salt.
  • Always check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 per cent means the food is high in sodium.
  • Patients with kidney disease have low levels of vitamin D.  The vitamin D we obtain either from sunlight or from food has to be activated by the kidneys before the body can use it. Patients may be given alfacalcidol or calcitriol.
  • Eat small portions of protein foods. Take guidance from your dietitian about how to choose the right combination of protein foods on daily basis.
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Choose foods that are healthy for your heart as to help keep fat from building up in your blood vessels, heart, and kidneys.

Heart-healthy foods:

  • Lean cuts of meat,
  • Poultry without the skin
  • Fish
  • Beans
  • Vegetables
  • Fruits

When your kidneys start to do function improperly, you need to eat foods which contain less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood.

Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. You should be very cautious while choosing food and drinks for the potassium level as too much is  not good for health,

  • Salt substitutes are sometimes okay but can be very high in potassium.
  • Try to read the ingredient label.
  • Always check with your provider about using salt substitutes.
  • Drain canned fruits and vegetables before eating.
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Exercise regularly

Physical activity also helps to improve your general health. Not only will it boost your energy, strengthen your bones, lowering down depression and keep you fit, it also reduces your risk of heart disease.

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At least around 150 minutes of total moderate-intensity of aerobic activity, like normal walking, cycling or interval walking(1min slow walk 2min fast walk),  30mins 5 days a week is recommended, as well as strengthening exercises on 2 days a week that work all the major muscles ( forex legs, hips, back, abdomen, chest, shoulders and arms).

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Your ability to exercise should not be reduced depending on your condition whether you have mild to moderate CKD. But if it is more advanced or on dialysis stage, your ability to exercise is likely to be reduced and you may become breathless quickly.

But exercise is still beneficial. Start slowly and build up gradually. Always check wt doctor before beginning a new exercise programme.

Stop smoking

Quitting smoking can improve your overall health and reduce your risk of many other health problems.

Limit your alcohol consumption

Try not to exceed the recommended limits of more than 14 alcohol units a week. Try and consult with your GP or care team if you find it difficult to cut down the amount of alcohol.

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Regular reviews and monitoring

You must have regular contact with your care team to monitor your condition. These appointments may involve:

Discussing your symptoms – such as if they’re affecting your normal activities or are getting worse

About your medicine – like whether you are experiencing any side effects

Tests to monitor your kidney function.

It’s also a good opportunity to clarify any questions you have or discuss any other issues you’d like to discuss with your care team.

Be careful with painkillers

Kidney disease can also occur by taking too many non-steroidal anti-inflammatories (NSAIDs), such as aspirin or taking them for longer than recommended. If you need to take painkillers, make sure you follow the instructions AND DONT IGNORE PHYSICIANS ADVICE.

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Subarna Ghosal, a graduate and postgraduate in Food and Nutrition from the University Of Calcutta and also a Certified Diabetes Educator from. Dr Mohan's Academy (NDEP), worked as a nutritionist, lifestyle Counsellor and also has specialization in Sports Nutrition and Pediatric Nutrition from IAPEN (The Indian Association Of parenteral and Enteral Nutrition)believes in making and creating permanent lifestyle changes which are Specific, measurable, attributable and easily achievable. My main motto in the nutrition field is to spread awareness among people about the complications of the diseases and how we can manage or treat by homemade lifestyle changes. I love some quotes which boost me up a lot. "Self Discipline is the key to good health" "10,000 steps a day make a man healthy fit and fine" "Take deeper breaths any time of the day to calm our mind" "Drink at least 8litres of water a day" "Stay always focussed on the important things in life" "Try to start your day with a positive mind" "Keep on listening to motivational videos at least one in a day"