Chronic kidney disease is one of the most common causes of morbidity and one of the leading causes of death worldwide. It can be briefly defined as permanent kidney damage or failure. Chronic kidney disease is the presence of kidney damage for more than 3 months or merely a decrease in renal function which seen as a decrease in GFR in the laboratory findings for more than 3 months with or without evidence of renal damage.
Chronic renal failure is classified into 5 stages. The first 3 stages are mostly asymptomatic but there is deterioration of the kidneys and decreasing function. Symptoms are only manifested on stage 4 where the GFR is below 30 ml/min. in this stage, patients will complain of decrease in frequency of urination. Localized edema can be observed mostly seen in the lower extremities. This is due to the retention of fluids in the body secondary to the dysfunction of the kidneys.
The fifth stage is considered as the worst and has the poorest prognosis. End stage renal disease or Stage 5 occurs when the Glomerular Filtration Rate is below 15 ml/min. in some cases of ESRD, GFR is 2 to none. Mortality rate of End Staged Renal Disease is very high because it leads to fatal complications and shutting down of some organs as a mechanism of the body to compromise the loss of kidney function.
In the first 3 stages in CKD, most patients are asymptomatic. However, there will be observable signs of decrease renal function seen as edema in the lower extremities, decrease frequency of urination and minimal pleural effusion. Patients with stage 4 renal failures and end stage renal disease will manifest symptoms like generalized edema known as Anasarca, massive pleural effusions, severe anemia due to the inability of the kidneys to produced erythropoietin that stimulates production of new red blood cells, acid-base abnormalities, damage to other organs of the body, Congestive Heart Failure, and Hepatorenal syndromes.
To diagnose Chronic Renal Disease, investigation must begin in asking the history of the present illness. Chronic Renal Disease is expressed in the patient's statement as a decrease in urinary frequency, body malaise, chest tightness, apnea and postural apneic episodes. Laboratory parameters that are relevant in CKD are the following:
A complete blood count must be taken to have a baseline on the patient's blood counts especially Hemoglobin and Red Blood Cells.
A Urine Analysis must be taken to look for presence of metabolites which can help determine the cause of CKD. Examples of these metabolites are glucose, urate crystals, and Magnesium salts. The presence of RBC in the urine means that there is traumatic damage in the urinary system possibly due to stones. An increase in the white blood cell count and a high bacterial content in urine is significant infection.
Serum creatinine is an important parameter to determine the extent of kidney damage.
The Glomerular Filtration Rate should also be calculated to determine the stage of CKD and to be able to classify the patient.
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