Chronic kidney disease
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]
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 dialysis
Etiology/cause
Bilateral renal artery stenosis may cause 5% to 15% of cases of chronic kidney disease.[2]
Etiology/cause
Bilateral renal artery stenosis (RAS) may cause 5% to 15% of cases of chronic kidney disease.[2]
2% of patients underoing coronary angiography in one study had bilateral RAS > 50%.[3] In this study, 11% had at least unilateral RAS. Of these patients one third do not have a history of hypertension; however, the rate of hypertension among those with bilateral disease was not reported.
In a second study of patients patients underoing coronary angiography, 4% has bilateral RAS with both lesions > 50% while 1.5% had both lesions > 75%.[4] Among all the patients with either unilateral or bilateral RAS, half had hypertension.
In an autopsy study, 10 of 15 patients with bilateral RAS (defined as reduction in artery diameter by 50%) were normotensive by history (defined as diastolic pressure < 100 mm Hg).[5]
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 m2 [6]
Treatment
Medications
Angiotensin inhibition
Angiotensin can be inhibited with either angiotensin converting enzyme inhibitors[7] or angiotensin II receptor antagonists. These medications can help patients with an elevated creatinine,[8] including those with a creatinine of 1.5 to 5.0 mg per deciliter.[9]
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.
References
- ↑ 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. Research Blogging.
- ↑ 2.0 2.1 Rimmer JM, Gennari FJ (May 1993). "Atherosclerotic renovascular disease and progressive renal failure". Ann. Intern. Med. 118 (9): 712–9. PMID 8460859. [e]
- ↑ Park S, Jung JH, Seo HS, et al (November 2004). "The prevalence and clinical predictors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography". Heart Vessels 19 (6): 275–9. PMID 15799174. [e]
- ↑ Harding MB, Smith LR, Himmelstein SI, et al (May 1992). "Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization". J. Am. Soc. Nephrol. 2 (11): 1608–16. PMID 1610982. [e]
- ↑ HOLLEY KE, HUNT JC, BROWN AL, KINCAID OW, SHEPS SG (July 1964). "RENAL ARTERY STENOSIS. A CLINICAL-PATHOLOGIC STUDY IN NORMOTENSIVE AND HYPERTENSIVE PATIENTS". Am. J. Med. 37: 14–22. PMID 14181143. [e]
- ↑ Meyer TW, Hostetter TH (2007). "Uremia". N. Engl. J. Med. 357 (13): 1316–25. DOI:10.1056/NEJMra071313. PMID 17898101. Research Blogging.
- ↑ 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. [e]
- ↑ 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. [e]
- ↑ 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. Research Blogging.