Assignment

On

Chronic Kidney Disease:

A non-communicable disease

Submitted By:

Gaulib Haidar

NSU ID: 1510898630

Department: BBA

Course: PBH

Section: 47

Submitted To:

Dr. Tanzila Rafique

BDS, FCPS, MPH

Department of Public Health

Submission date: 28-01-2015

North South University (NSU) Bashundhara, Dhaka 1229

Bangladesh

What is non-communicable disease?

Any disease that is not caused by a pathogen and not transmitted from one person to another is

called a non-communicable disease. It might be transmitted from hereditary factors, improper diet,

smoking, or other factors.

In other words, A non-communicable disease,

or NCD, is a medical condition or disease that can be

defined as non-infectious and non-

transmissible among people. NCDs can refer to

chronic diseases which last for long periods of time

and progress slowly.

Sometimes, NCDs result in rapid deaths such as seen

in certain types of diseases such as autoimmune

diseases, heart diseases, stroke,

most cancers, asthma, diabetes, chronic kidney

disease, osteoporosis, Alzheimer's disease, cataracts,

and many more. While sometimes (incorrectly)

referred to as synonymous with "chronic diseases",

NCDs are distinguished only by their non-infectious

cause, not necessarily by their duration. Some

chronic diseases of long duration, such as HIV/AIDS,

are caused by transmittable infections. Chronic

diseases require chronic care management as do all

diseases that are slow to develop and of long

duration.

The World Health Organization (WHO) reports NCDs to be by far the leading cause of death in the

world, representing over 60% of all deaths. That is approximately 63% of total deaths

worldwide. Risk factors such as a person's background, lifestyle and environment are known to

increase the likelihood of certain NCDs. Every year, at least 5 million people die because of tobacco

use and about 2.8 million die from being overweight. High cholesterol accounts for roughly 2.6

million deaths and 7.5 million die because of high blood pressure.

Some key non-communicable diseases:

Cancer

Cardiovascular disease

Diabetes

Chronic kidney disease

However, in this assignment, we will discuss about chronic kidney disease or CKD.

What is chronic kidney disease?

Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal

function over a period of months or years. The symptoms of worsening kidney function are not

specific, and might include feeling generally unwell and experiencing a reduced appetite. Often,

chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney

problems, such as those with high blood pressure or diabetes and those with a blood relative with

CKD. This disease may also be identified when it leads to one of its recognized complications, such

as cardiovascular disease, anemia, or pericarditis. It is differentiated from acute kidney disease in

that the reduction in kidney function must be present for over 3 months.

Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate

a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete

waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is

discovered if urinalysis (testing of a urine sample) shows the kidney is allowing the loss

of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney

damage, various forms of medical imaging, blood

tests, and often renal biopsy (removing a small

sample of kidney tissue) are employed to find out

if a reversible cause for the kidney malfunction is

present. Recent professional guidelines classify

the severity of CKD in five stages, with stage 1

being the mildest and usually causing few

symptoms and stage 5 being a severe illness with

poor life expectancy if untreated. Stage 5 CKD is

often called end stage renal disease, end stage

renal failure, or end-stage kidney disease, and is

synonymous with the now outdated terms chronic kidney failure or chronic renal failure.

No specific treatment is unequivocally shown to slow the worsening of CKD. If an underlying cause to

CKD, such as vasculitis, is found, it may be treated directly to slow the damage. In more advanced

stages, treatments may be required for anemia and bone disease. Severe CKD requires renal

replacement therapy, which may involve a form of dialysis, but ideally constitutes a kidney

transplant.

The Facts about Chronic Kidney Disease (CKD)

26 million American adults have CKD and millions of others are at increased risk.

Early detection can help prevent the progression of kidney disease to kidney failure.

Heart disease is the major cause of death for all people with CKD.

Glomerular filtration rate (GFR) is the best estimate of kidney function.

Hypertension causes CKD and CKD causes hypertension.

Persistent proteinuria (protein in the urine) means CKD is present.

High risk groups include those with diabetes, hypertension and family history of kidney failure.

African Americans, Hispanics, Pacific Islanders, American Indians and seniors are at increased risk.

Two simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

What causes CKD?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are

responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high,

causing damage to many organs in your body, including the kidneys and heart, as well as blood

vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your

blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high

blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also,

chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are:

Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's

filtering units. These disorders are the third most common type of kidney disease.

Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys

and damage the surrounding tissue.

Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may

occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This

causes infections and may damage the kidneys.

