ESSENTIALS OF DIAGNOSIS
Decline in the GFR over months to years.
Persistent proteinuria or abnormal renal morphology may be present.
Hypertension in most cases.
Bilateral small or echogenic kidneys on ultrasound in advanced disease.
Symptoms and signs of uremia when nearing end-stage disease.
CKD affects at least 10% of Americans. Many are unaware of the condition because the disease is asymptomatic until it nears end stage. The National Kidney Foundation’s staging system helps clinicians formulate practice plans (Table 22–4). Over 70% of cases of late-stage CKD (stage 5 CKD and ESKD) in the United States are due to diabetes mellitus or hypertension/vascular disease. Glomerulonephritis, cystic diseases, chronic tubulointerstitial diseases, and other urologic diseases account for the remainder (Table 22–5). Genetic polymorphisms of the APOL-1 gene have been shown to be associated with an increased risk of the development of CKD in persons of sub-Saharan African ancestry.
Table 22–4.Stages of CKD: a clinical action plan.1,2 ||Download (.pdf) Table 22–4. Stages of CKD: a clinical action plan.1,2
|Stage3 ||Description ||GFR (mL/minute/1.73 m2) ||Action |
|1 ||Kidney damage with normal or ↑↑ GFR ||≥ 90 ||Diagnosis and treatment of underlying etiology if possible. Treatment of comorbid conditions. Estimate progression, work to slow progression. CVD risk reduction. |
|2 ||Kidney damage with mildly ↓ GFR ||60–89 |
|3a ||Mildly-moderately ↓ GFR ||45–59 ||As above, and evaluating and treating complications. |
|3b ||Moderately-severely ↓ GFR ||30–44 || |
|4 ||Severely ↓ GFR ||15–29 ||Preparation for ESKD. |
|5 ||ESKD ||< 15 (or dialysis) ||Dialysis, transplant, or palliative care. |
Table 22–5.Causes of CKD. ||Download (.pdf) Table 22–5. Causes of CKD.
|Glomerular Diseases |
Primary glomerular diseases
Focal segmental glomerulosclerosis
Alport syndrome (hereditary nephritis)
Secondary glomerular diseases
Collagen-vascular diseases (eg, SLE)
HCV-associated membranoproliferative glomerulonephritis
|Tubulointerstitial Nephritis |
Sickle cell nephropathy
|Cystic Diseases |
Polycystic kidney disease
Medullary cystic disease
|Obstructive Nephropathies |