Chronic kidney disease (CKD) is a progressive loss of kidney function over time, typically due to underlying conditions such as diabetes, hypertension, or glomerulonephritis. The kidneys gradually lose their ability to filter waste, regulate electrolytes, and maintain fluid balance, leading to systemic complications.

Etiology and Risk Factors

The most common causes of CKD include:

• Diabetes Mellitus – Persistent hyperglycemia damages glomerular capillaries.
• Hypertension – Increased pressure leads to nephron damage and sclerosis.
• Glomerulonephritis – Chronic inflammation contributes to scarring and dysfunction.
• Polycystic Kidney Disease – A genetic disorder causing cyst formation and kidney enlargement.
• Autoimmune Diseases – Conditions like lupus can cause kidney inflammation.

Clinical Presentation and Systemic Effects

Early CKD is often asymptomatic, but as kidney function declines, symptoms emerge:

• Fatigue and Weakness – Due to anemia from reduced erythropoietin production.
• Edema – Sodium and fluid retention cause swelling in extremities.
• Hypertension – Impaired sodium regulation leads to elevated blood pressure.
• Electrolyte Imbalances – Hyperkalemia, metabolic acidosis, and hypocalcemia can occur.
• Cardiovascular Complications – Increased risk of heart failure, left ventricular hypertrophy, and atherosclerosis.
• Endocrine Effects – Altered vitamin D metabolism leads to secondary hyperparathyroidism and bone disease.

Classification Using Glomerular Filtration Rate (GFR)

CKD is staged based on estimated GFR:

• Stage 1 (GFR ≥90 mL/min) – Kidney damage with normal function.
• Stage 2 (GFR 60–89 mL/min) – Mild reduction in kidney function.
• Stage 3 (GFR 30–59 mL/min) – Moderate decline; increased complications.
• Stage 4 (GFR 15–29 mL/min) – Severe reduction in function.
• Stage 5 (GFR <15 mL/min) – End-stage renal disease (ESRD), requiring dialysis or transplantation.

Treatment Strategies

• Blood Pressure and Glucose Control – ACE inhibitors/ARBs slow progression.
• Dietary Management – Low-protein, low-sodium, and potassium-controlled diets.
• Anemia Treatment – Erythropoiesis-stimulating agents and iron supplements.
• Electrolyte and Acid-Base Management – Phosphate binders, bicarbonate therapy.
• Dialysis or Transplantation – Required for ESRD management.

Early detection and intervention are crucial to slowing CKD progression and preventing complications. APA