Lupus and other diseases that affect the body's immune system.

Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.

Repeated urinary infections.

What are the symptoms of CKD?

Most people may not have any severe symptoms until their kidney disease is advanced. However,

you may notice that you:

feel more tired and have less energy

have trouble concentrating

have a poor appetite

have trouble sleeping

have muscle cramping at night

have swollen feet and ankles

have puffiness around your eyes,

especially in the morning

have dry, itchy skin

need to urinate more often, especially at night.

Who can get CKD?

Anyone can get chronic kidney disease at any age. However, some people are more likely than

others to develop kidney disease. You may have an increased risk for kidney disease if you:

have diabetes

have high blood pressure

have a family history of kidney failure

are older

belong to a population group that has a high rate of diabetes or high blood pressure, such as African

Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.

Diagnosis:

In many CKD patients, previous renal disease or other underlying diseases are already known. A

small number present with CKD of unknown cause. In these patients, a cause is occasionally

identified retrospectively.

It is important to differentiate CKD from acute

renal failure (ARF) because ARF can be reversible.

Abdominal ultrasound, in which the size of

the kidneys is measured, is commonly performed.

Kidneys with CKD are usually smaller (< 9 cm) than

normal kidneys, with notable exceptions such as

in diabetic nephropathy and polycystic kidney

disease. Another diagnostic clue that helps

differentiate CKD from ARF is a gradual rise in serum creatinine (over several months or years) as

opposed to a sudden increase in the serum creatinine (several days to weeks). If these levels are

unavailable (because the patient has been well and has had no blood tests), it is occasionally

necessary to treat a patient briefly as having ARF until the renal impairment has been established to

be irreversible.

Additional tests may include nuclear medicine MAG3 scan to confirm blood flows and establish the

differential function between the two kidneys. Dimercaptosuccinic acid (DMSA) scans are also used

in renal imaging; with both MAG3 and DMSA being used chelated with the radioactive

element technetium-99.

In chronic renal failure treated with standard dialysis, numerous uremic toxins accumulate. These

toxins show various cytotoxic activities in the

serum and have different molecular weights, and

some of them are bound to other proteins,

primarily to albumin. Such toxic protein-bound

substances are receiving the attention of

scientists who are interested in improving the

standard chronic dialysis procedures used today.

Stages of CKD:

All individuals with a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 for 3 months are classified

as having chronic kidney disease, irrespective of the presence or absence of kidney damage. The

rationale for including these individuals is that reduction in kidney function to this level or lower

represents loss of half or more of the adult level of normal kidney function, which may be associated

with a number of complications.

All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the

level of GFR. The rationale for including individuals with GFR > 60 mL/min/1.73 m2 is that GFR may

be sustained at normal or increased levels despite substantial kidney damage and that patients with

kidney damage are at increased risk of the two major outcomes of chronic kidney disease: loss of

kidney function and development of cardiovascular disease.

The loss of protein in the urine is regarded as an independent marker for worsening of renal function

and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic

kidney disease if protein loss is significant.

Stage 1:

Slightly diminished function; kidney damage with normal or relatively high GFR (≥90 ml/min/1.73

m2): Kidney damage is defined as pathological abnormalities or markers of damage, including

abnormalities in blood or urine test or imaging studies.[1]

Stage 2:

Mild reduction in GFR (60–89 ml/min/1.73 m2) with kidney damage: Kidney damage is defined as

pathological abnormalities or markers of damage, including abnormalities in blood or urine test or

imaging studies.

Stage 3:

Moderate

reduction in GFR

(30–59

ml/min/1.73

m2):. British

guidelines

distinguish

between stage 3A

(GFR 45–59) and

stage 3B (GFR 30–

44) for purposes of

screening and

referral.

Stage 4:

Severe reduction in

GFR (15–29

ml/min/1.73

m2) Preparation for

renal replacement

therapy

Stage 5:

Established kidney

failure (GFR <15 ml/min/1.73 m2, permanent renal replacement therapy, or end-stage renal disease

What happens if my test results show I may have chronic kidney disease?

Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your

treatment. The doctor may do the following:

Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney

function you have. You do not need to have another test to know your GFR. Your doctor can

calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your

doctor your stage of kidney disease and helps the doctor plan your treatment.

Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your

doctor whether your kidneys are too large or too small, whether you have a problem like a kidney

stone or tumor and whether there are any problems in the structure of your kidneys and urinary

tract.

Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease,

see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor

removes small pieces of kidney tissue and looks at them under a microscope.

