Deborah Anthony Bassey, *1 Sunday Olajide Awofisayo 2
1. Bioscientifics Research and Development (Ltd/Gte), Ikot Ekpene,
2. Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy,
University of Uyo, Nigeria
Deborah Anthony Bassey
Bioscientifics Research and Development (Ltd/Gte), Ikot Ekpene, Nigeria
Kidneys are vital organs in the body. The kidneys are central to the body’s haemostatic and osmotic balance. This is a state of steady and consistent internal, physical and chemical conditions maintained by living systems. The flow of blood to the kidneys is at about 1000 to 1200 ml/min or 20% to 25% of the cardiac output. The nephrons receive the product of glomerular filtration at 120 ml/min and reabsorbs about 99% of the filtrate which includes water
and electrolytes. The final concentration of the urine is dependent on the level of anti –diuretic hormone (ADH). Hormonal secretions by the kidney includes 1, 25 – OH 2 D 2 and erythropoietin.
Renal function are evaluated by renal clearance, measuring substances like creatinine in both plasma and urine (i.e. GFR, blood urea nitrogen, BUN), urinalysis evaluating the color, turbidity, protein, PH, specific gravity, sediments and supernatants. The presence of bacteria, red blood
cells, white blood cells, casts or crystals are evidence of renal disorder. As age progresses, the functionability of the kidney decreases due to loss in number of nephrons, decline in renal blood flow and GFR. A review of the pathophysiology of the kidney and chemical management is
The kidney do a lot of things in our body system like getting rid of wastes that are left in the body system over a period of time from the food and passes out waste products from the metabolic proteins. It also helps to get rid of excess salt. The kidney helps to regulate sodium chloride, potassium, (nerve conduction), Calcium (bones), Magnesium (bones and teeth and
many of them may metabolic functions), Phosphorous (bones, teeth, metabolism and energy stores).The kidney helps to regulate the blood pressure (BP) through the control of salt to balance
it by secreting the hormones that affect blood vessels.
COMPLICATION OF KIDNEY DISEASE
Permanent kidney disease or damage: This is when the conditions are not diagnosed on time or properly, it may lead to permanent kidney disease,
Fluid build up, Chest pain, Death and Muscle weakness.
Fluid retention: this could lead to the swelling of the arms and legs
High blood pressure or fluid or fluid in the lungs [pulmonary edema].
A sudden rise in the potassium levels in your blood [hyperlalenia] may affect them.
The hearts inability to function and it may be life threathning.
COMORBIDITY OF KIDNEY DISEASE
Most patients with kidney disease have other diseases that can cause kidney disease or that can contribute to the risk of cardiovascular events or death. Managing this comorbidity is mostly a challenge like; Diabetes, Hypertension, Cardiovascular disease, Anemia etc.
This are most common in patients that has kidney disease an individual who do not have kidney disease and the prevalence of the co – morbidities can increase the kidney disease progress. Most patients who are[80%] of kidney disease which may lead to advanced kidney disease may
have at least comorbidity.
Primary care providers and specialists[PCPS] which have an important role in the diagnosis and management of co-morbidities in the patients who has kidney disease.
Patients with kidney diseases have inter related co-morbidities with shared risk factors which
include hypertension, aiabetes, atherosderosis, lipid disorders and glucose intolerance.
This can worsen the renal or kidney and cardiovascular outcomes strategies that can target this
comorbidites are common features in the primary prevention programs in general medical
practice. Treatment of comorbidities help to prevent cardiovascular events death and progression
of kidney disease to dialysis or renal transplantation[ kidney replacement therapy]KRT.
Death is most common at all kidney disease stages than progression to kidney disease replacement therapy [KDSRT].
A longitudinal study of patients in a managed care organization found in 5 years rate of kidney
disease replacement therapy which was 1.1%, 1.3% and 19.9% for kidney disease stage 2,3,4
respectively while the mortality rate was 19.5%,24.3% and 45.7%, many of the patient dies from cardiovascular events, therefore the major focus of the treatment is cardiovascular with the risk factors which are;Adequate blood pressure [ABP] can be controlled in patient with hypertension
Strict blood glucose [SBG] can be controlled in patient with diabetes.
