Stages of Chronic Kidney Disease Stage 1 2 3 4 5 Description Slight kidney damage with normal or increased filtration Mild decrease

in kidney function Moderate decrease in kidney function GFR* mL/min/1.73m2 More than 90 60-89 30-59

Severe decrease in kidney function 15-29 Kidney failure

Less than 15 (or dialysis) *GFR is glomerular filtration rate, a measure of the kidney's function. Diabetes Mellitus One cause of kidney failure is diabetes mellitus, a condition characterised by high blood glucose (sugar) levels. Over time, the high levels of sugar in the blood damage the millions of tiny filtering units within each kidney. This eventually leads to kidney failure. Around 20 to 30 per cent of people with diabetes develop kidney disease (diabetic nephropathy), although not all of these will progress to kidney failure. A person with diabetes is susceptible to nephropathy whether they use insulin or not. The risk is related to the length of time the person has diabetes. There is no cure for diabetic nephropathy, and treatment is lifelong. Another name for the condition is diabetic glomerulosclerosis. People with diabetes are also at risk of other kidney problems including narrowing of the arteries to the kidneys, called renal artery stenosis or renovascular disease. Kidneys explained The human body has two kidneys, one on either side of the spine beneath the lower ribs. Inside each kidney are about one million tiny units called nephrons. Each nephron consists of a small filter (glomerulus) attached to a tubule. Water that contains waste is separated from the blood by the filters and directed into the tubules. Much of the water is returned to the blood by the tubules, while the wastes are concentrated into urine. The urine is collected from the tubules by a funnel-like structure (renal pelvis). From there, the urine flows down a tube (ureter) that joins each kidney to the bladder. Urine leaves the bladder via the urethra, the thin tube that connects to the outside of the body. Kidneys affected by diabetic nephropathy no longer work efficiently, and trace amounts of protein appear in the urine (microalbuminuria). The retained water and salts cause the

The mechanism is unknown It is clear that diabetes can lead to kidney disease. In this case.is also thought to be involved in the development of diabetic nephropathy. Diabetic nephropathy progresses steadily despite medical intervention. • Blood in the first compartment is pumped along one side of a semipermeable membrane. • Concentration gradients of substances between blood and dialysate lead to desired changes in the blood composition. such as a reduction in waste products (urea nitrogen and creatinine). Na wasting can occur and predispose to ECF volume depletion. However. and. The mechanism involves. or tubulointerstitial damage) resulting from urinary tract obstruction. Other risk factors include cigarette smoking and family history. UTI. the blood pressure begins to rise. among many factors.characteristic fluid retention and. Obstructive uropathy It is the structural or functional hindrance of normal urine flow. renal failure. The dialyzer has two fluid compartments and is configured with bundles of hollow fiber capillary tubes. nephropathy may result in renal insufficiency. sometimes leading to renal dysfunction Obstructive nephropathy: Obstructive nephropathy is renal dysfunction (renal insufficiency.which helps regulate blood pressure . If obstruction is bilateral. but just why high blood sugars should damage the glomeruli is unclear. frequently. increased intratubular pressure. while dialysate (the fluid that is used to cleanse the blood) is pumped along the other side. treatment can significantly slow the rate of damage. in a separate compartment. • . High blood pressure (hypertension) is a known risk factor for kidney disease and people with diabetes are prone to hypertension. in the opposite direction. Obstruction may result in type 1 renal tubular acidosis due to reduced distal hydrogen secretion probably because of a defect in the hydrogen ion transporter. The renin-angiotensin system . Renal insufficiency may rarely occur when obstruction is unilateral because autonomic-mediated vascular or Hemodialysis Hemodialysis involves circulation of blood through a filter or dialyzer on a dialysis machine. a correction of acid levels. local ischemia. and equilibration of various mineral levels. often.

decreasing the volume of circulating blood and lowering blood pressure. Beta-blockers. by continuously irrigating the bladder with Normal Saline. The blood is then returned to the body. Calcium channel blockers. reducing blood pressure. Medicines to lower blood pressure (antihypertensives) are used to keep blood pressure in a safe range and slow the progression of kidney damage that is caused by high blood pressure. This is done over a period of time. and runs continuously. Beta-blockers decrease blood pressure by decreasing heart rate and cardiac output. These medicines block the action of a hormone that causes blood vessels to narrow. blood vessels relax and open. Calcium channel blockers dilate blood vessels by relaxing the muscles in the vessel walls. They also relax blood vessels. allow free flow of urine and maintain IDC patency. Diuretics. Diuretics help remove extra sodium and fluid from the body. The type of blood pressure medicine used is thought to be less important than how well the medicine lowers blood pressure. ACE inhibitors slow damage to the kidneys caused by diabetes and other kidney diseases. Common blood pressure medicines include: • • • • • Angiotensin-converting enzyme (ACE) inhibitors. • To prevent blood clot formation. Bladder Irrrigation / Cystoclysis • Bladder irrigation is the process of flushing the bladder with normal saline to prevent or treat clot formation. Angiotensin II receptor blockers. ACE inhibitors decrease blood pressure by opening (dilating) blood vessels. This makes it easier for blood to flow through the vessels and helps lower blood pressure. Bladder irrigation may also be used to instill medications such as antibiotics for treating bladder infections. The target is to keep your blood pressure below 130/80. Medical Management Medicines to treat high blood pressure From 80% to 90% of people who have chronic kidney disease have problems with high blood pressure at some time during their disease.• • Excess water is also removed. . As a result. A special catheter is used for the above procedure.

making it easier for blood to flow through the vessels. Specific medicines are sometimes needed to treat imbalances of electrolytes. which opens (dilates) the blood vessels. which often develops in advanced chronic kidney disease. Vasodilators relax the smooth muscle of blood vessels. when anemia is severe and causing symptoms. Medicines to treat complications of chronic kidney disease Other medicines may be used to treat complications of chronic kidney disease. Vitamin D helps keep bones strong and healthy. • • • Erythropoietin (rhEPO) stimulates the production of new red blood cells and may decrease the need for blood transfusions. Anemia occurs during chronic kidney disease. blood vessels relax and widen. This therapy may also be started before dialysis is needed. Medicines for electrolyte imbalances. Diuretics to treat fluid buildup caused by chronic kidney disease. Direct renin inhibitors block the enzyme renin from starting a process that helps regulate blood pressure. which is needed to make new red blood cells. the kidneys produce too little erythropoietin. ACE inhibitors and angiotensin II receptor blockers for heart failure. . As a result. Medicines used during dialysis Both erythropoietin (rhEPO) therapy and iron replacement therapy may also be used during dialysis to treat anemia. because as kidney function declines. and low calcium levels. Iron therapy can help increase levels of iron in the body when rhEPO therapy alone is not effective. Regular blood tests are required to make sure that these medicines do not raise potassium levels (hyperkalemia) or make kidney function worse. such as high potassium. which lowers blood pressure. such as: • • • • Erythropoietin (rhEPO) therapy and iron replacement therapy for anemia. high phosphate.• • Vasodilators.