Your doctor may also ask you to see a kidney specialist who will consult on your case and help

manage your care.

Treatments: The presence of CKD confers a markedly increased risk of cardiovascular disease, and people with

CKD often have other risk factors for heart disease, such as high blood lipids. The most common

cause of death in people with CKD is cardiovascular disease rather than renal failure. Aggressive

treatment of hyperlipidemia is warranted.

Apart from controlling other risk factors, the goal of therapy is to

slow down or halt the progression of CKD to stage 5. Control

of blood pressure and treatment of the original disease,

whenever feasible, are the broad principles of management.

Generally, angiotensin converting enzyme inhibitors (ACEIs)

or angiotensin II receptor antagonists (ARBs) are used, as they

have been found to slow the progression of CKD. Although the

use of ACE inhibitors and ARBs represents the current standard

of care for people with CKD, people progressively lose kidney

function while on these medications, as seen in the IDNT and RENAL studies, which reported a

decrease over time in estimated GFR (an accurate measure of CKD progression, as detailed in the

K/DOQI guidelines) in people treated by these conventional methods.

Replacement of erythropoietin and calcitriol, two hormones processed by the kidney, is often

necessary in people with advanced disease. Guidelines recommend treatment with parenteral

iron prior to treatment with erythropoietin. A target hemoglobin level of 9–12 g/dl is recommended.

Phosphate binders are also used to control the serum phosphate levels, which are usually elevated

in advanced chronic kidney disease. The normalization of hemoglobin has not been found to be of

any benefit. It is unclear if androgens help with anemia. Although the evidence for them is

limited, phosphodiesterase-5 inhibitors and zinc show potential for helping men with sexual

dysfunction.

At stage 5 CKD, renal replacement therapy is usually required, in the form of either dialysis or a

transplant.

Organizations:

In the USA, the National Kidney Foundation is a national organization representing patients and

professionals who treat kidney diseases. The American Kidney Fund is a national nonprofit

organization providing treatment-related financial assistance to one of every five dialysis patients

each year. The Renal Support Network is a nonprofit, patient-focused, patient-run organization that

provides nonmedical services to those affected by CKD. The American Association of Kidney

Patients is a nonprofit, patient-centric group focused on improving the health and well-being of CKD

and dialysis patients. The Renal Physicians Association is an association

representing nephrology professionals.

In the United Kingdom, the UK National Kidney Federation represents patients, and the Renal

Association represents renal physicians and works closely with the National Service Framework for

kidney disease.

Kidney Health Australia serves that country.

The International Society of Nephrology is an international

body representing specialists in kidney diseases.

CKD in Bangladesh:

The prevalence of Chronic Kidney Disease (CKD) is rapidly increasing worldwide. Population-based

studies on the prevalence of kidney damage are limited in developing countries. The present work

relates to a population-based screening study in a rural population.

The study was performed to investigate the prevalence of chronic kidney disease (CKD) in rural

residents and find out the association of the associated risk factors and variables.

This is a descriptive cross sectional study. The demographic variables included were age, sex, marital

status, religion, occupation, socioeconomic status, monthly income. The clinical variable was

hypertension. The risk factors under the study were Body Mass Index (BMI), smoking habit,

hypertension, and diabetes mellitus. Data pertaining to biochemical investigations were urine for

albumin, serum creatinine and random serum glucose. CKD suspected patients were subjected to

repeat serum creatinine and urinary albumin testing three months after the initial testing to confirm

diagnosis of true CKD.

1240 patients of which 650 were males and 590 females, aged between 18 and 65 years were

entered into this study. The result evidenced over-all CKD prevalence 19 % determined by Cockcroft-

Gault and 19.5 % MDRD equations. Stage 3 CKD was found to be predominant in both Cockcroft-

Gault (12.8%) and MDRD equations (13.2%). The risk factors were thought to be associated with CKD

which demonstrated association with hypertension (19.3%), diabetes (4.9%) and others (1.3%). A

total of 206(88%) patients determined by Cockcroft-Gault and 210 (89.4%) by MDRD equations were

diagnosed as having CKD in 2nd follow up visit (3 months after the 1st visit).

Conclusion:

It appears from this study that one out of three people in this population at risk remained undiag-

nosed as CKD and with poorly controlled CKD risk factors. This is a growing problem and a challenge

to this country. On priority basis CKD needs to be addressed through the development of

multidisciplinary health teams and establishment of improved communication between traditional

health care givers and nephrology services.

THE END