Pathophysiology

Kidney diseases impair the nephron’s ability to filter blood efficiently, leading to:

• Accumulation of waste products like urea and creatinine
• Imbalance in electrolytes (e.g., potassium, sodium, calcium)
• Retention of excess fluid, causing swelling and hypertension
• Hormonal imbalances affecting erythropoietin (anemia) and vitamin D metabolism

Over time, irreversible damage can lead to fibrosis, loss of nephron function, and the need for dialysis.

Symptoms

In early stages, kidney disease is often asymptomatic. As it progresses, symptoms may include:

• Fatigue and weakness
• Swelling in legs, ankles, or face (edema)
• Nausea and vomiting
• Loss of appetite
• Foamy urine or blood in urine
• Decreased urine output or frequency
• High blood pressure
• Shortness of breath

Advanced CKD may lead to complications such as anemia, bone disease, cardiovascular issues, and metabolic acidosis.

Diagnosis

Diagnosis is based on clinical evaluation, laboratory tests, and imaging:

Blood tests:

• Serum creatinine and blood urea nitrogen (BUN)
• Glomerular filtration rate (GFR) estimation

Urine tests:

• Proteinuria (albumin-to-creatinine ratio)
• Hematuria and urine sediment analysis

Imaging:

• Renal ultrasound or CT scan to detect structural abnormalities

Kidney biopsy: To confirm specific types of glomerular or interstitial disease

Staging of CKD

CKD is classified into five stages based on GFR:

• Stage 1: GFR ≥90 (normal function with some signs of damage)
• Stage 2: GFR 60–89
• Stage 3: GFR 30–59 (moderate damage)
• Stage 4: GFR 15–29 (severe damage)
• Stage 5: GFR <15 (kidney failure or ESRD)

Conventional Treatment

Management depends on the type, cause, and stage of kidney disease:

Blood pressure control:

• ACE inhibitors or ARBs to reduce proteinuria and slow progression

Blood sugar management: Tight control in diabetic patients

Dietary management:

• Low sodium, low protein, and potassium/phosphorus restrictions

Anemia treatment:

• Erythropoiesis-stimulating agents and iron supplementation

Bone mineral management:

• Vitamin D analogs, phosphate binders

Dialysis:

• Hemodialysis or peritoneal dialysis in ESRD

Kidney transplantation: Preferred treatment for eligible ESRD patients

Stem Cell Therapy in Kidney Diseases

Stem cell therapy is being explored for its regenerative potential in kidney damage.

Types of stem cells:

• Mesenchymal stem cells (MSCs): Derived from bone marrow or adipose tissue
• Renal progenitor cells

Mechanism of action:

• Anti-inflammatory and immunomodulatory effects
• Promotion of tubular cell regeneration
• Reduction of fibrosis and apoptosis
• Enhancement of microvascular repair

Applications:

• Acute kidney injury
• Diabetic nephropathy
• Chronic glomerular and interstitial diseases

Hyperbaric Oxygen Therapy (HBOT) in Kidney Diseases

HBOT delivers 100% oxygen under increased pressure to enhance tissue oxygenation and healing.

Mechanism:

• Increases oxygen supply to hypoxic renal tissues
• Reduces inflammation and oxidative stress
• Promotes angiogenesis and cellular repair

Applications:

• Renal ischemia-reperfusion injury
• Adjunctive therapy for wound healing in diabetic kidney disease
• Under investigation for prevention of contrast-induced nephropathy

Lifestyle and Supportive Management

Dietary adjustments:

• Low-sodium, kidney-friendly diets
• Fluid restrictions in advanced stages

Exercise: Moderate activity to control blood pressure and weight

Smoking cessation and alcohol moderation

Vaccinations: To reduce infection risk, especially hepatitis and flu

Mental health support: For dealing with chronic illness and dialysis

Monitoring and Follow-Up

• Regular testing of kidney function (GFR), electrolytes, and urine protein
• Blood pressure and glucose control monitoring
• Screening for complications such as cardiovascular disease

Prognosis

Prognosis depends on the underlying cause, disease stage at diagnosis, and adherence to treatment. Early intervention can slow or halt progression, while ESRD requires lifelong renal replacement therapy. Advances in regenerative therapies offer potential to restore kidney function and reduce reliance on dialysis or transplantation in the future.

Conclusion

Kidney diseases are serious conditions that require timely detection and integrated care to prevent progression and complications. While conventional treatments focus on controlling contributing factors and symptoms, emerging regenerative approaches like stem cell therapy and HBOT offer hope for repairing kidney tissue and improving outcomes. A holistic, patient-centered strategy combining medical, dietary, lifestyle, and emerging therapies is key to managing kidney diseases effectively and improving quality of life.