Chronic Kidney Disease

Abstract
Chronic kidney disease is a progressive disease that destroys the function of the human kidneys. This purpose of this research paper is to present an introductory profile of the disease. The profile includes a description of the disease, leading causes, how it is diagnosed, and its stages. Current statistics of the individuals impacted by the disease and mortality are provided. This paper will also explain the progressive nature of the disease and how the kidneys are damaged. Finally, the treatment goals and actions for the different stages of the disease are laid forth.

Chronic Kidney Disease
Kidneys are vital organs that regulate the body’s fluid level, filter toxins, control blood pressure, and more. A human cannot live without at least one functioning kidney. Chronic Kidney Disease (CKD) is a progressive disease that destroys the operating capacity of the kidneys. CKD impacts millions of Americans and is often undiagnosed until it is in an advanced stage. The human body attempts to compensate for the disease and, in doing so, worsens the condition. CKD is usually caused by another underlying cardiovascular condition. Treatment for CKD seeks to slow the progression of the disease by relieving the underlying condition. Once CKD has reached its final stage, kidney function is insufficient and renal replacement therapy is required.
Chronic Kidney Disease (CKD) was formerly known as chronic renal failure (Haynes & Winearls, 2010). CKD can be diagnosed when there is damage to a kidney or the function of the kidney is decreased (Levey & Coresh, 2012). The loss of kidney function can be measured by glomerular filtration rate (GFR). CKD is often progressive and is classified in five stages that are determined by the estimated GFR (Haynes & Winearls, 2010). If the estimated measurement of GFR is less than 60 mL/minute per 1.73m2 for a period of time no less than 3 months, then stage one of CKD is in occurrence. When the GFR is found to be 15 mL/minute per 1.73m2, then stage five has been reached and the kidneys can no longer support life (Lewis, 2012). Stage five is also called end-stage renal disease (ESRD), and either dialysis or a kidney transplant is required (Jha et al., 2013). Urinalysis is used to perform the basic testing to determine the presence and severity of CKD (Ackland, Goldsmith, & Jayawardene, 2013). Also, an ultrasound may be performed when abnormal function is detected. An ultrasound can detect shrinkage of the kidney, which is a characteristic of CKD (Lewis, 2012). Hypertension and diabetes mellitus are the most common causes of CKD (Jha et al., 2013).
According to the National Kidney Foundation, 26 million adults in the United States currently have kidney disease, which is over 10 percent of the population (Fast Facts, 2015). Additionally, a third of the population is at risk for developing kidney disease. A publication by the Centers for Disease Control and Prevention states that over 110,000 people in the U.S. began treatment for ESRD in 2011 ("National Chronic Kidney Disease Fact Sheet, 2014," 2014). The publication also states that African Americans are over three and half times more likely to develop stage five CKD than whites; while Hispanics are one and a half times as likely. In the United States, kidney disease is 9th on the list of causes of death and, annually, it kills more people than do prostate or breast cancer (Fast Facts, 2015). Chronic kidney disease causes a loss of operational nephrons, which are the kidney’s functional unit (Haynes & Winearls, 2010). Each kidney has approximately one million nephrons, with each nephron containing a glomerulus and a renal tubule (Lewis, 2012). The glomerulus acts as a filter, passing the filtrate to the renal tubule, where waste secretion and water reabsorption occurs (Tortura, 2012). About 25% of blood pumped from the heart goes to the kidneys for glomerular filtration. This is the reason that kidneys are highly vulnerable to diseases that impact vascular endothelium, such as diabetes and hypertension (Lewis, 2012). These vascular diseases damage the glomerulus, causing blood vessels to be supplanted with amorphous collagen, stopping the flow of blood and, thereby, filtration (Lewis, 2012). This condition is called glomerulosclerosis and the damage to the glomeruli is irreversible. When glomerulosclerosis occurs, whether from a vascular disease or other kidney injury, functional nephrons increase blood flow to glomeruli in order to preserve the glomerular filtration rate (Haynes & Winearls, 2010). Hypertension is created within the healthy glomeruli by the increased blood flow, causing them to become damaged in the same manner (Lewis, 2012). In addition to the glomerulosclerosis, there is usually dysfunction in the renal tubule, caused by the increased blood flow to the glomerulus (Lewis, 2012). This causes a condition called proteinuria, which means there is protein in the urine. Proteinuria causes inflammation and fibrosis in the distal tubule as it receives the overflow of protein that inundates the proximal tubule (Haynes & Winearls, 2010). The self-perpetuating cycles of glomerulosclerosis and proteinuria, make CKD a progressive disease that will, over time, cause kidney failure. Treatment of chronic kidney disease depends upon the stage at which it has been classified. The goal of treatment for early stage CKD is to manage the underlying cause, which serves to slow the progression of the disease, and reduce the risk of complications (Levey & Coresh, 2012). Those diagnosed with CKD are more likely to die from a cardiovascular disorder than to progress to ESRD (Lewis, 2012). Individuals with CKD usually require multiple medications to control blood pressure (Haynes & Winearls, 2010). CKD patients should also stop smoking and avoid obesity, as they cause a faster progression of the disease, in addition to other health complications (Haynes & Winearls, 2010). Bone disease is a risk with CKD and treatment may include replacing vitamin D and phosphate binders (Thorp, 2010). Once stage three is reached, anemia is a risk and may be treated with erythropoietin (Thorp, 2010). Non-Steroidal anti-inflammatory drugs (NSAIDS) should not be used by individuals with CKD, especially once stage four is reached (Haynes & Winearls, 2010). Once ESRD is reached, renal replacement therapy must begin. The most ideal treatment for ESRD is for the individual to receive a living donor kidney transplant prior to onset of end-stage disease (Lewis, 2012). A transplant from a donor that is deceased is the second best option. The 10 year survival rate for transplant patients is 40%, which is substantially higher than dialysis patients (Levey & Coresh, 2012). There are over 101,000 individuals on the waiting list for a kidney transplant, but less than 17,000 receive one each year (Fast Facts, 2015). When the lack of availability or another condition prevent a transplant, then a person with stage five CKD must begin dialysis to live. There are currently over 450,000 people in the United States undergoing dialysis (Fast Facts, 2015). Dialysis gets rid of toxins, excess fluid, sodium, and potassium. Dialysis works by bringing the blood into equilibrium with a dialysate fluid using a semi-permeable membrane to separate the two (Haynes & Winearls, 2010). ESRD patients must also restrict their diet to control water, sodium, phosphate, and potassium intake.
Chronic kidney disease progressively destroys the human body’s blood cleaner. Without a functioning kidney, a human cannot live. Millions of people in the United States have been diagnosed with varying stages of the disease, but there are not enough transplants available to meet the need. The kidneys are robust and attempt to compensate for the disease, but CKD is a downward spiral that leads to kidney failure. The underlying causes can be corrected to slow the progression of the disease and extend life. Though most people die of other causes before the final stage of CKD reached, ESRD is inevitable. Once the final stage is reached, the kidneys cannot support life and the individual must seek a replacement kidney and undergo dialysis until one is available.

References
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