The internal balance of the organism, particularly that of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulphate), depends on the kidneys. In addition to producing erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol), the kidneys also play a role in the endocrine system. Calcitriol is involved in the creation of bones, and erythropoietin is involved in the production of red blood cells. In addition to hypertension, the kidneys can be impacted by a number of illnesses, and a decline in renal function can happen suddenly or gradually over a number of years.

About 5–7% of hospitalised patients have acute renal failure (ARF) or acute kidney injury (AKI), which is defined as a detectable increase in the blood creatinine (Cr) concentration (often a relative increase of 50% or an absolute increase of 44–88 µmol/L [0.5–1.0 mg/dL]). It is linked to a significant rise in in-hospital morbidity and mortality. There are no particular pharmaceutical treatments that have been shown to be effective in preventing or treating AKI, although it can be expected in certain clinical situations (such as following radiocontrast exposure or severe surgery). It's critical to understand that AKI is a clinical diagnosis rather than a structural one.

AKI can occur in a patient with or without renal parenchymal damage. The severity of AKI can vary from mild and temporary alterations in glomerular filtration rate (GFR) laboratory measurements to severe and quickly lethal disruptions in efficient circulation volume regulation and electrolyte and acid-base plasma composition. In most clinical situations, maintaining optimum renal perfusion and intravascular volume is crucial; hypovolemia and medications that impair renal perfusion and/or glomerular filtration (nonsteroidal anti-inflammatory drugs) are significant cofactors in AKI. [NSAIDs], angiotensin receptor blockers, and inhibitors of the angiotensin-converting enzyme [ACE]).

Water and other uremic metabolites are retained as acute kidney damage worsens. Furthermore, medications (or their metabolites) that the kidneys typically eliminate will build up in the body and cause more or less significant side effects. Potassium is an important metabolite that needs to be taken into consideration because it can result in abrupt cardiac arrhythmia. Another risk that could lead to acute pulmonary oedema is fluid retention. The general practitioner should send these patients as soon as possible to hospitals so that multidisciplinary teams can treat them. The processes of chronic kidney injury will be the exclusive focus of this thesis.

In developing nations, chronic kidney disease (CKD) is becoming a leading cause of morbidity and mortality. Before exhibiting clinical symptoms, CKD patients frequently go through a protracted asymptomatic phase. Regardless of the precise diagnosis (i.e., type of kidney disease), the main consequences of chronic kidney disease (CKD) are the development of cardiovascular disease, problems from reduced kidney function, and progression to kidney failure.

 
Chronic Kidney Disease (CKD) is not only a problem for the elderly; younger persons are increasingly experiencing it, which is concerning for a group of people who previously thought they were immune to such long-term illnesses. Given the increase in CKD cases among young people, it is more important than ever to comprehend the subtleties of this illness.

A growing body of research indicates that early detection and treatment can frequently avoid or postpone some of these negative consequences and stop the development of end-stage renal disease (ESRD). Diabetic nephropathy, hypertensive nephrosclerosis, glomerulonephritis, chronic interstitial nephritis, obstructive uropathy, renovascular disease, and genetic mediation are among the many causes of chronic kidney disease (CKD). Therefore, a thorough study of the incidence of CKD and its risk factors in various individuals from various regions is required. However, there is still a dearth of information about the range of kidney diseases in India, which puts a tremendous burden on any society's healthcare system

Study Setting: PG Dept. of General Medicine and Department of Nephrology, SCB MCH, CUTTACK, ODISHA

Study Duration: April 2023 to June 2024

Study Design: Cross-sectional Observational Study

Study Sample: All the young patients of CKD between 15 to 24 years admitted to the PG Dept. of Medicine and Department of Nephrology, SCBMCH, Cuttack.

These patients will then be screened under the light of inclusion and exclusion criteria before recruiting them into the study population.

