Common Causes of Chronic Kidney Disease

Who should get tested for kidney disease?

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Common causes of chronic kidney disease as per USRDS data.

What could cause a perfectly fine kidney to start working abnormally? What diseases put your kidney's ability to filter out toxins in jeopardy? These are common questions that my patients have when I tell them about their chronic kidney disease (CKD) diagnosis. 

Let’s talk about disease conditions that put you at a risk of developing kidney disease. These are the very diseases that should make you and your physician keep an eye on your kidney function regularly, and treat it accordingly.

The typical entities that cause kidney damage are often secondary illnesses like diabetes and not intrinsic kidney diseases. This conclusion is based on objective evidence that we can glean from the United States Renal Data System (USRDS) data.

How Common is Chronic Kidney Disease?

When defined by GFR <60  during 2005–2010, 6.3 percent of US population met the diagnosis of chronic kidney disease, or CKD (compared to 9.3 and 8.5 percent for diabetes and cardiovascular disease, respectively). If, however, we were to include other parameters by which CKD can be defined (like increased protein excretion in the urine, or albumin excretion over 30 mg/day), the prevalence rate for CKD rises to 9.2 percent. In other words, almost one in ten people will have CKD.

Causes of Chronic Kidney Disease

Diabetes has been the undisputed number one risk factor for CKD, with about 40 percent of the patients reporting the illness, both in the periods 1988-1994, and 2005-2010.

The contribution of hypertension as a possible cause seems to have risen from low to the mid 20 percent. Obesity seems to have remained a significant cause, but the contribution from cardiovascular disease seems to have jumped from mid 20s to almost 40 percent. This would make it as prevalent as diabetes as a risk factor.

This increase could also be related to greater diagnosis of cardiovascular disease owing to widespread testing and greater patient recognition.

You might notice that most of these diseases mentioned above are not really stemming from the kidneys. In fact, the kidneys usually bear the brunt of these secondary diseases. These diseases affect the kidney's function is through different mechanisms which are beyond the scope of this article. Just to give you an idea though, these mechanisms could include an increase in the blood pressure inside the kidney's filter (glomerulus), which leads to an increased filtration rate. This is called "adaptive hyperfiltration." In the short term, this is what masks the fact that you actually could have kidney disease since it makes the blood test results "look normal." In the long term, this is also precisely why the kidneys begin to "burn out" and develop scar tissue. Imagine a car that is being driven continuously at 200 miles/hour. That car will break down pretty soon, right?

This is what happens when diabetes affects your kidney.

So why am I lecturing the readers on the causes of CKD? My intention is to drive home the point that should you have the following conditions, you should consider yourself a person at a high risk for developing kidney disease and make sure that you are tested. Depending on your stage, you may need to be referred to a nephrologist as well for further management. Again to summarize, these conditions are:

  • Diabetes mellitus
  • Hypertension
  • Cardiovascular disease (this could include people who have ischemic heart disease, heart attacks, strokes, peripheral vascular disease, aneurysms, etc.)
  • Obesity
  • Genetic tendency and risk factors like polycystic kidneys
  • Miscellaneous causes like long-standing NSAID (pain killer) use, long-term lead exposure, etc.

Source:

U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2013

The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.

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