ESSENTIALS OF DIAGNOSIS
Decline in GFR over months to years.
Persistent proteinuria or abnormal renal morphology may be present.
Hypertension is commonly present.
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 that they have CKD as it is asymptomatic until it becomes advanced. The National Kidney Foundation’s staging system helps clinicians formulate practice plans according to stage or severity of CKD (Table 24–5). 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 24–6). Genetic polymorphisms of the APOL-1 gene are associated with an increased risk of developing CKD in persons of sub-Saharan African ancestry.
Table 24–5.Stages of CKD: a clinical action plan.1,2 ||Download (.pdf) Table 24–5. Stages of CKD: a clinical action plan.1,2
|Stage3 ||Description ||GFR (mL/min/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 24–6.Causes of CKD. ||Download (.pdf) Table 24–6. 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 |