1. Treatment of hyperlipidemia
2. Reduction in proteinuria
Control of blood pressure and proper management of diabetes also can slow the progression of
kidney disease. Reduction in proteinuria independent of hypertension also appears to slow
progression of kidney disease and may reduce the cardiovascular risk.
COMORBIDITIES OF KIDNEY DISEASES
The risk factors of kidney diseases are diabetes, high blood pressure, heart and blood vessel
(cardiovascular) diseases, smoking. Obesity, abnormal kidney structure, family history of kidney
disease. Tribal affiliation also play significant role in predisposition to kidney disease i.e., being
African – American, Native American or Asian – American.
DIAGNOSIS OF KIDNEY DISEASES
Kidney disease can be diagnosed with blood and urine and tests, in some cases, kidney disease is
only found when a routine blood or urine test you have for another problem shows that your
kidneys may not be working normally.
TEST FOR KIDNEY DISEASE
Presentation with persistent symptoms of kidney disease such as weight loss or poor appetite, swollen ankles, feet or hands, short of breath, tiredness, blood in urine, urinating more than usual particularly at night.
Regular testing is recommended if patients have high blood pressure, diabetes, kidney injury:
sudden damage to the kidney can cause the kidney to stop working properly.
A family history of advanced kidney diseases or an inherited kidney disease and protein or blood
in urine where there is no known cause, patients are also more likely to develop kidney disease
as black or of South Asian origin. People may be taking long -term medicines that can affect the
kidneys such as; lithium, omeprazole or non steroidal anti – inflammatory drugs which could
also lead to kidney disease.
This is the main test for kidney diseases which is a blood test. Your doctor should use your blood test result plus your age, size, gender and ethnic group to calculate how many milliliters of waste products that your kidney should be able to filter in a minute.
This calculation is known as
ESTIMATED GLOMERULAR FILTRATION RATE [EGFR]. Healthy kidneys should be able to filter more than 90 ml/min. you may have kidney disease if your rate is lower than this.
A urine test is also done to check the level of substances called albumin and creatinine in your
urine known as the albumin creatinine ratio or ACR. This test is also carried out to check for blood or protein in your urine.
Alongside with your EGFR, urine tests can help give a more accurate picture of how well your kidneys are working.
Other tests are also carried out to assess the level of damage in your kidney, such test are;
An Ultrasound Scan, MRI Scan or CT Scan: this scan is carried out in other to see what the
kidney looks like if there are any blockage.
A kidney Biopsy: a small sample of kidney tissue is removed using a needle and the cells are
examined under a microscope for signs of damages.
STAGES OF KIDNEY DISEASES
Your last result can be used to determine how damaged your kidneys are, this can help your doctor to decide the best treatment for you and how often you should have tests to monitor your condition.
The EGFR results have given you at least 5 stages which are;
1. Stage 1 [G1]: a normal EGFR above 90ml/min but other tests have detected signs of kidney disease or damage.
2. Stage 2 [G2]: A slightly reduced EGFR of 60 – 89ml/min with other signs of kidney
3. Stage 3a [G3a]: An EGFR of 45 – 59ml/min.
Stage 3b [G3b]: An EGFR of 30 – 44ml/min
4. Stage 4 [G4]: An EGFR of 15 – 29ml/min
5. Stage 5 [G5]: An EGFR below 15ml/min meaning the kidneys have lost almost all of its
Your ACR result is given as stage from 1 – 3
a. A1 – An ACR of less than 3mg/mmol
b. A2 – An ACR of 3 – 30mg/mmol
c. A3 –An ACR of more than 30mg/mmol
For both EGFR and ACR, a higher stage indicates more severe kidney diseases.
