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Causes of Kidney Disease


 What are the leading causes of Chronic Kidney Disease?

Epidemiological studies suggest that early identification and treatment of CKD can help reduce the burden of patients requiring renal replacement therapy, such as hemodialysis or even kidney transplant. However, there is evidence that CKD is often disregarded at its earliest stages, when the disease is still treatable usually because there are no particular symptoms or due to deficient follow up, although the prevalence, outcomes and underlying causes of End Stage Renal Disease (ESRD) are well documented. The key to avoid CKD is prevention, so raising awareness as to what may cause CKD is absolutely crucial.

According to the third National Health and Nutrition Examination Survey study (NHANES III), which represents one of the most comprehensive sources of epidemiological data regarding CKD, close to 11% of the adult population could have some degree of CKD. That brings us to the major risk factors for CKD, which are also the main causes of CKD worldwide.

Here are some of the most common causes of CKD:

1. Diabetes Mellitus

Diabetic nephropathy is the leading cause of ESRD in USA, as much as the rest of the world, accounting for the 45% of all new cases. Up to 35% of patients of both diabetic type I and II eventually develop nephropathy after 15-20 years of diabetes. What you need to know about Diabetes & CKD:
  • Screening is of paramount importance. It is recommended that a urinalysis be performed annually starting 5 years after the onset of diabetes type I and at the time of recognition of diabetes type II.

 

  • As shown by latest studies (DCCT, SDIS, UKPDS, Kumamoto study) the onset and the progression of diabetic nephropathy can be delayed by interventions, which are instituted early in the course of the disease, such as tight glycemic control, strict control of arterial blood pressure, specific antihypertensive drugs, like ARBB etc.

 

  •  It is crucial that the diabetic patient has early referral to the nephrologist specialist when diabetic nephropathy is diagnosed, because consultation should be specified thereafter.

2. Hypertension

Hypertension (primary or due to secondary causes) has long been recognized to target the kidneys, the same way it targets the heart and the blood vessels. It is also recognized as a consequence of renal impairment per se and as an important risk factor of CKD progression.

What you need to know about Hypertension & CKD:
  • It is easy to understand that elevated systemic blood pressure is transmitted to the glomerulus, the functional machine of the kidney, contributing to the glomerular hypertension of the CKD, thus accelerating renal damage.

 

  • In the MDRD study among patients with CKD, higher baseline arterial blood pressure predicted a greater rate of GFR decline independently of the cause of kidney damage.  Therefore, it is important to know that systemic blood pressure, as a primary cause of CKD or as a consequence of CKD, should be tightly controlled within the normal range. In the case of CKD, hypertension should be controlled with specific drugs, such as ARBB, especially if there is concomitant albuminuria.

3. Glomerulonephritis

Glomerulonephritis, as the term implies, is an inflammatory type of condition that affects the filtrating barrier of the nephron, giving symptoms like hematuria or proteinuria and at later stages renal failure if untreated.

What you need to know about Glomerulonephritis & CKD:
  • Glomerulonephritis is a hereditary disease and is among the most common types of chronic kidney disease, after diabetes and high blood pressure.

 

  • The aetiology of glomerulonephritis might be primary, for example focal and segmental glomerulonephritis, or secondary, for example glomerulonephritis of systemic lupus which is an autoimmune disease or post-infectious glomerulonephritis after streptococcal infection.

 

  • Tight blood pressure control, as well as all common measures that are taken for CKD, is crucial for this kidney condition.

4. Inherited Kidney Diseases

Autosomal Dominant Polycystic Disease
What you need to know about Autosomal Dominant Polycystic Disease & CKD:
  • Autosomal Dominant Polycystic Disease also known as Polycystic Kidney Disease is the most common inherited kidney disease. The clinical hallmark of ADPKD is massive cystic enlargement of the kidneys and is diagnosed by ultrasonography at individuals who are at risk.

 

  • The presence of enlarged kidneys with multiple cysts is required for the diagnosis of ADPKD.

 

  • ADPKD affects 1 to 400-1000 live births and accounts for almost 5% of the ESRD population in the USA and Europe.

5. Alport's Syndrome

What you need to know about Alport’s Syndrome & CKD::
  • Alport’s syndrome is also known as Tuberous Sclerosis complex.

 

  • It is Important to know that if a patient with unexplained hematuria or renal failure has a family history of hematuria or renal failure this specific history should be investigated.
Generally, patients with any inherited nephropathy should be informed about the nature of their disease and genetic analysis in order to avoid any unnecessary investigation.

6. Other conditions affecting the kidneys and causing permanent kidney damage are:

  • Tubulointerstitial diseases of the kidneys, such as:a. Nephrolithiasis , b. Urinary tract infection ,c. Reflux nephropathy ,d. Obstructive uropathy ,What you need to know about Tubulointerstitial diseases & CKD: ,The diseases affecting the tubular system and the interstitial cells in between are called tubulointerstitial diseases of the kidneys and can cause chronic kidney disease, the same way the glomerulopathies mentioned above do. The glomerular filtrate of the kidney undergoes a series of modifications before becoming the final urine, including removal or absorption, and addition or secretion of solutes or fluids. This process is achieved by a specific system of tubular cells called the tubular system of the nephron which is found to be equally important as the glomerulus in the kidney’s role in human homeostasis. Malfunctions of this system lead to tubulointerstitial diseases affecting the kidney.

 

  • Any disease which affects the human immune system such as HIV.

 

  • Congenital diseases, such as renal artery stenosis that can cause infections resulting to kidney damage.

 

  • Tumors or enlarged prostate gland in men

 

  • Drugs, specific pain medications (e.g. for cancer) and toxins.

It should be noted that there are many other causes affecting the kidneys which are not as common as the aforementioned ones. Each patient is unique, so the Virtus Vita expert nephrologist advises that you refer to your doctor for details concerning your personal condition.