INCLUSION CRITERIA

• Patients of chronic kidney disease in the age group of 15-24 years (WHO)
• Patients who give informed consent to participate

EXCLUSION CRITERIA

• Patients with any acute or chronic infections, liver failure, congestive heart failure
• Pregnant women
• Patients with solitary kidney
• Patients with obstructive renal pathology

METHODOLOGY

When the patients will agree to participate and give informed consent, they will be subjected to detail history taking, examination and investigations. A predesigned semi structural performa will be used for each of the CKD patient which will include Brief clinical information including particulars of the patient, chief complaints, family and past history etc. Height, weight will be measured and Body mass index of the patients will be calculated Investigations – after obtaining informed consent, blood samples will be drawn for CBC, differential leucocyte count, total platelet count, serum urea, serum creatinine, serum sodium, serum potasium, ESR, CRP, lipid profile, RBS. ANA profile Renal Artery Doppler Ultrasound of Kidney, Ureter, Bladder Renal Biopsy The glomerular filtration rate (GFR) will be calculated using the CKD epidemiological collaboration (CKD-EPI) formula and the staging of CKD will be done according to eGFR. Patients will be followed regularly with serum urea, serum creatinine and CBC reports

Table 1-Gender Wise Distribution of Chronic Kidney Disease

Table 1 illustrates a significant gender disparity among chronic kidney disease (CKD) patients, with males comprising 70% and females 30% of the total. This distribution highlights a notable predominance of CKD among males, suggesting potential gender-specific risk factors or healthcare utilization patterns.

Figure 1: Graphical Representation Ofof Gender Distribution Of CKD In Young

Table 2: Etiological Distribution Of CKD In Young

Table: 2 represents the etiological distribution of chronic kidney disease (CKD), categorizing its causes into specific percentages. Hypertensive nephrosclerosis emerges as the leading cause at 35%, followed closely by diabetic nephropathy at 30%. Chronic glomerulonephritis contributes significantly at 20%, while obstructive uropathy, cystic disease of the kidney, and renovascular disease each account for 5%. This breakdown underscores the diverse origins of CKD, with hypertension and diabetes standing out as primary drivers.

Figure 2: Graphical Representation Ofof Etological Distribution Of CKD In Young

Table 3 :Symptoms of CKD in Young

Table: 3 outlines the clinical features of chronic kidney disease (CKD) based on their prevalence in patients. Periorbital edema stands out as the most common symptom, noted in 75% of cases, followed by dyspnea at 80% and anorexia at 70%. Other prevalent symptoms include nausea (70%), oliguria (60%), and vomiting (50%). Fatigue is reported in 33% of cases, while abdominal distension is observed in 30%. This distribution underscores the systemic nature of CKD, affecting various organ systems and presenting diverse symptoms.

Figure3: Graphical Representation Ofof Symptoms Of CKD In Young

Table 4 : Signs of CKD IN Young

Table 4 presents the signs of chronic kidney disease (CKD) in young individuals, detailing their prevalence as percentages. Pallor and bilateral pedal edema are the most commonly observed signs, each reported in 90% of cases. Raised jugular venous pressure (JVP) is noted in 33% of cases, while icterus is seen in 10%.

Figure4: Graphical Representation Ofof Signs Ofof CKD In Young

Table 5 : Modifiable Risk Factors of CKD in Young

Table 5 outlines the modifiable risk factors associated with chronic kidney disease (CKD), detailing their prevalence as percentages. Tobacco emerges as the most significant risk factor, reported by 60% of cases, followed by alcohol at 40% and smoking at 30%.

Figure5: Graphical Representation Ofof Modifiable Risk Factor Of CKD In Young

Table 6: Stages of CKD

Table 6 categorizes the staging of chronic kidney disease (CKD) based on glomerular filtration rate (GFR) ranges and their respective percentages. Stage I includes GFR greater than 90, accounting for 5% and considered early CKD. Stage II spans GFR between 60-89, also at 5%. Stage III, categorized by GFR of 30-59, constitutes 10% and marks the late stages. Stage IV, with a GFR of 15-29, represents 35% of cases, indicating advanced CKD. Stage V, with GFR less than 15, encompasses 45% and signifies terminal CKD.

Figure 6. Graphical Representation of Stages of CKD In Young

Table 7: Comorbidities Associated With CKD In Young

The table 7 represents the prevalence of pre-existing co-morbidities in young patients with Chronic Kidney Disease (CKD). Hypertension and cardiovascular disease are notably prominent, with 35% and 30% respectively, underscoring their significant association with CKD in this demographic. Diabetes follows closely at 30%, highlighting its role in kidney disease development. Lupus, an autoimmune condition, affects 20% of these patients, indicating its impact on kidney health. Obstructive uropathy, though less common at 5%, signifies another risk factor. This data underscores the multifactorial nature of CKD in young individuals, necessitating comprehensive management strategies addressing both renal and systemic health conditions to improve patient outcomes.

