1. Diabetes
Uncontrolled blood sugar for a prolonged period that occurs in Diabetics is the most important and preventable cause of chronic kidney disease. Its prevalence is rising across the world. It has been proven that controlling blood sugar, in the long run, prevents the progression of chronic kidney disease to advanced stages.
Targeting Fasting blood sugar between 80-130 mg/dl and less than 180 mg/dl 2 hours after meals is considered good control. The target for A1C (a test that depicts average blood sugar for the last 3 months) is less than 7%. Many new drugs are available and others are undergoing research for diabetic kidney disease patients. Drugs like SGLT2 (Sodium-glucose transporter -2) inhibitors are readily available in India and have been shown to slow the progression of kidney disease in diabetic patients. Other drugs (like Finerenone, a mineralocorticoid receptor antagonist), which will soon be available in Iareia, are another class of medication that slows the progression of kidney disease.
2. Hypertension
Hypertension is both a cause and a manifestation of CKD. It also leads to the rapid progression of kidney disease when blood pressure (BP) is uncontrolled. Blood pressure should be kept under control, which means average BP below 130/80 mmHg. Certain antihypertensive medications e.g ACEi/ARB have a significant role in not just blood pressure control but also in slowing the progression of kidney disease.
3. Glomerulonephritis
Glomerulonephritis is inflammation and damage of the filtering portion of the kidneys(glomerulus). There are several causes of Glomerulonephritis which include Systemic diseases affecting various body organs and diseases predominantly involving kidneys. These diseases could be autoimmune disorders like Lupus (SLE), infections (like hepatitis B, C, or other infections), blood disorders ( like Multiple myeloma or amyloidosis), or drugs/medicines (like nonsteroidal medicines).
4. Infections
Infections that affect kidneys can be local and involve the kidney and Urinary tract specifically or may be systemic. Repeated infection in this tract may lead to chronic kidney disease. Systemic viral infections like Hepatitis B, Hepatitis C, and HIV can also cause kidney disease.
5. Structural abnormalities
Some patients have structural problems in their urinary tract which could be present at birth e.g., Single kidney, Small-sized kidneys, Fused or Ectopic kidneys, Kidneys may be afflicted with cysts or there may be Urinary bladder defects. These are developmental anomalies of the kidney and urinary tract, children born with them may develop normally without any apparent symptoms and hence are diagnosed later in life. Elderly males commonly develop enlargement of the prostate which hampers urine flow and affects the kidneys due to back pressure changes. When such obstruction is prolonged kidney disease may occur.
6. Kidney stone disease
Stones can develop anywhere along the kidney and urinary tract even in the bladder, they may serve as a nidus for infections as well as cause obstruction to the free flow of urine. The majority of stones pass on their own (especially smaller than 5 mm) but larger ones may get stuck and block the kidney. In these situations, a procedure or surgery may be required to remove the stone. There is a 50% chance of a person who has formed a stone once to form a stone again and hence it is important to get evaluated for it and discuss a dietary change to prevent recurrent stone disease.
7. Drugs
There are many over-the-counter drugs that when taken unnecessarily or unmonitored for prolonged periods can cause both Acute and Chronic kidney disease. Drugs like pain killers, Anti acidity medicines like PPI & antibiotics are the common culprits in these cases.
8. Familial Kidney diseases
Some kidney diseases run in families. Most common among them is Polycystic kidney disease, which affects both Males and Females, they usually have a Family history of Hypertension and Kidney disease in various family members either maternal or paternal side. If diagnosed early and managed well the progression of the disease can be slowed.
