Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD)

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🌱 來自: Huppert’s Notes

Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD)🚧 施工中

Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD)

•   Definitions:

-   CKD: Any of the following signs of kidney disease lasting >3 months

•   GFR <60 mL/min/1.73 m2

•   Albuminuria >30 mg/g or 30 mg/24 hr

•   Urine sediment suggesting kidney damage (e.g., tubular casts, hematuria with dysmorphic RBCs)

•   Electrolyte abnormalities attributed to tubular disease

-   Or the following:

•   Abnormalities on histology from a kidney biopsy

•   Structural kidney disease on imaging

•   History of kidney transplantation

•   Stages:

-   GFR category:

•   G1: eGFR >90 mL/min/1.73 m2

•   G2: eGFR 60–90 mL/min/1.73 m2

•   G3a: eGFR 45–59 mL/min/1.73 m2

•   G3b: eGFR 30–44 mL/min/1.73 m2

•   G4: eGFR 15–29 mL/min/1.73 m2

•   G5: eGFR <15 mL/min/1.73 m2

-   Albuminuria category:

•   A1: UACR <30 mg/g

•   A2: UACR 30–300 mg/g

•   A3: UACR >300 mg/g

-   ESRD: Term that typically refers to patients with CKD who have either:

•   GFR <15 mL/min/m2

•   Requirement of long-term dialysis or history of kidney transplant

•   Etiologies:

-   Systemic disease: Diabetes, hypertension, glomerulonephritis due to autoimmune, infectious or inflammatory disease, polycystic kidney disease, malignancy, nephrotoxin exposure

-   Primary kidney disease: Primary glomerulonephritis, renal artery stenosis, chronic urinary obstruction, congenital kidney disease

•   Treatment:

-   Treat the underlying cause of kidney disease

-   Prevent progression of kidney damage

-   Avoid nephrotoxic medications and adjust dosing of renally excreted medications

•   NSAIDs are a particularly common nephrotoxic medication

•   Most antibiotics need dose adjustment for decreased renal function

-   Manage complications

•   Renal diet: Na+ 2–3 g/day, low K+, low phos, fluid restriction (if anuric generally 1.5 L/day max)

-   Prepare for renal replacement when GFR is severely decreased

•   See dialysis section below

•   Includes referring for transplant evaluation and preparing access for dialysis

•   Consider a tool to predict the probability of dialysis or transplant for a patient with CKD stage G3 to G5

•   References:

-   Chen TK et al. Chronic kidney disease diagnosis and management: A review (JAMA 2019;322(13): 1294–1304).

-   KDIGO Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease (Kidney Int Suppl 2013;3(1):1–150).