Figure 8 : Graphical Representation of Pre-Existing Co-Morbidities

Figure 8 : Graphical Representation of Pre-Existing Co-Morbidities

CKD has been acknowledged as a significant worldwide public health issue for the past few decades. The public health system did not acknowledge chronic kidney disease (CKD) as a serious issue until recently, despite persistent global campaigning. This was true even though managing CKD takes up a disproportionately large percentage of the available healthcare resources. Thankfully, this gap has been filled to a significant degree with the establishment of the Indian CKD Registry. In this study, individuals with chronic renal disease who visited a government tertiary care hospital were characterised, with an emphasis on the younger demographic.

CKD is categorised into stages I through V using the eGFR determined by the CKD-EPI Equation.According to KDIGO 2024 guidelines, CKD is defined as abnormalities of kidney structure or function that have been observed for at least three months and have an impact on health. Cause, Glomerular Filtration Rate (GFR), and Albuminuria category (A1-A3), or CGA, are used to categorise chronic kidney disease (CKD).

In order to determine the most common causes of chronic kidney disease (CKD) among young people in SCB Medical College and Hospital over a one-year period, this study was a cross-sectional study of patients in various stages of CKD with a mean age of 19.1 years (ranging between age group fifteen to twenty-four) @young (according to WHO). Twenty patients in all were prospectively examined and their clinical and biochemical parameters examined. Thirty percent of the participants in this study are female and seventy percent are male. The ratio of men to women was 2.33:1. Similar results from database research were found in a number of investigations.

According to Mani and Kher, the majority of research conducted in India are hospital-based (as opposed to community-based studies in the West), which reflects the bias that male patients are brought to hospitals more frequently. This helps to explain the higher prevalence of male population in India. Males are more frequently affected, and the condition appears to develop to renal failure more quickly in males than in girls, according to another study by Hida M et al22.

The most prevalent symptoms in this study include dyspnoea (80%), oedema (75%), anorexia (70%), nausea and vomiting (70%), oliguria (70%), weariness (33%), and abdominal distension (30%).the higher frequency of oedema with dyspnoea brought on by water and salt retention as well as a drop in blood protein levels. These results were in line with research by VK Jha and Sashibhusan, who discovered that anorexia (50%) and pedal oedema and dyspnoea (60%) were the most prevalent symptoms. In Sathyan et al.'s study, oliguria and dyspnoea were the most common presenting complaints3. Reduced food intake (dietary protein) due to gastrointestinal problems may increase the prevalence of protein-energy malnutrition and worsen health in CKD patients. Hanststrid et al. made these observations. In a different study, Drs. Sourav Singh Dube and Shiwanee Gupta discovered that the most prevalent symptom of chronic kidney disease (CKD) was oedema with dyspnoea (80%), followed by oliguria (62%), nausea, and vomiting (60%).

This study demonstrates the substantial burden of chronic kidney disease (CKD) among young patients at a government tertiary care hospital, which is marked by a high incidence of lifestyle-related risk factors, hypertension, and diabetes mellitus, as well as a considerable male predominance. The clinical profile highlighted the significant effects of chronic kidney disease (CKD) on patients' health and quality of life by revealing common symptoms such dyspnoea, oedema, and anaemia. The study emphasises the urgent need for improved public health initiatives aimed at CKD care, prevention, and early identification. Effective CKD control methods must include targeted screening programs, healthy lifestyle education campaigns, and increased access to healthcare services.Additionally, this study supports additional research to confirm these results in a variety of contexts and groups, improving our knowledge of the aetiology and epidemiology of CKD in young people. Healthcare systems may be able to reduce the socioeconomic burden of chronic kidney disease (CKD), enhance patient outcomes, and allocate healthcare resources more efficiently by addressing known risk factors and optimising management options. In the end, this study offers insightful information that can help academics, policymakers, and healthcare professionals create all-encompassing strategies for successfully managing CKD in young populations, ultimately enhancing general public health outcomes.

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