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 macroscopic severe bilateral RAS were normotensive by history.[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.