{"id":7725,"date":"2021-10-24T12:12:09","date_gmt":"2021-10-24T10:12:09","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/chronic-kidney-disease-importance-classification-screening-referral-progression-inhibition\/"},"modified":"2022-01-03T00:57:38","modified_gmt":"2022-01-02T22:57:38","slug":"chronic-kidney-disease-importance-classification-screening-referral-progression-inhibition","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/chronic-kidney-disease-importance-classification-screening-referral-progression-inhibition\/","title":{"rendered":"Chronic kidney disease (importance, classification, screening, referral, progression inhibition)"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Definition and importance<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Chronic kidney disease (CKD) means impaired GFR (&lt;60mL\/min\/1.73m^2) for 3 months or more.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>CKD has an important role in the development of cardiovascular disease and stroke, and in fact, it contributes to their risk due to a vicious circle that causes HTN.<\/li><li>CKD can progress into end-stage renal diseasse (<strong>ESRD<\/strong>) where the regulation of fluid and electrolyte balance, and filtration and excretion of toxins becomes impaired to the degree that the patient has to be put on dialysis or undergo renal transplantation in order to continue sustating life.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">The two main contributors to CKD are HTN and diabetes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other causes include chronic GN, cystic kidney disease, obstructive nephropathy, lupus nephritis.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Mechanism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Initiating etiology (developmental abnormaility, immune complex deposition, inflammation, toxin exposure)<\/li><li>Hyperfiltration and hypertrophy of the remaining viable nephrons (short-term adaptation)<\/li><li>The increased filtration causes glomerular damage<\/li><li>Increased RAS activity contributes to the process<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">There are several different guidelines and classification systems. The most common one (<strong>Kidney Disease Improving Global Outcome &#8211; KDIGO<\/strong>) includes 6 stages based on the GFR (G), and 3 stages based on albuminuria (A).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Stage G1 means the highest GFR (&gt;90) and G5 the lowest (&lt;15), while A1 means low proteinuria (&lt;30mg) and A3 means high proteinuria (&gt;300mg).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lower GFR and higher proteinuria indicate a poor prognosis.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Screening<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Screening tests can help diagnose the disease earlier (as it is asymptomatic until late-stage) and they include urine tests for proteinuria and blood tests for serum creatinine &amp; eGFR.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Referral<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Based on the guidelines, referral to the nephrologist is indicated in eGFR &lt;30\u2009mL\/min\/1.73\u2009m2 or when there is a rapid decline of eGFR, elevated ACR, or other \u2018alert\u2019 signs such as the presence of urinary red blood cell casts in urine microscopy.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Progression inhibition<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in the pathogenesis of hypertension (HTN) and the progression of CKD. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">AT-II contributes to intracapillary hypertension and increased ultrafiltration of plasma proteins, which may contribute to the onset and progression of CKD. In addition, HTN further contributes to the atherosclerosis process.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>RAS inhibition slows down the progression of CKD and lowers CV risks associated with CKD.<\/li><li>Lipid-lowering therapy reduces the risk of atherosclerotic events.<\/li><li>Lifestyle modification is also important (limit fluid, sodium, potassium, and phosphate intake, along with a low-protein diet)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Pharmacotherapy<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li><strong>ACEi<\/strong><ul><li>Ramipril 2.5mg\/day<\/li><li>Enalapril 20mg\/day<\/li><\/ul><\/li><li><strong>ARBs<\/strong><ul><li>Losartan 50mg\/day<\/li><li>Telmisartan 40mg\/day<\/li><\/ul><\/li><li><strong>Statins and other lipid-lowering drugs<\/strong><ul><li>Lovastatin 20mg\/day<\/li><li>Atorvastatin 20mg\/day<\/li><li>Ezetimibe 10mg\/day<\/li><\/ul><\/li><li><strong>Mineralocorticoid receptor antagonist<\/strong><ul><li>Finerenone (Kerendia) in CKD + DM<\/li><\/ul><\/li><li>Melatonin<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Definition and importance<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Mechanism<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Screening<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Referral<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Progression inhibition<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pharmacotherapy<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Definition and importance Chronic kidney disease (CKD) means impaired GFR (&lt;60mL\/min\/1.73m^2) for 3 months or more. CKD has an important role in the development of cardiovascular disease and stroke, and in fact, it contributes to their risk due to a vicious circle that causes HTN. CKD can progress into end-stage renal diseasse (ESRD) where the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7725","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Chronic kidney disease (importance, classification, screening, referral, progression inhibition) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/chronic-kidney-disease-importance-classification-screening-referral-progression-inhibition\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/chronic-kidney-disease-importance-classification-screening-referral-progression-inhibition\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/chronic-kidney-disease-importance-classification-screening-referral-progression-inhibition\\\/\",\"name\":\"Chronic kidney disease (importance, classification, screening, referral, progression inhibition) &#8211; 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