Previous: Diagnosis of CKD

Causes of and Risk Factors for Chronic Kidney Disease

Data from CKD Registry of India

Across the world, Diabetes Mellitus remains the most common cause of Kidney disease.

In the western countries, this is followed by Hypertension and chronic glomerulonephritis.

However, in India, according to the latest data from CKD registry of India , the second commonest cause in India is ‘unknown cause’, most likely because the disease is detected at an advanced stage when the basic cause would be difficult to establish.

Chronic Tubulo-interstitial Disease ( CTID) is another common cause. One of the causative factors for CTID is the excess use of over-the-counter painkillers. These drugs are used for headaches, knee pains etc and several are consumed on daily basis for long times before the disease develops.

Alternative medications including indiscriminate use of Ayurvedic drugs and several herbal medications ( both Indian and Chinese) are known to lead to CTID.

Ironically, diagnosis of CKD often prompts the patient and family to try these alternative medications further worsening the disease.

Symptoms of CKD

Symptoms do not arise till late stages of the disease. Hence, commonly CKD gets diagnosed at stage IV or V.

Symptoms include:

• Easy fatigability
• Generalized weakness
• Reduced appetite
• Nausea
• Reduced urine amount
• Increased urine amount
• Increased night time frequency of Urination
• Swelling over feet
• Breathlessness at rest or after exertion
• clouded thoughts

It can never be overemphasized that, absence of these symptoms does not rule out kidney disease and therefore screening of individuals at risk is of utmost importance.

Cardinal problems in CKD

1. Anemia

   • This is because of reduced erythropoeitin (EPO), a hormone that is essential for normal blood formation.

   • Apart from EPO deficiency,poor iron stores, poor nutritional status, vitamin deficiency contribute to anemia.

2. Bone Disorders

   • This is because of abnormalities of calcium, phosphorus and reduced production of active vitamin D.

3. Nutrition
4. Acidosis

   • A situation where acids in the body are not neutralized because the base ( bicarbonate), that is normally produced by the kidney, is no longer available.

   • This affects Blood Pressure, heart, bones, muscles and is detrimental in long term. It is difficult to detect without specific blood test as symptoms appear very late.

Screening for CKD

Anyone who is at risk should be screened for early detection of kidney disease. This includes:

• Those who have Diabetes
• Those who have Hypertension
• Those who have family members with kidney disease
• Those who have had kidney disease (e.g. nephrotic syndrome) in past

If one is undergoing a ‘health check’ package, always ensure that screening for kidney disease is included in that package, even if there are none of the risk factors enumerated above.

Next: Treatment of CKD