13 CHRONIC KIDNEY DISEASE General Discussion Chronic kidney disease (CKD) is defined by the presence of sustained abnormalities of renal function and results from different causes of renal injury. CKD can lead to progressive loss of renal function and may result in end-stage renal disease after a variable period of time following the initiating injury. The National Kidney Foundation has defined CKD as the presence of kidney damage for 3 or more months with or without decreased GFR. Kidney damage is manifested by pathologic abnormalities or markers of kidney damage, which include abnormalities in the composition of the blood or urine, such as proteinuria, abnormalities in the urine sediment, and abnormalities on imaging studies. Among individuals with CKD, the stages are classified based on the level of kidney function. • Stage 1 GFR ≥ 90 • Stage 2 GFR = 60–89 • Stage 3 GFR = 30–59 • Stage 4 GFR = 15–29 • Stage 5 GFR <15 or dialysis Patients with CKD should be monitored for progression of renal failure. All individuals with GFR <60 for at least 3 months are classified as having CKD regardless of the presence or absence of kidney damage. When renal disease reaches this stage, the patient should be monitored more closely for control of hypertension, anemia, renal bone disease, and nutritional status. Patients with CKD should be evaluated to determine the type of kidney disease, comorbid conditions, disease severity, complications, risk for loss of kidney function, and risk for development of cardiovascular disease. Patients with CKD should be referred to a nephrologist for consultation and co-management if a clinical action plan cannot be prepared or the prescribed evaluation and recommended treatment cannot be carried out. In general, patients with GFR <30 mL/min/1.73 m2 should be referred for nephrology consultation. Risk Factors for Chronic Kidney Disease Advancing age Autoimmune diseases Cardiovascular disease Diabetes mellitus Drug toxicity Family history of kidney disease Hyperlipidemia Hypertension Low birth weight Low income/education Lower urinary tract obstruction Malignancy Recovery from acute renal failure Reduction in kidney mass Smoking Systemic infections Urinary stones Urinary tract infections US ethnic minority status • African-American • Asian or Pacific Islander • Hispanic • Native American Causes of Chronic Kidney Disease Cystic diseases • Polycystic kidney disease Diabetic kidney disease Glomerular diseases • Autoimmune diseases Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on CHRONIC KIDNEY DISEASE Full access? Get Clinical Tree
13 CHRONIC KIDNEY DISEASE General Discussion Chronic kidney disease (CKD) is defined by the presence of sustained abnormalities of renal function and results from different causes of renal injury. CKD can lead to progressive loss of renal function and may result in end-stage renal disease after a variable period of time following the initiating injury. The National Kidney Foundation has defined CKD as the presence of kidney damage for 3 or more months with or without decreased GFR. Kidney damage is manifested by pathologic abnormalities or markers of kidney damage, which include abnormalities in the composition of the blood or urine, such as proteinuria, abnormalities in the urine sediment, and abnormalities on imaging studies. Among individuals with CKD, the stages are classified based on the level of kidney function. • Stage 1 GFR ≥ 90 • Stage 2 GFR = 60–89 • Stage 3 GFR = 30–59 • Stage 4 GFR = 15–29 • Stage 5 GFR <15 or dialysis Patients with CKD should be monitored for progression of renal failure. All individuals with GFR <60 for at least 3 months are classified as having CKD regardless of the presence or absence of kidney damage. When renal disease reaches this stage, the patient should be monitored more closely for control of hypertension, anemia, renal bone disease, and nutritional status. Patients with CKD should be evaluated to determine the type of kidney disease, comorbid conditions, disease severity, complications, risk for loss of kidney function, and risk for development of cardiovascular disease. Patients with CKD should be referred to a nephrologist for consultation and co-management if a clinical action plan cannot be prepared or the prescribed evaluation and recommended treatment cannot be carried out. In general, patients with GFR <30 mL/min/1.73 m2 should be referred for nephrology consultation. Risk Factors for Chronic Kidney Disease Advancing age Autoimmune diseases Cardiovascular disease Diabetes mellitus Drug toxicity Family history of kidney disease Hyperlipidemia Hypertension Low birth weight Low income/education Lower urinary tract obstruction Malignancy Recovery from acute renal failure Reduction in kidney mass Smoking Systemic infections Urinary stones Urinary tract infections US ethnic minority status • African-American • Asian or Pacific Islander • Hispanic • Native American Causes of Chronic Kidney Disease Cystic diseases • Polycystic kidney disease Diabetic kidney disease Glomerular diseases • Autoimmune diseases Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on CHRONIC KIDNEY DISEASE Full access? Get Clinical Tree
