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Diagnosing and Managing Chronic Kidney Disease

Mar 30, 2017

Diagnosing and Managing Chronic Kidney Disease

Chronic Kidney Disease (CKD) also known as chronic renal disease or chronic renal failure is gradual loss of function of kidney over time. CKD can be classified over symptomatology and pathology into 6 stages. The most important cause of CKD is diabetes mellitus and high blood pressure.

CKD is characterized by metabolic acidosis characterized by Protein-energy malnutrition (PEM), loss of muscle mass and muscle weakness. Other sign and symptoms include peripheral edema, anemia, pulmonary edema, hypertension etc.


Lab studies for diagnosis of CKD includes Complete blood count (CBC), Urinalysis, Lipid profile, serum albumin, Serum calcium and phosphate, 25-hydroxyvitamin D, Alkaline phosphatase, parathyroid hormone (PTH) levels, Antinuclear antibodies (ANA), serum and urine protein electrophoresis etc. Imaging studies include renal ultrasonography, which is useful for hydronephrosis, echogenic kidneys, adenopathy, retroperitoneal fibrosis or tumor. Retrograde pyelography is used for diagnosing renal stones or other obstructions. Computed tomography (CT) scanning is used to detect renal masses and cysts. Percutaneous renal biopsy is also done in few cases.


The treatment is symptomatological and depends on the pathological condition. In case of anemia, treatment is done with erythropoiesis-stimulating agents (ESAs).  Hyperphosphatemia is treated with dietary phosphate binders etc. In case of Hypocalcaemia, calcium supplementation is done. If there is Hyperparathyroidism, calcitriol or vitamin D analogues are given. In case of volume overload, diuretics are used. Metabolic acidosis is treated with oral alkaline supplementation. Renal replacement therapy which includes hemodialysis, peritoneal dialysis and renal transplantation can be done in case of encephalopathy, severe metabolic acidosis, peripheral neuropathy, severe hyperkalemia etc.

Latest Development In Chronic Kidney Disease

Kidney International  recently published findings  of Ziyad Al-Aly, MD, VA St. Louis Health Care System, and his colleagues who did a cohort study of  over one hundred thousand first time veteran consumers of PPI medications and found  although  all of them had a normal kidney function at the start, risk of CKD increased in most of them. The study thus went on to suggest that CKD is more likely to develop in people who take PPIs.

Disclaimer: The information given in this write-up is purely for educating the reader. It is not meant to be a substitute for any advice from a medical expert.

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