10 Causes of Chronic Kidney Disease (CKD)

The causes of CKD are numerous. For each cause, there is much to write about. The following is a summary and should not be viewed as personalised advice.

1

In Mauritius, diabetes is by far the biggest cause with just over half of all cases of CKD. This is no surprise! A third of mauritian adults have diabetes or borderline diabetes ( ‘pre-diabetes’). Diabetes usually takes 10 years or more to damage the kidneys. Do note though many Mauritians discover they have diabetes many years after it started. Act now to reduce the risk of becoming diabetic and get regular tests for diabetes.

2

Hypertension is high blood pressure. A quarter of adults have it but only 60% are on treatment. Of those on tablets, 70% still have uncontrolled blood pressure readings. Hypertension take many years to damage kidneys but, in severe cases, only a few weeks suffice. As for diabetes, act now to reduce your risk of developing high blood pressure, get your blood pressure measured frequently and get treated if needed.

3

Vascular disease is fairly common and is the narrowing of arteries with cholesterol deposits (atheroma). Main risk factors include diabetes, hypertension, smoking, obesity, poor diet, lack of exercise and family factors. It shows up as heart attacks, strokes, poor leg circulation and CKD. Diabetes, hypertension and vascular disease are responsible for most of local CKD cases. Many Mauritians have more than one of these 3 conditions.

4

The remaining causes altogether are responsible for less of a quarter of CKD cases. Long term or repeated kidney infections can also damage kidneys. Such infection are more frequent and severe in diabetic patients. The worrying thing is that they occur with few symptoms.

5

Mauritius, like most hot countries, is likely to have 1 in 8 people affected with kidney stones. These can block the urine flow from one or both kidneys. The most dangerous of many types of stones is the staghorn calculus (really looks like ‘coray’). These grow very fast and harbour chronic kidney infections. To avoid getting kidney stones, drink enough water, cut down on salt and soft drinks and don’t become diabetic.

6

Gout causes severe pain in the joints especially the base of the big toe. High uric acid level in the blood leads to uric acid crystals forming in joints. In severe gout, these crystals also build up in the kidney tissue and in kidney stones. Gout therefore can cause CKD. For pain, many patients take anti-inflammatory painkillers (NSAIDS – see below) that can also harm the kidneys.

7

NSAIDS is short for non-steroidal anti-inflammatory drugs. Widely used for joint and muscle pains and headaches, they can be bought without a doctor’s prescription. They can precipitate kidney failure in people who already have CKD. Some people without any previous kidney disease, can develop CKD with long term use and, if allergic, just a few doses. NSAIDS are best avoided.

8

The immune system normally protects the body against viruses, bacteria and parasites. In glomerulonephritis, it also attacks the kidneys causing inflammation. Ankle swelling, hypertension, froth or blood in the urine are some of the possible features. There are many types of glomerulonephritis. It occurs at any age but it is the main cause of CKD in young adults.

9

Prostate enlargement occurs frequently in older men. The urine flow slows down with a wait to get started and dribbling at the end. Frequent urge to pass urine day and night occurs. When urine infection and retention occur in advanced cases, the kidneys get damaged too. In a minority of cases, prostate disease can be due to cancer.

10

Some children are born with small, misshapen or poorly draining kidneys due to abnormal development in the mother’s womb. People can also be born with genetic diseases. The commonest one is adult polycystic kidney disease. These developmental and genetic diseases are rare but are the main causes of CKD in children. However, they can manifest much later in life.

Pic of the month 1

What is it?

Is it a small brain? Intestines? Poo?

No it’s a glomerulus from a mouse. A glomerulus is a little ball of very fine microscopic blood vessels. Each healthy human kidney has just over a million of these glomeruli.

A healthy glomerulus filters blood. The product is filtrated fluid that passes out goes through a long passage (the tubule) where water and essential chemicals are taken back from the fluid into the body as required at the time.

The end result is urine. The urine we pee is therefore the sum of the individual urine of about 2.5 million nephrons. A nephron is a glomerulus and its following tubule.

If you want to learn more about the glomerulus, check the wikipedia entry.

The above beautiful picture is from a mouse imaged by Stimulated Emission Depletion (STED) super-resolution microscopy. It comes from a recent research article “Drug Testing for Residual Progression of Diabetic Kidney Disease in Mice Beyond Therapy with Metformin, Ramipril, and Empagliflozin” by Motrapu et al. Picture is the great work of Maria Lucia Angelotti and Giulia Antonelli.

If the Covid-19 pandemic never existed…

… we would not be approaching 10 million of infected people and half a million deaths. There is no clear easy exit route yet of this tragedy.

The consequence for our Association is of course trivial compared to the global calamity but it was nevertheless a nasty shock for a newly born organisation. There had been a feverish ( of the non-viral type!) preparation for our first annual conference “Let’s Talk Kidneys” and first evening CPD event of a series which we named “The Kidney Club”.

The first 3 cases of Covid-19 came together on March 18 2020. I think everyone will always remember what they were doing at the time of the prime ministerial announcement. We had just completed dinner after an association business meeting full of big plans…

So the best plans went in smoke. There was an excited scramble online for more information but one thing was for sure. We had to put a brave face and get ready for a long crisis. Lockdown and the frontline.

Mauritius has weathered the first wave relatively well but not without tragic losses. We are in a lull but let’s not make any illusions. It’s not over yet. The worse is yet to come.

