Gastrointestinal Manifestations in Patients with Chronic Kidney Disease
Keywords:
Chronic kidney disease, Upper gastrointestinal manifestations, Erosive gastritis.Abstract
Background: Chronic kidney disease is a silent epidemic of the 21 century. Surveys have suggestedthat as many as 16% of the adult population have CKD1. The most common, non –renal, chronic disorders in patients with ESRD are gastro intestinal disorders2. Among upper gastrointestinal lesions caused by chronic kidney disease gastritis, an esophagus is,gastric ulcers are the most prevalent lesions. Here an attempt is being made to study the upper gastro intestinal changes in chronic kidney disease and evaluate theirrelationship with the stage of CKD or GFR. Objectives: 1. To determine the prevalence of various upper gastro intestinal lesions withthe use of fibro optic endoscopy.2. To evaluate the relation between the gastro intestinal lesion with the stage ofCKD or GFR. Subjects and Methods: We conducted a cross sectional study on 50 patients ,who are diagnosed to haveChronic kidney disease and being presented to OPD and admission in NavodayaMedical College and Research Center, Raichur over a period of one year. All patientswith chronic kidney disease underwent upper gastrointestinal endoscopy wereincluded in the study. Results: Majority of the subjects belongs to age group of 31 to 40 years (26%) and least belongs to 70 to 80 years age group (6%).Out of the 50 subjects, males were 28 and females were 22.Majority of the cases in our study belonged to stage IV. 84% of the cases had upper gastrointestinal involvement on endoscopic examination in our study. Erosive gastritis (26%), either antral or fundal, was the predominant lesion found on endoscopy. Majority of the subjects having erosive gastritis, had stage IV CKD (53.8%).Out of 50 cases in our study 55% of subjects had lesions of the stomach, 26% of subjects had lesions in the duodenum, 19% of subjects had lesions in esophagus. Out of 50 subjects in our study 52% were undergoing haemodialysis and 48% of subjects were under conservative management. Majority of subjects undergoing haemodialysiswere belongs to stage V. Conclusion: Majority of the patients with chronic kidney disease have upper gastrointestinal involvement on endoscopic evaluation. Erosive gastritis is the most common upper gastrointestinal manifestation in our study. Upper gastrointestinal manifestations are predominant in stage V. Upper gastrointestinal findings are frequently observed in chronic kidney disease patients on dialysis. Early diagnosis and management can reduce mortality and morbidity and prevent fatal complication like massive upper gastrointestinal bleed.
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1. Goyal, M., Charan, S., Singh, S., Chawla, S. P. S., Garg, R., &Kaur,
S. (2014). Study of upper gastrointestinal changes in chronic kidney disease. International Journal of Bioassays, 3(11), 3526-3531. 2. Nand, N., Malhotra, P., &Bala, R. (2014). Evaluation of upper gastrointestinal symptoms and effect of different modalities of treatment in patients of chronic kidney disease. JIACM,15(3-4),182- 7.
3. Krishnan, A., Sigamani, R., &Venkataraman, J. (2011). Gastrointestinalevaluation in chronic kidney diseases. J Nephrol Therapeutic, 1(3), 110. 17.
4. Serme AK, Lengani A, Ilboudo PD, Sawadogo N, Sombie R. Les lesions endoscopiques digestives hautesdansl'insuffisancerénalechroniquesévère en Afrique Noire. Médecined'Afrique noire. 2003;50(1):31-6.
5. Nardone G, Rocco A, Fiorillo M, Del Pezzo M, Autiero G, Cuomo R, Sarnelli G, Lambiase A, Budillon G, Cianciaruso B. Gastroduodenal lesions and Helicobacter pylori infection in dyspeptic patients with and without chronic renal failure. Helicobacter. 2005 Feb 1;10(1):53- 8.
6. Schneider S, Malecki AK, Boenisch O, Schönfeld R, Kielstein JT. Cognitiv function at 2443 μmol/l creatinine. BMC nephrology. 2012 Aug 15;13(1):86.
7. Eknoyan G. The Early Modern Kidney—Nephrology in and about the Nineteenth Century (Part 2). InSeminars in dialysis 2014 Sep 1 (Vol. 27, No. 5, pp. 494-503).
8. George CR. William Charles Wells (1757–1815)—a nephrologist of the Scottish enlightenment. Nephrology Dialysis Transplantation. 1996 Dec 1;11(12):2513-7.
