CKD Flashcards
chronic kidney disease (CKD) - defined
*defined by 3 or more months of:
-kidney damage
OR
-decreased kidney function
chronic kidney disease (CKD) - etiologies
- glomerular diseases:
-DIABETES, autoimmune diseases, systemic infections, drugs, neoplasias - vascular diseases:
-atherosclerosis, HTN, ischemia, vasculitis, thrombotic microangiopathy - tubulointerstitial diseases:
-chronic UTIs, stones, obstruction, drug toxicity - cystic diseases:
-polycystic kidney disease
decreased kidney function
*GFR is best overall index of kidney function for healthy individuals & those with CKD
*GFR = sum of the filtration rates in all of the functioning nephrons
*healthy glomeruli collectively filter 180 liters per day
*normal GFR in healthy young adults ~125 mL/min
*GFR < 15 mL/min is defined as kidney failure
measured GFR
*measurement of ideal urinary clearance filtration markers
*gold standard is inulin or lothalmate
estimated GFR
*serum biomarkers input to complex equations to approximate the true GFR
*this is routinely done in clinical practice
*note that all of the equations for eGFR have limitations
chronic kidney disease (CKD) due to kidney damage - defined
*preserved GFR
*histopathological abnormalities
*abnormalities in serum/urine tests or abnormalities on imaging that may lead to a drop in GFR (e.g. albuminuria, polycystic kidney disease)
chronic kidney disease (CKD) due to decreased kidney function - defined
*drop in GFR (GFR < 60 mL/min per 1.73 m^2)
*with or without kidney damage
stage I chronic kidney disease (CKD)
*kidney damage with normal or increased GFR
*GFR > 90
stage II chronic kidney disease (CKD)
*kidney damage with mild decreased GFR
*GFR 60-89
stage III chronic kidney disease (CKD)
*moderately decreased GFR
*GFR 30-59
stage IV chronic kidney disease (CKD)
*severely decreased GFR
*GFR 15-29
stage V chronic kidney disease (CKD)
*kidney failure
*GFR < 15 (or dialysis)
who should be screened for CKD?
*all patients who have increased susceptibility or have potential inciting factors should be screened for CKD
*most screening is done with serum creatinine based estimating equations
CKD progression
*chronic kidney disease is often PROGRESSIVE and leads to IRREVERSIBLE loss of renal function
*once GFR falls below about 50% of normal, kidney function tends to continually decline, even if the initial insult has been eliminated
adaptive hyperfiltration
*a compensatory process in which the kidneys adapt to the initial damage by increasing the filtration rate in the normal (undamaged) nephrons
*results in long-term damage to the remaining nephrons
*manifested by more proteinuria and progressive CKD