Causes of Chronic Kidney Disease (CKD)

According to the Third National Health and Nutrition Examination Survey (NHANES III), one of the most comprehensive sources of epidemiological data regarding CKD, close to 11% of the adult population could have some degree of the disease.

Studies suggest that by identifying and treating the CKD early, patients are less likely to need renal replacement therapy, such as hemodialysis or even a kidney transplant. The data, nonetheless, shows that CKD is often disregarded at its earliest stages when it’s still treatable. This is usually due to the lack of any particular symptoms or follow-up.

What are the leading causes of Chronic Kidney Disease?

The key to avoiding kidney disease is prevention, so raising awareness as to what might be the reason behind CKD is crucial.

Some of the most common causes of CKD

1. Diabetes mellitus

Diabetic nephropathy is the leading cause of ESRD (end-stage renal disease) in the USA (and the rest of the world), accounting for 45% of all new cases. Up to 35% of diabetic patients (both type I and II) eventually develop nephropathy after 15-20 years. What do you need to know about diabetes and CKD?

• Screening is of the utmost importance! For diabetes type I, it is recommended to start with annual urinalysis 5 years after the onset and for diabetes type II at the time of recognition.
• As shown by latest studies (DCCT, SDIS, UKPDS, Kumamoto study) the onset and the progression of diabetic nephropathy can be delayed by interventions instituted early in the course of the disease, such as tight glycemic control, strict control of arterial blood pressure, specific antihypertensive drugs (like ARBs), etc.
• It is crucial for a diabetic patient to be referred to the nephrologist early when diabetic nephropathy is diagnosed. During this consultation, the doctor will assess the situation and define the next steps accordingly.

2. Hypertension (high blood pressure)

Hypertension has long been recognized to target the kidneys, the same way it targets the heart and blood vessels. It is both an important risk factor of CKD progression and a consequence of renal impairment.

What do you need to know about hypertension and CKD?

• When the increased systemic blood pressure is transferred to the glomerulus, the filtering unit of the kidney, that contributes to glomerular hypertension. The kidneys then filter more than usual, which accelerates renal damage.
• In the MDRD study, a higher baseline arterial blood pressure predicted a greater decline of GFR among patients with CKD regardless of the cause of kidney damage. Therefore, systemic blood pressure, whether as a primary cause or consequence of CKD, should be tightly controlled within the benchmark range. In the case of CKD, hypertension is controlled with specific drugs, such as angiotensin receptor blockers (ARBs), especially if it is accompanied by proteinuria (protein in urine).

3. Glomerulonephritis

Glomerulonephritis is an inflammatory condition that affects the filtrating barrier of the nephron. The symptoms include hematuria, proteinuria and even renal failure at later stages, if untreated.

What do you need to know about glomerulonephritis and CKD?

• Glomerulonephritis is a hereditary disease and is among the most common causes of chronic kidney disease, after diabetes and high blood pressure.
• The cause of glomerulonephritis can be primary, (focal segmental glomerulonephritis, for example), or secondary, such as glomerulonephritis from systemic lupus (an autoimmune disease) or post-infectious glomerulonephritis after streptococcal infection.
• Tight blood pressure control, as well as all common measures taken for chronic kidney disease, are crucial for this kidney condition.

4. Inherited kidney diseases

4.1. Autosomal dominant polycystic kidney disease (ADPKD)

What do you need to know about the autosomal dominant polycystic kidney disease and CKD?

• ADPKD, also known as polycystic kidney disease, is the most common inherited kidney disease. A clear sign of the disease is massive cystic enlargement of the kidneys, which is diagnosed through ultrasonography of individuals who are at risk.
• ADPKD affects 1 to 400,1000 live births and accounts for almost 5% of the ESRD population in the USA and Europe, respectively.

4.2. Alport's syndrome

What do you need to know about Alport’s syndrome and CKD?:

• Alport’s syndrome is a disease that damages the minuscule blood vessels in your kidneys. It can lead to kidney disease and kidney failure, but also cause hearing land eye problems.
• It is caused by genetic mutations to collagen, which is important for the normal structure and function of the kidneys.

It is important to note that any unexplained hematuria or renal failure should be cross-referenced with a family history of the same condition first. In general, patients with inherited nephropathy (kidney diseases) should be informed about the nature and genetic analysis of their disease in order to avoid any unnecessary investigation.

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

• Tubulointerstitial diseases, such as:
  • Nephrolithiasis,
  • Urinary tract infection,
  • Reflux nephropathy,
  • Obstructive uropathy

Tubulointerstitial diseases affect the tubular system and the interstitial cells in between and can cause chronic kidney disease, the same way as other glomerulopathies mentioned above. The glomerular filtrate undergoes a series of modifications before becoming the final product (urine), including removal or absorption, and addition or secretion of solutes and fluids. This is achieved by a specific system of tubular cells called the tubular system. If the system malfunctions that leads to a tubulointerstitial disease.

• Any disease which affects the human immune system (e.g. HIV)
• Congenital diseases, such as renal artery stenosis that can cause infections resulting in kidney damage
• Tumors or enlarged prostate glands in men
• Drugs, specific pain medications (e.g. for cancer) and toxins.

Please be aware that there are many other causes that affect the kidneys and are not as common as the ones mentioned here. Each patient is unique, so we advise you to refer to your doctor for details concerning your personal condition.