9. Wöhler F. Friedrich Wöhler.Bright R. History of nephrology: the middle period. History. 2012
10. Wills MR. Biochemical consequences of chronic renal failure: a review. Journal of pathology. 1968 Sep;21(5):541
11. Witting C. The Terminology of Glomerulonephritis A Review. InGlomerulonephritis 1976 (pp. 45-60).
12. Springer, Berlin, Heidelberg.Steensma DP, Kyle RA. A history of the kidney in plasma cell disorders.InThe Kidney in Plasma Cell Dyscrasias 2007 (Vol. 153, pp. 5-24). Karger Publishers.
13. Cameron JS. A history of urine microscopy. Clinical Chemistry andLaboratory Medicine (CCLM). 2015 Nov 1;53(s2):s1453-64. 14. Doherty CC. Peptic ulcer and chronic renal failure. The Ulster medicaljournal. 1979;48(2):145.
15. Moynihan BG. Uremic Ulcer of the Duodenum. Duodenal Ulcer. WBSaunders Co. 1910:44.
16. Shepherd AM, Stewart WK, Wormsley KG. Peptic ulceration in chronic renalfailure. The Lancet. 1973 Jun 16;301(7816):1357-9. 17. Moore TC, Hume DM. The period and nature of hazard in clinical
renaltransplantation. I. The hazard to patient survival. Annals of Surgery. 1969Jul;170(1):1.
18. Tisher CC, Kristen M. Anatomy of the Kidney In:BrennerBM,edition.BrennerandRectors’s The Kidney , vol 1 6th edn, Philadelphia; WB Saunders comp:2000 p 3-67.
19. Skorecki, K., Chertow, G. M., Marsden, P. A., Taal, M. W., Alan, S. L., &Luyckx, V. (2015).
20. Brenner and Rector's The Kidney E-Book. Elsevier Health SciencesSchieppati A, Remuzzi G. Chronic renal diseases as a public health problem: epidemiology, social, and economic implications. Kidney International. 2005Sep 30;68:S7-10.
21. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, WangAY, Yang CW. Chronic kidney disease: global dimension and perspectives.The Lancet. 2013 Jul 26;382(9888):260-72.
22. Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, AlmeidaAF, Gang S, Gupta A, Modi G, Pahari D, Pisharody R. What do weknowabout chronic kidney disease in India: first report of the Indian CKD registry.BMC nephrology. 2012 Mar 6;13(1):10.
23. Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y,Yu X, Chen N. Prevalence of chronic kidney disease in China: a crosssectionalsurvey. The Lancet. 2012 Mar 9;379(9818):815-22.
24. Arogundade FA, Barsoum RS. CKD prevention in Sub-Saharan Africa: a callfor governmental, nongovernmental, and community support. AmericanJournal of Kidney Diseases. 2008 Mar 31;51(3):515-23.
25. Feehally J. Ethnicity and renal disease. Kidney international. 2005 Jul1;68(1):414-24.
26. Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, NahasME, Jaber BL, Jadoul M, Levin A, Powe NR. Chronic kidney disease as aglobal public health problem: approaches and initiatives–a position statementfrom Kidney Disease Improving Global Outcomes.
Kidney international. 2007Aug 1;72(3):247-59
27. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Tamura MK, Feldman HI. KDOQI US commentary on the 2012 KDIGO clinical practiceguideline for the evaluation and management of CKD. American Journal ofKidney Diseases. 2014 May 31;63(5):713-35.
28. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrisons manual of medicine. McGraw-Hill Medical Publishing Division;2016 May
29. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, ZeeuwDD, Hostetter TH, Lameire N, Eknoyan G. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney international. 2005 Jun 30;67(6):2089-100.
30. El NahasAM, Bello AK. Chronic kidney disease: the global challenge. The Lancet. 2005 Jan 22;365(9456):331-40
31. Bergman S, Key BO, Kirk KA, Warnock DG, Rostand SG. Kidney disease inthe first-degree relatives of African-Americans with hypertensive end-stagerenal disease. American journal of kidney diseases. 1996 Mar 1;27(3):341-6.
32. Buck K, Feehally J. Diabetes and renal failure in Indo-Asians in the UK—a paradigm for the study of disease susceptibility. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association-European Renal Association. 1997 Aug 1;12(8):1555-7.
33. Brenner BM, Chertow GM. Congenital oligonephropathy and the etiology ofadult hypertension and progressive renal injury. American journal of kidneydiseases. 1994 Feb 1;23(2):171-5.1)
34. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, KoppleJD.Malnutrition-inflammation complex syndrome in dialysis patients: causes andconsequences. American Journal of Kidney Diseases. 2003 Nov 30;42(5):864-81.
35. Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Stamler J. Endstagerenal disease in African-American and white men: 16-year MRFITfindings. Jama. 1997 Apr 23;277(16):1293-8.
36. Iseki K. The Okinawa screening program. Journal of the American Society ofNephrology. 2003 Jul 1;14(suppl 2):S127-30.
37. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL,McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P. Kidneydisease as a risk factor for development of cardiovascular disease. Circulation.2003 Oct 28;108(17):2154-69
38. Jungers P, Chauveau P, Descamps-Latscha B, Labrunie M, Giraud E, ManNK, Grünfeld JP, Jacobs C. Age and gender-related incidence of chronic renalfailure in a French urban area: a prospective epidemiologic study. NephrologyDialysis Transplantation. 1996 Aug 1;11(8):1542-6.
39. Hannedouche T, Chauveau P, Kalou F, Albouze G, Lacour B, JungersP.Factors affecting progression in advanced chronic renal failure. Clinicalnephrology. 1993 Jun;39(6):312-20.
40. Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in theprogression from chronic renal insufficiency to end-stage renal disease in theUnited States. Journal of the American Society of Nephrology. 2003 Nov1;14(11):2902-7.
41. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, StrikerG. The effects of dietary protein restriction and blood-pressure control on theprogression of chronic renal disease. New England Journal of Medicine. 1994Mar 31;330(13):877-84.
42. Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE, de Zeeuw D, Shahinfar S, Toto R, Levey AS. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta
analysis. Annals of internal medicine. 2003 Aug 19;139(4):244-52. 43. Iseki K, Kinjo K, Iseki C, Takishita S. Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. American Journal of Kidney Diseases. 2004 Nov30;44(5):806-14.
44. Remuzzi G, Bertani T. Pathophysiology of progressive nephropathies. NewEngland Journal of Medicine. 1998 Nov 12;339(20):1448-56. 45. Gowda MA. Evaluation of Thyroid Function Status in Patients with ChronicKidney.
46. Kim, M. J., Kwon, K. H., & Lee, S. W. (1998). Gastroesophagealrefluxdisease in CAPD patients. Advances in Peritoneal Dialysis, 14, 98-101.
47. Kang, J. Y., Ho, K. Y., Yeoh, K. G., Guan, R., Wee, A., Lee, E., ...& Tan, C.C. (1999). Peptic ulcer and gastritis in uraemia, with particular reference to theeffect of Helicobacter pylori infection. Journal of
gastroenterology andhepatology, 14(8), 771-778.
48. De Schoenmakere, G., Vanholder, R., Rottey, S., Duym, P., &Lameire, N.(2001). Relationship between gastric emptying and clinical and biochemicalfactors in chronic haemodialysis patients. Nephrology DialysisTransplantation, 16(9), 1850-1855.
49. Strid, H., Simren, M., Stotzer, P. O., Abrahamsson, H., &Björnsson, E. S.(2004). Delay in gastric emptying in patients with chronic renal failure.Scandinavian journal of gastroenterology, 39(6), 516-520
50. Silang, R., Regalado, M., Cheng, T. H., & Wesson, D. E. (2001). Prokineticagents increase plasma albumin in hypoalbuminemic chronic dialysis patientswith delayed gastric emptying. American journal of kidney diseases, 37(2),287-293
51. 52) Scheff, R. T., Zuckerman, G., Harter, H. E. R. S. C. H. E. L., Delmez, J. A. M.E. S., & Koehler, R. (1980). Diverticular disease in patients with chronic renalfailure due to polycystic kidney disease. Ann Intern Med, 92(2 Pt 1), 202-204.
52. Adams, P. L., Rutsky, E. A., Rostand, S. G., & Han, S. Y. (1982). Lowergastrointestinal tract dysfunction in patients receiving long term hemodialysis.Archives of internal medicine, 142(2), 303-306.
53. Zeier, M., Wiesel, M., Rambausek, M., & Ritz, E. (1995). Non occlusivemesenteric infarction in dialysis patients: the importance of prevention andearly intervention.
54. Tsai, C. J., & Hwang, J. C. (1996). Investigation of upper gastrointestinalhemorrhage in chronic renal failure. Journal of clinical gastroenterology,22(1), 2-5.
55. Yorioka, N., Hamaguchi, N., Taniguchi, Y., Asakimori, Y., Nishiki, T., Oda,H., &Yamakido, M. (1996). Gastric antral vascular ectasia in a patient onhemodialysis improved with CAPD. Peritoneal dialysis international, 16(2),177.
56. Cunney, R. J., Magee, C., McNamara, E., Smyth, E. G., &Walshe, J. (1998).Clostridium difficile colitis associated with chronic renal failure. Nephrology,dialysis, transplantation: official publication of the European Dialysis andTransplant Association-European Renal Association, 13(11), 2842-2846.
