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CHRONIC KIDNEY DISEASE (CKD) Introduction:
CKD is also known as Chronic Renal Failure or Chronic Renal Disease. It is a slow and progressive loss of kidney function over a period of several years.(1) This occurs when the renal reserve is lost and there is irreversible damage to about 75% of nephrons.(2) Mostly people realize that they have it when their kidney function down to 25% of normal.(1)
As shown in figure: (6)
Causes: • Chronic Nephritis (cause swelling of glomerulus).
• Polycystic Kidney Disease (fluid filled cysts formed in kidney).
• Renal Calculi (kidney stones).
• Urethral Constriction ( constriction of urethra due to tissue inflammation).
• Hypertension (high blood pressure). (2)
• Blood in urine (dark urine)
• Diabetes type I and II
• Edema –swollen feet , hands and ankles.
• Insomnia and loss of appetite
• Erectile dysfunction (male inability to get or maintain an erection)
• Decreased urine output and more frequent urination especially at night
• Muscle cramp and twitches
• Pain on the side or mid to lower back
• Hypertension (1)
CKD stages are classified as follows:
Stage1: GFR (Glomerular Filtration Rate) is normal(evidence of kidney disease detected).
Stage2: GFR is lower than 90ml (evidence of kidney disease detected).
Stage3: GFR is lower than 60ml. It is common.
Stage4: GFR is lower than 30ml.
Stage5: GFR is lower than 15ml. Renal Failure has occurred. (1)
The following tests are used for diagnosis of kidney disease:
• Blood test: If level of urea creatinine is high in the blood then doctor will most likely diagnose end stage kidney disease.
• Urine test: It find out either protein or blood present in urine.
• Kidney scans: MRI, CT and Ultrasound techniques are used in CKD diagnosis. In advanced stages the kidneys are smaller and have uneven shape.
• Chest X-ray: It aims to check pulmonary edema
• Glomerular Filtration Rate: GFR measures how many ml of waste the kidneys can filter per minute. The healthy kidney can filter over 90ml per minute. (1)
There is no current cure for CKD. Patients with CKD typically need to take large number of medication include:
• Anemia Treatment: If HB level is low CKD patient has to take IRON supplements such as Ferrous Sulphate tablets or in the form of injection.
• PhosphateBalance: CKD patients are unable to eliminate phosphate so they are advised to reduce phosphate intake such as eggs , red meat , fish and dairyproducts.
• High Blood Pressure: CKD patients are advised to bring their BP to lower levels to slow down the progression of disease. ACEinhibitors bring the BP to lower levels.
• Skin itching:Antihistamines such as Chlorophenamine help to alleviate itching.
• Anti-Sickness Medication: Cyclizine or Metaclopramide help to relieve sickness.
• NSAIDS (non-steroidal anti-inflammatory drugs): NSAIDs such as Aspirin or Ibuprofen should be avoided. (1)
• End Stage Treatment: The patient will need dialysis or a kidney transplant in order to survive when diet , medication , and treatments are no longer enough. Dialysis and surgery treatment is required.
▲ KidneyDialysis: Removal of waste products and excessive fluids from blood through artificial means called dialysis.
It is of two types:
■ Hemodialysis: Patient’s blood is filtered through dialyzer three times per week for three hours. As shown in figure(3)
Perito nal Dialysi s: Blood is filtered in the patient’s
abdomen in the peritoneal cavity with the help of catheter implanted in its own abdomen. As shown in figure (5)
▲ KidneyTransplant: At end stage, the kidney is transplanted by the kidney donor who has same blood type and cell tissues as that of recipient to reduce the antibody response. It can be taken from living donor such as siblings or close relatives or from a dead donor (cadaver) (1)
HerbalTreatment: Herbal medicines are natural therapies as they cause few side effects and injuries to kidney.
Following herbs are used in this disease:
• Buteamonosperma (flame of the forest): A herb to treat painful urination and effective in curing hepatic disorders and aid in excretion process of kidney. Shown in figure(7)
Land Caltrops: It contain analgesic properties as it is loaded Saponins , Carboline alkaloids. This herbal tonic is effective in rejuvenating the kidneys and healing damaged cells.As shown in figure(8)
Red Sandalwood: This excellent herb is considered as great urinary alkaliser as it soothe the urinary tract and it contains anti-microbial properties.It has natural diuretic properties that help to eliminate excess water in the form of urine from body. As shown in figure (9) .
