Chronic Kidney Disease, a.k.a Chronic Kidney Failure, is a vast but serious topic that requires thorough study. This presentation entails the essentials - its stages, pathogenesis, risk factors, etiology, symptoms, diagnosis, treatment and prognosis.
3. INCIDENCE:
Chronic kidney disease arises when one or both of the following
conditions are present:
⢠When there is evidence of kidney damage lasting for at least 3
months with or without a decreased glomerular filtration rate
(GFR), as demonstrated either by pathologic abnormalities or by
markers of kidney damage, including urine or blood abnormalities
or abnormalities noted on imaging.
⢠When the GFR is less than 60 ml/min/1.73 m2 for at least 3
months with or without kidney damage.
4. â˘Stage 1: Normal GFR (⼠90 mL/min/1.73 m2) plus either persistent
albuminuria or known structural or hereditary renal disease
â˘Stage 2: GFR 60 to 89 mL/min/1.73 m2
â˘Stage 3a: 45 to 59 mL/min/1.73 m2
â˘Stage 3b: 30 to 44 mL/min/1.73 m2
â˘Stage 4: GFR 15 to 29 mL/min/1.73 m2
â˘Stage 5: GFR < 15 mL/min/1.73 m2
STAGES
13. TREATMENT:
⢠Lifestyle modifications (dietary management, weight management,
physical activity)
⢠Blockade of the renin angiotensin aldosterone system with either an
angiotensin converting enzyme inhibitor (ACEI) or an angiotensin
receptor blocker (ARB)
⢠Blood pressure control reduces renal disease progression and
cardiovascular morbidity/mortality.
- Target BP <130/80mm Hg if without hypotension risk (eg,without:
orthostatic hypotension, heart failure, older age).
- Consider a target BP of <140/90 mm Hg if risk for hypotension.
14. TREATMENT
â˘Optimally manage comorbid diabetes and
address cardiovascular risk factors.
Statin or statin/ezetimibe therapy is
recommended in all CKD patients age ⼠50
years to decrease the risk of cardiovascular or
atherosclerotic events.
⢠Monitor for other common complications of
CKD including: anemia, electrolyte
abnormalities, abnormal fluid balance, mineral
bone disease, and malnutrition.
⢠Avoid nephrotoxic medications to prevent
worsening renal function.
15. PROGNOSIS:
⢠Chronic kidney disease results in worse all-cause mortality (the
overall death rate) which increases as kidney function decreases.
⢠The leading cause of death in chronic kidney disease is
cardiovascular disease, regardless of whether there is progression
to stage 5.
⢠While kidney replacement therapies can maintain people
indefinitely and prolong life, the quality of life is negatively affected.
⢠Kidney transplantation increases the survival of people with stage 5
CKD when compared to other options