Chronic Kidney Disease

January 2, 2021

5 min read

The term chronic kidney disease refers to a condition where the kidneys are damaged and that gets worse over a period of time. If the damage is very severe the kidneys may stop working resulting in kidney failure or end-stage renal disease. One may require dialysis or a renal transplant to survive¹.

CKD prevalence is estimated to be 8-16% worldwide².

Diabetes and hypertension are the leading cause of chronic kidney disease in all developed and developing countries³. Environmental pollution, pesticides, analgesic abuse, herbal medications, and the use of unregulated food additives also contribute to the burden of chronic kidney disease in developing countries⁴.

Other factors that contribute to chronic kidney diseases are

systemic lupus erythematosus, vasculitis),
infections (bacteria, HBV, HCV, HIV, schistosomiasis, malaria),
malformations to the baby in the womb,
inherited diseases such as polycystic kidney disease,
repeated urinary tract infections and
other problems such as renal stones, enlarged prostate gland in men⁵.

The National Kidney Foundation (NKF) and the National Kidney Disease Education Program (NKDEP) recommend that people at high risk be screened for kidney disease. A renal panel is a group of tests that may be performed together to evaluate kidney (renal) function. The tests measure levels of various substances, including several minerals, electrolytes, proteins, and glucose (sugar), in the blood to determine the current health of the kidneys.

Components Of Renal Function Test ^6,7,8

Electrolytes:
- Sodium
- Potassium
- Chloride
- Bicarbonate (Total CO2)
Minerals:
- Phosphorus
- Calcium
Protein:
- Albumin
Waste products:
- Urea
- Creatinine
Energy Source:
- Glucose
Other three calculated values:
- Urea (BUN)/Creatinine Ratio
- Estimated Glomerular Filtration Rate (eGFR)
- Anion Gap

Risk Factors associated:

Urinary tract infections (UTI)
Bladder infection (cystitis)
Kidney infections (pyelonephritis)
Hydronephrosis
Hypertension
Kidney stones (nephrolithiasis and/or ureterolithiasis)
Kidney cancer
Glomerulonephritis
Blood clots in the kidneys (renal vein thrombosis)
Polycystic kidney disease (congenital)
Congenital malformations
End-stage renal disease

Reference Range for Renal parameters

Parameter	Normal range
Sodium	Normal range: 135 to 145 mmol/L Hyponatremia: Below 135 mmol/L Hypernatremia: Above 145 mmol/L
Potassium	Normal range: 3.5 to 5.0mmol/L Hypokalemia:Below 3.5mmol/L Hyperkalemia:Above 5.0mmol/L
Chloride	Adults: 98 to 106 mEq/L Children: 90 to 110 mEq/L Newborn: 96 to 106 mEq/L
Bicarbonate (Total CO2)	23-27 mmol/L
Phosphorus	2-4.5mg/dL
Calcium	8.5-10.5 mg/dL
Urea	2.5-7.8 mmol/L
Blood Urea Nitrogen (BUN)	7 to 20 mg/dL
Uric acid	Adult Female: 2.4 to 6.0 mg/dL Adult Male: 3.4 to 7.0 mg/dL Children: 3 to 4 mg/dL
Creatinine	Adult males: 0.6 to 1.2 mg/dL Adult females: 0.5 to 1.1 mg/dL
Ammonia:	15-50 Âµmol/L
Urea (BUN)/Creatinine Ratio	12:1 to 20:1
Estimated Glomerular Filtration Rate (eGFR)	Healthy adults have a GFR of about 140 Normal is greater than 90. A GFR of less than 15 is kidney failure.

Medical nutrition therapy plays an important role in managing complications due to chronic kidney disease.

A higher dietary ratio of plant to animal protein has been associated with significantly reduced mortality in those CKD patients with lower eGFR values⁹.

A 265 participant study was conducted to investigate whether medical nutrition therapy (MNT) provided by registered dietitians slows the progression of CKD and improves nutrition related markers. The results suggested that participants with CKD who received MNT had improved biomarkers such as glomerular filtration rate, albumin, blood urea nitrogen, CKD mineral and, bone disorder markers such as calcium, phosphorus and intact parathyroid hormone than the participants who did not receive MNT. In addition, the MNT group was observed to be less likely to start dialysis in comparison to the control group¹⁰.

REFERENCES: