Essay Example on Chronic Kidney Disease has become one of the big Burdens









Chronic Kidney Disease has become one of the big burdens to the world and its major causes are increasing incidence of diabetes hypertension obesity and the sedentary lifestyle CKD according to K DOGI is defined as abnormalities of kidney structure or function present for more than 3 months with implications for health and is classified into various stages on the basis of cause GFR and albuminuria The worldwide prevalence of CKD is estimated to be 8 16 1 Leading cause of CKD is diabetic kidney diseases approximately 40 and others are non diabetic renal disease NDRD causes which includes mainly immunoglobulin A IgA nephropathy in Asian population and focal segmental glomerulosclerosis FSGS in western countries 2 CKD being an inflammatory disease has impact on all the aspects of the body It has effect on the vessels especially the microvasculature 3 The Patients with chronic kidney disease experience co morbid illnesses including cardiovascular disease CVD and retinopathy 4 Our findings may provide evidence that presence of retinopathy reflect early subclinical damage in the renal microvasculature that is subsequently associated with development of renal disease So it becomes very important to early recognize the condition and take measures to avoid the progression and complications of the disease Retinopathy is defined as presence of retinal micro vascular abnormalities microaneurysms hemorrhages hard and soft exudates or arteriovenous nipping focal arteriolar narrowing or lowest quartile arteriole venule ratio The retinal micro vascular examination is easiest way to visualize the micro vascular changes in human body and retinal vasculature may reflect similar changes in renal vasculature 

Micro vascular abnormalities have been suggested to represent early pathological abnormalities in the kidney 5 However such micro vascular changes occurring in the glomerular vascular bed cannot be visualized directly and non invasively 6 Retinal and renal circulations share similar anatomic and physiologic characteristics 7 8 and 9 The retinal microvasculature provides an opportunity to study the renal microvasculature Many renal diseases also have characteristic retinal features This is particularly true of inherited renal disease because the inner retina and glomerular filtration barrier share developmental pathways 10 and structural features 11 including ciliated epithelial cells 12 basement membranes comprising α 3 α 4 α 5 collagen IV and the extensive capillary beds seen in the choriocapillaris and glomerulus 13 Retinal abnormalities in inherited renal disease include drusen Alport syndrome dense deposit disease coloboma reflux nephropathy retinitis pigmentosa nephronophthisis Myopathy Encephalopathy Lactic Acidosis Stroke like episodes MELAS syndrome crystal deposits oxalosis cystinosis and vascular anomalies Hereditary Angiopathy Nephropathy and muscle Cramps syndrome Fabry disease 14 15 Retinal effects in acquired renal disease include vasculitis and infarcts in systemic lupus erythematosus Wegener granulomatosis and microscopic polyangiitis 16 17 and possibly central serous retinopathy in Goodpasture syndrome in which antibodies bind to the internal limiting and Bruch membranes 18 Non invasively Ocular photography may provide a noninvasive method to assess the vascular condition of the kidneys 19 There is increased prevalence of retinopathy in patients with CKD 20 Various studies have been done to show the correlation between retinopathy and CKD 

A study conducted by Sabanayagam C et al in adults of Malay ethnicity aged 40 80 years living in Singapore showed that retinopathy was found to be positively associated with both estimated glomerular filtration rate eGFR and micro macro albuminuria and that retinal arteriolar narrowing is associated with chronic kidney disease independent of diabetes and Hypertension 21 Juan E Grunewald et al in chronic renal insufficiency study showed that 11 of non diabetic and 49 percentage of diabetic CKD patients has retinopathy 22 Another study conducted by Wang TJ et al in Taiwan showed that patients with CKD had significantly higher prevalence of retinal disorders and other eye problems i e 16 62 23 Moreover it has already been suggested for regular retinal examination in the patients of CKD because CKD is associated with progression of retinal micro vascular changes 24 With the age there is degeneration of macula but with CKD there is early macular degeneration occurs 25 Cardiovascular events are the major causes of mortality in CKD patients Ana C Ricardo et al conducted a study in USA for knowing major causes of mortality and compared normal with those having CKD and retinopathy and found that cardiovascular or other causes of mortality were 1 02 with retinopathy 1 52 with CKD and 2 39 with both CKD and retinopathy 26 So retinopathy can be predictor for defining the prognosis of cardiovascular events in CKD patients Presence of retinopathy reflect early subclinical damage in the renal microvasculature which may lead to the subsequent development of renal disease so Retinal microvascular changes may precede the development of overt proteinuria and renal failure and Intervention at this level may retard the progression of CKD and associated complications This study will help us to get idea about the correlation of retinopathy with various stages of CKD and its management to be done

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