Management of Chronic Kidney Disease

Chronic kidney disease (CKD) can be defined as permanent impairment of exocrine and endocrine renal function, caused by irreversible loss of functioning nephrons. The result is:

• Impaired excretion of solute leading to sodium retention, resulting in oedema formation and hypertension.
• Retention of nitrogenous substances leading to symptoms of uraemia.
• Impairment of endocrine function leads to decreased erthyropoietin production and anaemia. In addition there is failure to activate vitamin D causing upsets in calcium / phosphate metabolism and secondary hyperparathyroidism.

Urine output is often normal or high as in steady state, excretion of solute load must equal input and in the face of an inability to produce hyperosmolar urine, this requires excretion of a larger volume of hypo / isotonic urine. As renal function deteriorates urine output may start to fall and this requires initiation of renal replacement therapy (a transplant or dialysis).

If untreated, CRF leads on mainly to CNS symptoms, ending in uraemic coma. In addition gastrointestinal upset results in nausea and vomiting and cardiovascular dysfunction manifests as pericarditis and left ventricular failure.

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