List the diseases/conditions that most commonly lead to chronic kidney disease (CKD)? Explain the role of diabetes in the development of CKD

Question

What will be an ideal response?

Answer 1

• Primary diseases that lead to CKD are:
- Diabetes (45% of patients)
- Hypertension (27%)
- Glomerulonephritis (13%)
- Hereditary cystic and congenital renal disease (4%)
- Interstitial nephritis and pyelonephritis
• In diabetic nephropathy, the earliest detectable change is a thickening in the glomerulus probably caused by hyperglycemia and a change in the basement membrane.
• At this stage, the kidney may start allowing more protein (albumin) than normal to be excreted in the urine.
• As nephropathy progresses, increasing numbers of glomeruli are destroyed and increasing amounts of albumin are excreted.
• As the number of functioning nephrons declines, each remaining nephron must clear an increasing solute load.
• Eventually, the limit to the amount of solute that can be cleared is achieved and the concentration in body fluids increases, leading to azotemia and uremia.
• Because progression is slow (microalbuminuria can last up to 5-10 years before other symptoms develop), the body can partially adapt to the changes.
• As diabetic nephropathy progresses, increasing numbers of glomeruli are destroyed.
• At this stage, the amount of albumin being excreted in the urine increases, and can be detected by a urinalysis.
• In addition to the damage to the glomerulus, the increased blood pressure that can be a result of diabetes can further exacerbate kidney damage