Fruit Juice: It keeps body hydrated and help to remove the toxins , infections , harmful particles from body. It includes orange,lemon,grapes ,apples etc. As shown in figure (10)
• Marshmallow: It relieves swelling in mucous membranes as well as swelling in urinary tract. Moreover, it increases the urine flow due to its diuretic properties. It is source of anti- oxidant and protects body cells from free radical damage. As shown in figure (11)
• Aloe Vera Juice and Gel: It contains antiseptic and anti-inflammatory effects. Hence, very useful in CKD treatment. (4) As shown in figure (12)
Following measures are taken to avoid CKD.
• Physical activities like exercise , yoga.
• Healthy Diet include plenty of fruits and vegetables , whole grains helps in prevention of hypertension one of major causes of CKD
• Avoid the alcohol consumption and intake of drugs
• Avoid exposure to heavy metals like and other toxic chemicals (1)
2: Ross and Wilson Anatomy physiology in health and illness. 3:https://www.google.com.pk/ search? q=hemodialysis&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj22NuRpJjYAhXJqo8 KHa3-DVQQ_AUICigB&biw=1024&bih=662#imgrc=0lGxf98fT4bytM:
4: www.allremedies.com/home-remedies-for-kidney-failure/ 5:https://www.google.com.pk/ search?q=peritoneal +dialysis&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjU9L6DhZvYAhXGMY8KH cbKB0kQ_AUICigB&biw=1024&bih=613#imgrc=wCkTiRSvHMraxM:
6: https://www.google.com.pk/imgres?imgurl=https://www.mayoclinic.org/-/media/kcms/gbs/ patient-consumer/images/2016/06/07/08/06/ mcdc7_diseased_kidney-8col.jpg&imgrefurl=https://www.mayoclinic.org/diseases-conditions/ chronic-kidney-disease/symptoms-causes/ syc-20354521&h=455&w=632&tbnid=IqInab7rliwsDM:&tbnh=151&tbnw=210&usg=__3f6W
HN-xVmjq3nyesjnbokPzNzo% 3D&vet=10ahUKEwjjp_fuhp3YAhUFuY8KHcznBvUQ9QEIKjAA..i&docid=mvPrxNZNxQNj eM&sa=X&ved=0ahUKEwjjp_fuhp3YAhUFuY8KHcznBvUQ9QEIKjAA
7:https://www.google.com.pk/search?q=flame+of+the+forest+for +ckd&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjqraWpyqDYAhXJIOwKHfJ1AB AQ_AUICigB&biw=1366&bih=662#imgrc=h5ZMf8EAp5KseM
8: https://www.google.com.pk/search?dcr=0&biw=1366&bih=662&tbm=isch&sa=1&ei=6Ic- WqrqOdDFsAf234LYAQ&q=land+caltrops+for+ckd&oq=land+caltrops+for+ckd&gs_l=psy- ab.3...202942.207350.0.2075220.127.116.11.0.0.0.398.1787.2-3j3.6.0....0...1c.1.64.psy- ab..8.1.305...0i7i30k1.0.4aIiqVB1PVU#imgrc=eOrByvtR-w64fM:
9:https://www.google.com.pk/search?q=herbal+treatment+for +ckd&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwimlPSCvqDYAhXD16QKHfjqANIQ_AU IDCgD&biw=1366&bih=662#imgrc=QAJGAy9SYkNKEM:
10:https://www.google.com.pk/search?dcr=0&tbm=isch&q=fruit+juice+for +ckd&spell=1&sa=X&ved=0ahUKEwjw6YqszaDYAhVB3aQKHYUaAlYQvwUIOSgA&biw= 1366&bih=662&dpr=1#imgrc=vTp6a3cFyO15uM:
11: https://www.google.com.pk/search?dcr=0&biw=1366&bih=662&tbm=isch&sa=1&ei=FIs- WvmmMYSXkwXAyJ-4Dg&q=marshmallow+for+ckd&oq=marshmallow+for+ckd&gs_l=psy- ab.3...132741.137296.0.137718.104.22.168.0.0.0.269.2486.2-10.10.0....0...1c.1.64.psy- ab..2.1.267...0i7i30k1.0.CQsnxKETZBg#imgrc=kt1i81HFdkjWoM:
12: https://www.google.com.pk/search?dcr=0&biw=1366&bih=662&tbm=isch&sa=1&ei=oYs- WrmiFMnHsAeNjYfgDg&q=aloe+vera+for+ckd&oq=aloe+vera+for+ckd&gs_l=psy- ab.3..0i24k1.171873.175564.0.175922.214.171.124.0.0.0.271.1774.2-7.7.0....0...1c.1.64.psy- ab..3.2.528...0i7i30k1.0.DZ-AbM8BJeQ#imgrc=YWGOv1SmkwcpfM:
Retrieved on 17th Dec,2017