What Is Chronic Kidney Disease?
Chronic kidney disease (CKD) is a progressive condition in which the kidneys gradually lose their ability to filter waste products and excess fluid from the blood. It is classified into five stages based on the glomerular filtration rate (GFR), with Stage 5 representing kidney failure (end-stage renal disease, ESRD) requiring dialysis or transplantation. CKD affects approximately 10% of the global population and is a leading cause of cardiovascular disease and premature death. Shanghai's nephrology departments at Zhongshan Hospital and Ruijin Hospital are among China's most experienced centers for CKD management, glomerular disease, and renal replacement therapy.
Common Kidney Conditions
- IgA nephropathy — the most common primary glomerulonephritis worldwide; particularly prevalent in Asia
- Nephrotic syndrome — including minimal change disease, focal segmental glomerulosclerosis (FSGS), and membranous nephropathy
- Lupus nephritis — kidney inflammation caused by systemic lupus erythematosus
- Diabetic nephropathy — the leading cause of ESRD globally; kidney damage from chronic diabetes
- Hypertensive nephrosclerosis — kidney damage from chronic high blood pressure
- Polycystic kidney disease (PKD) — hereditary condition causing cyst formation and progressive kidney enlargement
- Acute kidney injury (AKI) — sudden loss of kidney function requiring urgent management
- Chronic tubulointerstitial nephritis — from medications, infections, or autoimmune causes
Symptoms
CKD is often silent in early stages. As it progresses, symptoms may include:
- Fatigue and weakness
- Swelling in the legs, ankles, and feet (edema)
- Shortness of breath from fluid accumulation
- Decreased urine output or changes in urine color and frequency
- Foamy urine (indicating protein loss)
- High blood pressure that is difficult to control
- Nausea, vomiting, and loss of appetite
- Itching and dry skin
- Muscle cramps and restless legs
- Confusion or difficulty concentrating (uremic encephalopathy in advanced disease)
Causes & Risk Factors
- Diabetes mellitus — the single most common cause of CKD and ESRD
- Hypertension — the second most common cause
- Glomerulonephritis — immune-mediated kidney inflammation
- Autoimmune diseases — lupus, vasculitis, anti-GBM disease
- Recurrent kidney infections (pyelonephritis)
- Obstructive uropathy — from kidney stones, enlarged prostate, or structural abnormalities
- Genetic disorders — polycystic kidney disease, Alport syndrome
- Nephrotoxic medications — NSAIDs, certain antibiotics, contrast agents
- Family history of kidney disease
Diagnosis
Comprehensive kidney assessment at Shanghai's leading nephrology centers includes:
- Serum creatinine and eGFR — the primary measures of kidney function
- Urine albumin-to-creatinine ratio (UACR) — to quantify proteinuria
- Urinalysis and urine microscopy — to detect blood, protein, casts, and infection
- Comprehensive metabolic panel — electrolytes, bicarbonate, phosphate, calcium, uric acid
- Immunological workup — ANA, anti-dsDNA, ANCA, anti-GBM, complement levels, serum protein electrophoresis
- Kidney ultrasound — to assess kidney size, echogenicity, and rule out obstruction
- CT urography — for structural assessment and stone detection
- Kidney biopsy — the gold standard for diagnosing glomerular disease; guides immunosuppressive therapy decisions
- 24-hour urine collection — for precise protein and creatinine clearance measurement
Treatment Options
Shanghai's nephrology teams offer comprehensive CKD management from early disease through renal replacement therapy:
- Blood pressure control — ACE inhibitors and ARBs are first-line agents; reduce proteinuria and slow CKD progression
- SGLT2 inhibitors — Dapagliflozin, Empagliflozin; proven to slow CKD progression in diabetic and non-diabetic kidney disease
- Finerenone — a novel mineralocorticoid receptor antagonist for diabetic kidney disease
- Immunosuppressive therapy — Corticosteroids, Cyclophosphamide, Mycophenolate mofetil, Tacrolimus, Rituximab for glomerulonephritis and lupus nephritis
- Sparsentan — emerging dual endothelin-angiotensin receptor antagonist for IgA nephropathy and FSGS
- Dietary and lifestyle management — low-protein diet, sodium restriction, phosphate management, fluid balance
- Anemia management — erythropoiesis-stimulating agents (ESAs), iron supplementation, HIF-PHI inhibitors
- Hemodialysis — thrice-weekly in-center or home hemodialysis for ESRD
- Peritoneal dialysis (PD) — home-based dialysis modality; CAPD or APD
- Kidney transplantation evaluation — pre-transplant workup and referral coordination
Why Treat Kidney Disease in Shanghai?
- Zhongshan Hospital and Ruijin Hospital both have nationally recognized nephrology departments with extensive experience in glomerular disease, particularly IgA nephropathy — highly prevalent in Asian populations
- Expert kidney biopsy services with rapid pathology turnaround including immunofluorescence and electron microscopy
- Access to the latest CKD therapies including SGLT2 inhibitors and novel immunosuppressive agents
- Comprehensive dialysis programs with both hemodialysis and peritoneal dialysis options
- Treatment costs significantly lower than equivalent care in Western countries
Our Specialists
Professor Ding Xiaoqiang (丁小强) — Chief of Nephrology, Zhongshan Hospital, Fudan University. Expert in CKD management, dialysis, and acute kidney injury, with a strong focus on renal replacement therapy optimization.
Professor Chen Nan (陈樠) — Chief of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. One of China's foremost authorities on glomerulonephritis, lupus nephritis, and IgA nephropathy, with extensive national and international research contributions.
How CMCS Can Help
China Medical Concierge Shanghai (CMCS) coordinates comprehensive kidney care for international patients — from arranging specialist nephrology consultations and kidney biopsy procedures, to facilitating dialysis access, coordinating immunosuppressive therapy, providing medical interpretation, and supporting long-term CKD management and follow-up at Shanghai's leading hospitals.
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