The silver lining to this pandemic is that I wouldn’t be penning this blog entry just now. My fellow members and I would have been in a bit of a panic on the eve of the first conference. Instead, we are officially launching our website renal.mu and ‘The Kidney Club” has morphed into a Free Online Access Medical Education(FOAMed) intiative of the association.

10 Symptoms of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a tricky condition. Most people have no symptoms until their kidney disease is advanced. Most people with CKD feel well.

These symptoms often start very gradually and are not noticed until too late. By the time, some people with CKD feel ill, they may already be in a life threatening situation. That’s the big danger of CKD.

Here are the 10 symptoms of CKD.

1

No symptoms

2

Feeling more tired and having less energy

3

Having difficulty to concentrate

4

Having little appetite and possibly some nausea on and off.

5

Finding it hard to have a good night’s sleep.

6

Having muscle cramps at night

7

Having swollen feet and ankles and puffy eyes, especially in the morning (oedema)

8

Having a dry skin which is very itchy

9

Needing to urinate more often, especially at night.

10

Having difficulty breathing, initially on lying flat or climbing stairs. Later, the breathlessness becomes more and more frequent. This is possibly the most serious symptom of CKD.

10 Facts about Nephrology

1

Nephrology is kidney medicine. This is the best short explanation. Kidney medicine was actually its original name until about 1960.

2

The word Nephrology  was made up from Greek word nephros (kidney) and the suffix -logy (the study of).

3

Nephrology is a specialty of medicine focused on the kidneys, kidney function and kidney disease. Nephrologists are the doctors who have done extra study in that speciality.

4

Nephrology seeks to maintain kidney health and treats kidney disease using lifestyle changes especially diet, medication and kidney replacement therapy.

5

Haemodialysis in the new unit at Jeetoo Hospital

Kidney replacement therapy is required when the kidneys stop working (kidney failure). There are two main options: dialysis and kidney transplantation.

6

Nephrologists treat whole body conditions affecting the kidneys such as diabetes, hypertension and immunological disease like lupus.

7

They also deal with conditions localised to the kidneys like kidney infection, kidney stones and drug toxicity to the kidneys.

8

Nephrology also deals with fluid, electrolytes (like sodium, potassium, calcium and chloride) and acid-base imbalances in the body.

9

Nephrologists treat complications due to kidney disease that affect other parts of the body such as renal bone disease, breathlessness, anaemia, oedema and hypertension.

10

Hypertension leads to kidney disease. Kidney disease causes hypertension. Nephrologists are quite possibly the best doctors to treat hypertension as they treat it every day.

10 Things Kidneys do…

1 Filtration. 

Just above a litre of blood passes both kidneys every minute and one tenth gets filtered out as fluid. Blood cells, most proteins and fat particles stay in. Water and anything smaller get squeezed out!

2 Reabsorption. 

Next, the kidneys do some fine tuning. They take back in what is useful to the body: the right amount of minerals, glucose, amino-acids and water.

3 Water balance.

Kidneys pee more when we drink more but conserves water by peeing little if we are not drinking enough.

4 Excretion 

Hundreds of waste products like urea, toxins and drugs are filtered out and not taken back. This way, the kidneys keep the inside of the body clean.

5 Acid-base balance

Our bodily functions like food metabolism produce a lot of acid. The kidneys are the only organs that gets rid of excess acid.

6 Homeostasis

The kidneys keep the environment in the body stable. It includes keeping the concentration of many chemicals in the body within a tight range.

7 Blood pressure control. 

The kidneys control blood pressure by getting rid of excess salt and releasing various hormones. If the kidneys are diseased, blood pressure goes up.

8 Erythropoeitin production 

The kidneys produce erythropoeitin (EPO) that makes the bone marrow produce red cells. Without any EPO, we become severely anaemic.

9 Vitamin D activation

Kidneys convert the vitamin D we get from food and the sun into an active form that keep our bones strong and healthy.

10 Glucose control

The kidneys help to stabilise blood sugars by controlling the loss of glucose in the urine and by making new glucose when levels go low. This is why the newest class of drugs for diabetes act on the kidneys.

10 Facts about Kidneys

1

The kidneys are located deep in the lower back to the left and right of the spine near the lower ribs.

2

Each kidney is shaped like a bean with the size of a fist. It is on average about 11cm long and 6cm wide and 150g in weight. These dimensions are obviously proportional to the person’s height.

3

The right kidney lies lower than the left kidney as a result of being pushed down by the liver. The right kidney is also slightly smaller than the left.

4

Most people are born with 2 kidneys but some healthy people can have 1 or 3 or 4 (click here and here to find out more) kidneys too!

5

The kidneys move up and down by a few centimetres as we breathe in and out.

6

The kidneys receive 20% of all the blood the heart pumps out. That is just above one thousand millilitres every minute!

7

Taking in all that blood flow, the kidneys filter out about 120 millilitres of fluid every minute. Don’t worry, they later reabsorb most of the fluid back in the body. After all, we normally pass just over a litre of urine a day!

8

Each kidney contains just over one million nephrons. A nephron is a miniature filter that receives blood, filters and reabsorbs fluid to produce urine.

9

Each kidney has a cap above upper pole. This is the adrenal gland which functions separately from the kidney and produces important hormones.

10

The kidneys shrink slowly as we get older but this process occurs faster and earlier in kidney disease. A badly shrunken kidney will barely function.