Clinical Profile of Chronic Kidney Diseases in Patients Attending Rural Tertiary Hospital in Kancheepuram District, Tamil Nadu

BACKGROUND: Chronic kidney disease is definedas abnormalities of kidney structure or function, present for>3 months, with implications of health. Kidney damage refers to a broad range of abnormalities observed during clinical assessment, which may be insensitive and non-specific OBJECTIVES: PRIMARY OBJECTIVE: 1. To study the clinical profile of chronic kidney disease patients attending rural tertiary care hospital in Kancheepuram district, Tamil Nadu. SECONDARY OBJECTIVES: 1. To study the etiology of chronic kidney disease and assess comorbidities. 2. To assess the clinico-hematological correlation of the risk factors and complications in patients with chronic kidney disease. METHODS: The present Descriptive study was done in the Department of General Medicine in collaboration with the nephrology department at Karpaga Vinayaga institute of medical sciences. The study was carried out during the period of October -2017 to June -2019 (20months). Totally 100 patients were included in the study who where diagnosed with CKD and staged. The age group distribution was 20years – 70 years above. Age group: 20-30 Years 15 patients (15%) 31-40 Years 16 patients (16%) 41-50 Years 13 patients (13.%) 51-60 Years 20 patients (20%)61-70 Years 15 patients (15%) Above 70 Years 21 patients (21%). RESULTS AND CONCLUSION: Gender distribution, Among 100 cases of CKD, there were 62 (62%) male patients and 38 (38%) female patients. The ratio of male to female was 2.63 i.e. males are 2.63 times more susceptible to CKD when compared to females. In 100 cases the differential diagnosis were analyzed. Diabetic nephropathy was in 31(31%), Interstitial kidney disease was in 19(19%), Polycystic kidney disease diagnosed in 17 patients which was (17%). Kidney stones of different types seen in 10 patients (10%), Glomerulonephritis in 12 patients (12%), Hypertensive nephropathy in (11%). Diabetic nephropathy was more common in the study which was statistically more significant of p-value. The presence of various symptoms observed in 100 patients are presented in the above table. We see that 79% of the cases had pedal edema followed by the most common urinary symptom Oliguria that is 73%. The Gastrointestinal symptom namely anorexia is found in 33 cases. 28% had general weakness and 44% were having vomiting as a symptom. The numbers of cases having facial edema were 25 and 70% of the cases exhibited breathlessness as a symptom. Puffiness of face 62 (77.50%), swelling over feet 58 (72.50%) and breathlessness 56 (70.00%) were the next predominant symptom. Nausea and vomiting were present in 54 (67.50%) and tingling and numbness of extremities were complained by 40 (50.00%) patient. Joint pain 24 (30.00%), were other less common presenting symptom in this study. Blood pressure was recorded by standard method.systolic blood pressure was 140. Diastolic blood pressure was 90. 39% of the patients have their hemoglobin level in the range of 5-10 gm%. Only 4% of the patients have their value below 5gm%, but 57% of the patients exhibit that their hemoglobin level more than 10 gm%. 28% of patients have Hyperkalemia. 60% had the value within normal limits (3.5-5 meq/L). Only 12% had the value of less than 3.5 meq/L. hyponatremia (Serum sodium level < 130 meq/L) is present in 29% of patients. Further, in 71% cases, this value lies between the normal limits (130-143 meq/L). Hypoalbuminemia (Serum Albumin < 3.5g/dl) can be seen in 68% of cases. 32% of cases have this value within normal limits (3.5 - 5 g/dl). 61% of the cases seem to have decreased kidney size and 29% appear to have an increased kidney size. Whereas 10% of the patients have normal size. Echo Cardiogram Was Not done in 21patients (21%) LVH was present in 41 cases(41%). Ischaemic dilated cardiomyopathy, Hypokinesia of wall or septum is seen in 12 patients (12%). Diastolic dysfunction in 8 patients (8%). Normal findings in echocardiography were seen in14 patients (14%), Pericardial effusion was seen in 4patients (4%). LVH was more common among CRF patients as it reflects on cardiac efficiency. Grade II parenchymal changes seen in 38 patients (38%). Grade III parenchymal changes in 12 patients (12%). B/Lshrunken Kidneys in18(18%). Grade I parenchymal changes seen in 18 patients (18%). Normal parenchymal seen in 14 patients (14%). In non-diabetic nephropathy 69(13.75) when compared to diabetic nephropathy 31(14.03). The patient in whom diabetic nephropathy was the cause of chronic kidney disease were of an older age group and were having better creatinine clearance compared to non-diabetic etiology of p value (0.816)