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From Citizendium, the Citizens' Compendium

In medicine, chronic kidney disease is defined as "kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) for 3 months or more, irrespective of cause. Kidney damage in many kidney diseases can be ascertained by the presence of albuminuria, defined as albumin-to-creatinine ratio >30 mg/g in two of three spot urine specimens."^[1]

Contents 1 Classification 2 Etiology/cause 3 Signs and symptoms 4 Treatment 4.1 Medications 4.1.1 Angiotensin inhibition 4.1.2 Phosphate binders 4.2 Renal replacement therapy 5 References 6 External links

Classification

There are five stages:^[1]

• Stage 1 - glomerular filtration rate is 90 ml/min/1.73 m² or more
• Stage 2 - glomerular filtration rate is 60-89 ml/min/1.73 m²
• Stage 3 - glomerular filtration rate is 30-59 ml/min/1.73 m²
• Stage 4 - glomerular filtration rate is 15-29 ml/min/1.73 m²
• Stage 5 - glomerular filtration rate is less than 15 ml/min/1.73 m² or on renal dialysis

Etiology/cause

Bilateral renal artery stenosis (RAS) may cause 5% to 15% of cases of chronic kidney disease.^[2]

Signs and symptoms

Uremia, "the illness accompanying kidney failure", may have subtle manifestations when the glomerular filtration rate falls below 60 ml/min/1.73 m^{2 [3]}

Treatment

Medications

Angiotensin inhibition

Angiotensin can be inhibited with either angiotensin converting enzyme inhibitors^[4] or angiotensin II receptor antagonists. These medications can help patients with an elevated creatinine,^[5] including those with a creatinine of 1.5 to 5.0 mg per deciliter.^[6]

Phosphate binders

Phosphate binders (calcium carbonate 650 mg tabs three times per day by mouth and calcitriol 0.25-0.5 µg once per day) are given once a patient has Stage 3 disease in order to prevent secondary hyperparathyroidism.

Renal replacement therapy

For more information, see: Renal replacement therapy

References

1. ↑ ^1.0 1.1 Levey AS, Eckardt KU, Tsukamoto Y, et al (2005). "Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)". Kidney Int. 67 (6): 2089–100. DOI:10.1111/j.1523-1755.2005.00365.x. PMID 15882252.
2. ↑ Rimmer JM, Gennari FJ (May 1993). "Atherosclerotic renovascular disease and progressive renal failure". Ann. Intern. Med. 118 (9): 712–9. PMID 8460859.
3. ↑ Meyer TW, Hostetter TH (2007). "Uremia". N. Engl. J. Med. 357 (13): 1316–25. DOI:10.1056/NEJMra071313. PMID 17898101.
4. ↑ Jafar TH, Stark PC, Schmid CH, et al (2003). "Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis". Ann. Intern. Med. 139 (4): 244–52. PMID 12965979.
5. ↑ Ruggenenti P, Perna A, Remuzzi G (2001). "ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy". J. Am. Soc. Nephrol. 12 (12): 2832–7. PMID 11729254.
6. ↑ Hou FF, Zhang X, Zhang GH, et al (2006). "Efficacy and safety of benazepril for advanced chronic renal insufficiency". N. Engl. J. Med. 354 (2): 131–40. DOI:10.1056/NEJMoa053107. PMID 16407508.

External links

• [National Kidney Disease Education Program - GFR Calculators]