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Chronic kidney disease

Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney
function over time. This happens gradually, usually months to years. Chronic kidney disease is divided
into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so
another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.

With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body,
that are normally excreted by the kidney. Loss of kidney function also causes other problems such as
anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty
acids, and bone disease.

Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-
stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous
accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease
need dialysis or transplantation to stay alive.

Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.

• Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its
blood supply, or urine flow from it.

• Acute kidney failure is often reversible, with complete recovery of kidney function.

• Some patients are left with residual damage and can have a progressive decline in kidney
function in the future.

• Others may develop irreversible kidney failure after an acute injury and remain dialysis-
dependent.

Table 1. Stages of Chronic Kidney Disease

GFR*
Stage Description
mL/min/1.73m2
Slight kidney damage with normal or
1 More than 90
increased filtration
2 Mild decrease in kidney function 60-89
3 Moderate decrease in kidney function 30-59
4 Severe decrease in kidney function 15-29
Less than 15 (or
5 Kidney failure
dialysis)
*GFR is glomerular filtration rate, a measure of the kidney's function.

Chronic kidney disease occurs when the kidneys are permanently damaged or scarred, and
their capacity to perform important functions in the body is decreased significantly.
Because the kidneys are very important organs involved in maintaining balance
inside our body, they can be affected by complications of untreated or uncontrolled
diseases, such as hypertension and diabetes mellitus. Glomerulonephritis, if not
detected early and treated properly, can lead to a chronic condition and
deterioration in kidney function. Intake of some medications, such as pain relievers,
in large amounts and over a prolonged period, can cause chronic kidney damage. If
an obstruction along the urinary tract, such as a large kidney or ureteral stone,
remains for a long time, chronic kidney disease can occur. This can also happen if
the kidneys are not able to recover from an acute injury, such as from dehydration,
bleeding and allergic reaction to drugs.

Lifestyle changes are of absolute importance. Dietary modifications have to be made in


patients with chronic kidney disease-less protein, less salt and less fat are recommended, to
decrease the workload of the kidney and reduce progression of hypertension and heart
disease. Water intake has to be adjusted with decreasing urine output as kidney function
diminishes. Patients are also advised to stop smoking, decrease alcohol intake and have a
physical activity or exercise program that will help improve blood pressure and sugar
control.

1 Prevention of the development of chronic kidney disease is still the key. Early
detection through regular screening procedures and early intervention and
treatment, together with lifestyle modifications for those who are at risk, are
essential in preventing the progression to chronic kidney disease.

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