TREATMENT OF KIDNEY DISEASE
1. TREATING THE CAUSE: Treatment options vary, depending on the cause but the
kidney damage can continue to worsen even when an ordinary condition such as high
blood pressure has been controlled.
2. Kidney disease complication can be controlled to make patients more comfortable, such
a. High blood pressure medications: people with kidney disease may experience worsening
high blood pressure. Commonly Angiotensin – converting enzyme inhibitors or
Angiotensin II receptor blockers and change electrolyte levels so you may need frequent
blood tests to monitor the progress of the condition. A water pill (diuretic) and low salt
diet may be recommended.
b. Medication to lower cholesterol level: your doctor may recommend medications called
statins to lower your cholesterol. People with chronic kidney disease often experience
high levels of bad cholesterol which can increase the risk of heart disease.
c. Medication to treat Anemia: in certain situations, your doctor recommend supplements
of the hormone erythropoietin sometimes with added ion. Erythropoietin supplements
aids in production of more red blood cells, which may relieve fatigue and weakness
associated with Anemia.
d. Medication to relieve swelling: people with kidney disease may retain fluids; this can lead to swelling in the legs as well as high blood pressure medication called Diuretics which can help maintain the balance of fluids in your body.
e. Medication to protect your bones: your doctor may prescribe Calcium and Vitamin B supplements to prevent weak bones and lower your risk of fracture. You may also take
medications known as Phosphate binder to lower the amount of phosphate in your blood
and protect your blood vessels from damage by calcium deposits.
f. A lower protein diet to minimize waste products in your blood as your body processes
protein from foods, it creates waste products that your kidneys must filter from your
blood. To reduce the amount of work your kidney does, your doctor may recommend
eating less protein in your diet, your doctor may also recommend you to a dietician who
can suggest ways to lower your protein intake while still eating a healthy diet.
MODE OF ACTION OF KIDNEY DISEASE
1. Anti – hypertensives: these lower blood pressure which reduces central venous
pressure and cardiac output. Examples Amlodipine (Calcium channel blocker)
MODE OF ACTION
Amlodipine is an angioselective calcium channel blocker that inhibits the movement of calcium
ions into vascular smooth muscle cells and cardiac muscle cells which inhibits the contraction of
cardiac muscle and vascular smooth muscle cells. This causes vasodiltion and reduction in
peripheral vascular resistance, thus lowering blood pressure. Their effects on cardiac muscle also
prevent excessive constriction in the coronary arteries.
Coresh J, Selvin E, Stevens L, et al. Prevalence of chronic kidney disease in the United
States. JAMA. 2007;298:2038-2047.
Gansevoort R, Matsushita K, van der Velde M, et al. Lower estimated GFR and higher
albuminuria are associated with adverse kidney outcomes: A collaborative meta-
analysis of general and high-risk population cohorts. Kidney Int. 2011:80:93-104.
Gilbert S, Weiner D, Gipson D, Perazella M, Tonelli M, eds. National Kidney
Foundation. Primer on kidney diseases. 6th ed. Philadelphia, PA: Saunders Elsevier;
Grams M, Chow E, Segev D, Coresh J. Lifetime incidence of CKD stages 3-5 in the
United States. Am J Kidney Dis. 2013;62:245-252.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012
clinical practice guideline for the evaluation and management of chronic kidney
disease. Kidney Int. 2013;3:1-150.
Levey A, Coresh J. Chronic kidney disease. Lancet. 2011;379:165-180.
Matsushita K, van der Velde M, Astor B, et al. Association of estimated glomerular
filtration rate and albuminuria with all-cause and cardiovascular mortality in general
population cohorts: a collaborative meta-analysis. Lancet. 2010;375:2073-2081.
National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQI).
KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the
evaluation and management of CKD. Am J Kidney Dis. 2014;63:713-735.
National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD:
2012 update. Am J Kidney Dis. 2012;60:850-886.
National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney
Disease: Evaluation, Classification and Stratification. Am J Kidney Dis. 2002;39:S1-