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Understanding Chronic Kidney Disease

You have probably heard of Chronic Kidney Disease (CKD), or “kidney failure” as it is often called. Did you know that CKD is currently the 12th most common cause of death in the world? In fact, CKD is expected to become more common in the coming years, as urbanization spreads globally at break-neck speed. The prevalence of CKD is increasing globally — rapidly rising in Asia and Africa (while declining in North America and Europe). In 2017, an estimated 700M people worldwide were suffering from the disease, with ~70M of them in Sub-Saharan Africa.

So, what exactly is Chronic Kidney Disease? Read on to find out…

Causes of CKD

The human body is made up of two Kidneys (Left and Right). The kidneys are responsible for removing waste and balancing the fluid content in the body. Chronic kidney disease is a condition whereby the kidneys undergo a steady decline in their ability to remove waste and balance fluid content over multiple years.

This decrease in function is most often caused by many years of continuous (chronic) injury to the kidneys, mainly due to poorly controlled blood sugar levels (diabetes) and/or high blood pressure. Hence, two major causes of CKD are Diabetes and Hypertension. Studies have shown that about 1 in 3 diabetics have a condition called diabetic nephropathy — which is a precursor to CKD. And >25% of people with CKD in Africa developed kidney disease as a result of untreated hypertension.

 

Signs that you may have kidney disease

Kidney disease is diagnosed by an objective assessment of kidney function, which can be measured using two tests:

1. Glomerular filtration rate(GFR): The GFR is measured by performing a blood test. The kidneys have filters called glomeruli that are responsible for removing waste and balancing fluids. The GFR tells us how much blood passes through the filter per minute. Reduced GFR indicates that the kidneys are filtering blood at a lower rate than normal, hence, a sign of decreased kidney health.

2. Albumin to Creatinine Ratio( ACR): This ratio is measured by collecting urine sample, typically over a period of 24hrs. Creatinine is a normal waste product found in urine and Albumin is a protein found in the blood. When Albumin is found in urine, it is a sign that the kidneys aren’t functioning properly.

Stages of CKD

To understand CKD, it is crucial to appreciate its chronic nature — as the name suggests. As a member of a group of non-communicable diseases called “silent killers”, most sufferers of CKD do not observe severe symptoms until their kidneys are significantly damaged (late stages of the disease). This is because the kidneys are able to meet most of the body’s demands for many years, even as their function is steadily declining. In Nigeria, for example, 85% of people only discover they have CKD at the point when they need weekly dialysis or a kidney transplant to survive.

Therefore, doctors use the glomerular filtration rate (GFR) to categorize CKD into 5 stages, as represented in the table below.

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