Chronic Kidney Disease

January 2, 2021
Chronic Kidney Disease

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

ParameterNormal range
SodiumNormal range: 135 to 145 mmol/L
Hyponatremia: Below 135 mmol/L
Hypernatremia: Above 145 mmol/L
PotassiumNormal range: 3.5 to 5.0mmol/L
Hypokalemia:Below 3.5mmol/L
Hyperkalemia:Above 5.0mmol/L
ChlorideAdults: 98 to 106 mEq/L
Children: 90 to 110 mEq/L
Newborn: 96 to 106 mEq/L
Bicarbonate (Total CO2)23-27 mmol/L
Phosphorus2-4.5mg/dL
Calcium8.5-10.5 mg/dL
Urea2.5-7.8 mmol/L
Blood Urea Nitrogen (BUN)7 to 20 mg/dL
Uric acidAdult Female: 2.4 to 6.0 mg/dL
Adult Male: 3.4 to 7.0 mg/dL
Children: 3 to 4 mg/dL
CreatinineAdult males: 0.6 to 1.2 mg/dL
Adult females: 0.5 to 1.1 mg/dL
Ammonia:15-50 µmol/L
Urea (BUN)/Creatinine Ratio12:1 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:

  1. What causes chronic kidney disease ?

  2. Vivekanand Jha et al, Chronic kidney disease: global dimension and perspectives, The Lancet, May(2013), 382, 9888, 260-272.

  3. Engelgau MM, El-Saharty S, Kudesia P, Rajan V, Rosenhouse S, Okamoto K. Regional aging and disease burden. In: Capitalizing on the Demographic Transition: Tackling Noncommunicable Diseases in South Asia. Washington, DC: World Bank, 2011: 15-40.

  4. Jha V. End-stage renal care in developing countries: the India experience Ren Fail 2004; 26: 201-8.

  5. Chronic kidney disease (CKD) - Symptoms, causes, treatment

  6. Smith et al, Lab tests online; American Association for Clinical Chemistry (AACC)2001-2020.

  7. Wintrobe's Clinical Hematology. 14th ed. Greer J, editor. Philadelphia, PA: Wolters Kluwer: 2019.

  8. Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Elsevier Saunders; 2011.

  9. The Associations of Plant Protein Intake With All-Cause Mortality in CKD

  10. Desiree de Waal, Heaslip E, Callas P. Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis. J Ren Nutr. 2016 Jan;26(1):1-9.

  • Chronic Kidney Disease
  • Medical Nutrition Therapy
  • Lifestyle Interventions
  • Unhealthy Diet
  • Physical Inactivity