57. Lankisch, P. G., Weber-Dany, B., Maisonneuve, P., &Lowenfels, A. B.(2007). Frequency and severity of acute pancreatitis in chronic dialysispatients. Nephrology Dialysis Transplantation, 23(4), 1401- 1405.
58. Morris-Stiff, G., Coles, G., Moore, R., Jurewicz, A., & Lord, R. (1997).Abdominal wall hernia in autosomal dominant polycystic kidney disease.British journal of surgery, 84(5), 615-617.
59. Woodrow, G., Innes, A., Boyd, S. M., & Burden, R. P. (1993). A case of IgAnephropathy with coeliac disease responding to a gluten-free diet. NephrologyDialysis Transplantation, 8(12), 1382-1383.
60. Strid, H., Simrén, M., &Björnsson, E. S. (2003). Overuse of acid suppressantdrugs in patients with chronic renal failure. Nephrology DialysisTransplantation, 18(3), 570-575.
61. Rathert P, Lutzeyer W, Goddwin WE. Philipp Bozzini (1773–1809) and thelichtleiter. Urology. 1974 Jan 1;3(1):113-8.
62. Desormeaux AJ. The Endoscope, and Its Application to the Diagnosis andTreatment of Affections of the Genito-urinary Passages: Lessons
Given atNecker Hospital. Robert Fergus' Sons, printers; 1867. 63. Eslick GD. Esophageal cancer: a historical perspective. GastroenterologyClinics of North America. 2009 Mar 31;38(1):1-5. 64. Schindler R, Eusterman GB. GASTROSCOPY: THE ENDOSCOPIC STUDYOF GASTRIC PATHOLOGY. Annals of Surgery. 1937 Nov 1;106(5):958.
65. Hirschowitz BI, Balint JA, Fulton WF. Gastroduodenal endoscopy with thefiberscope—an analysis of 500 examinations. Surgical Clinics of NorthAmerica. 1962 Oct 31;42(5):1081-90.
66. Fanti L, Agostoni M, Gemma M, Radaelli F, Conigliaro R, Beretta L, Rossi G,Guslandi M, Testoni PA. Sedation and monitoring for gastrointestinalendoscopy: A nationwide web survey in Italy. Digestive and Liver Disease.2011 Sep 30;43(9):726-30.
67. Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA,Mallery JS, Faigel DO. Guidelines for conscious sedation and monitoringduring gastrointestinal endoscopy. Gastrointestinal endoscopy. 2003 Sep30;58(3):317-22.
68. Cisse, M. M., Fary, K. E. H., Daouda, D., Mahamat, A. G., &Nzambaza, J. D.D. (2015). Upper Digestive Endoscopic Lesions in Chronic Kidney Disease(CKD): Experience of a Senegalese Center; About 50 Cases. J Nephrol Ther,5(202), 2161-0959.
69. Sreelatha, M., Kumar, V. S., Shekar, G. C., &Shekar, V. C. UpperGastrointestinal Manifestations in Chronic Renal Failure Through UpperGastrointestinal Endoscopy
70. Khedmat H, Ahmadzad-Asl M, Amini M, Lessan-Pezeshki M, EinollahiB,Pourfarziani V, Naseri MH, Davoudi F. Gastro-duodenal lesions andHelicobacter pylori infection in uremic patients and renal transplant recipients.InTransplantation proceedings 2007 May 31 (Vol. 39, No. 4, pp. 1003-1007).Elsevier.
71. Al-Mueilo SH. Gastroduodenal lesions and Helicobacter pylori infection inhemodialysis patients. Saudi medical journal. 2004;25(8):1010-4.
72. Agarwal SK, Srivastava RK. Chronic kidney disease in India: challenges andsolutions. Nephron clinical practice. 2009;111(3):c197- 203.
73. Varrma PP, Pruthi HS, Thakur SK, Prasher PK, Singh B. Uppergastrointestinal bleeding in chronic renal failure. Indian J Nephrol 1996;6:150-2
74. Esfahani, S. T., Madani, A., Ataei, N., Nadjafi, M., Mohseni, P., Allahverdi,B., &Haddadi, M. (2009). Upper gastrointestinal disorders in children withend-stage renal disease. ActaMedicaIranica, 47(1), 46-50.
75. Moustafa FE, Khalil A, Wahab MA, Sobh MA. Helicobacter pylori anduremic gastritis: a histopathologic study and a correlation with endoscopic andbacteriologic findings. American journal of nephrology. 1997;17(2):165-71.
76. Margolis DM, Saylor JL, Geisse G, DeSchryver-Kecskemeti K, Harter HR,Zuckerman GR. Upper gastrointestinal disease in chronic renal failure: aprospective evaluation. Archives of internal medicine. 1978 Aug1;138(8):1214-7.
