Kidney disease, chronic progression

Chronic kidney disease A progressive, irreversible decline in kidney function that occurs over a period of several months to years. 

Chronic renal failure or chronic kidney disease involves progressive and irreversible loss of kidney function. Kidney function progresses from less than half normal to end-stage failure with only one-tenth the normal GFR. 

List the risk factors for progression of chronic kidney disease (CKD). 

O Chronic kidney disease is a progressive disease that eventually leads to renal failure [end-stage renal disease (ESRD)]. 

Chronic kidney disease (CKD), also known as chronic renal insufficiency, progressive kidney disease, or nephropathy, is defined as the presence of kidney damage or decreased... 

FIGURE 23-1. Proposed mechanisms for progression of renal disease. (From Joy MS, Kshirsagar A, Paparello J. Chronic kidney disease Progression-modifying therapies. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 803, with permission.)... 

Other Interventions to Limit Progression of Chronic Kidney Disease... 

Chronic kidney disease (CKD) is a progressive loss of function over several months to years, characterized by gradual replacement of normal kidney architecture with interstitial fibrosis. 

FIGURE 76-7. Pathogenesis of secondary hyperparathyroidism and renal osteodystrophy in patients with chronic kidney disease. These adaptations are lost as renal failure progresses. (Ca, calcium, P04 phosphate PTH, parathyroid hormone.)... 

See Chap. 46, Chronic Kidney Disease Progression-Modifying Therapies, authored by Melanie S. Joy, Abhijit Kshirsagar, and Nora Franceschini, and Chap. 47, Chronic Kidney Disease Management of Complications, authored by Joanna Q. Hudson, for a more detailed discussion of this topic. 

Kidney Failure, Chronic An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body s electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH]... 

Chronic kidney disease (CKD) is increasingly recognized as a major public health problem. Defined as an irreversible progressive loss of renal function for 3 months or longer, CKD shows a glomerular filtration rate (GFR) less... 

Gooch K, Culleton BE, Manns BJ, Zhang J, Alfonso H,Tonelli M, Frank C, Klarenbach S, Hemmelgarn BR. NSAID use and progression of chronic kidney disease. Am J Med. 2007 120(3) 280.el-7. 

Interstitial nephritis has been found in kidney biopsies in patients treated with indinavir [146-151]. Some of these cases have described eosinophiluria and crystals (assumed to be indinavir) associated with histiocytes and giant cells in the renal tubules. Some of these patients were asymptomatic, while others reported classic symptoms of nephrohthiasis. Cortical atrophy was found in some patients, suggesting the progression from acute injury towards chronic kidney disease [152]. 

Lucas GM, Lau B, Atta MG, Fine DM, Keruly J, Moore RD. Chronic Kidney Disease Incidence, and Progression to End-Stage Renal Disease, in HIV-Infected Individuals ATale ofTwo Races. J Infect Dis. Apr 18 2008. 

Calcineurin inhibitor nephrotoxicity presents as two distinct forms of renal injury. Acute nephrotoxicity is a dose-dependent, hemodynamically mediated disorder, not accompanied by particular or permanent structural changes which is reversible with decrease or discontinuation of the offending drug. On the other hand, calcineurin inhibitor-induced chronic nephrotoxicity is an insidious lesion, characterized by an irreversible and progressive renal interstitial fibrosis, which may cause important impairment in renal function and even stage 5 chronic kidney disease. 

Klahr, S., and J. Morrissey. Progression of Chronic Renal Disease. American Journal of Kidney Disease 41, no. 3, Supplement 1 (March 2003) 83 7. 

In chronic progressive kidney disease, the concentrating ability of the tubules is diminished and in acute tubular necrosis the urinary osmolality, if there is urine output at all, approaches that of the glomerular filtrate. 

Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE, et al. Progression of chronic kidney disease the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition. Ann Intern Med 2003 139 244-52. 

Prajczer S et al (2010) Evidence for a role ofuro-modulin in chronic kidney disease progression. Nephrol Dial Transplant 25(6) 1896-1903... 

Patients with hypertension may develop damage to either the renal tissue (parenchyma) or the renal arteries. Chronic kidney disease presents initially as microalbuminuria (30-299 mg albumin in a 24-hour urine collection) that can progress to macroalbuminuria and overt kidney failure. The rate of kidney function deterioration is accelerated when both hypertension and diabetes are present. Once patients have an estimated glomerular filtration rate (GFR) of less than 60 mL/m per minute or macroalbuminuria, they have chronic kidney disease, and the risk of cardiovascular disease and progression to severe chronic kidney disease increases. Strict BP control to a goal of less than 130/80 mm Hg can slow the decline in kidney function. This strict control often requires two or more antihypertensive agents. 

Chronic Kidney Disease Progression-Modifying Therapies... 

Reduction of kidney mass, development of glomerular hypertension, and intratubular proteinuria are key mechanisms responsible for the progression of chronic kidney disease. 

Under normal conditions each of the two million nephrons of the kidney work in an organized approach to filter, reabsorb, and excrete various solutes and water. The kidney is a primary regulator of sodium and water as well as acid-base homeostasis. The kidney also produces hormones necessary for red blood cell synthesis and calcium homeostasis. Impairment of normal kidney function is often referred to as renal insufficiency. Based on the time course of development, renal insufficiency has historically been divided into two broad categories. Acute renal failure (ARF) refers to the rapid loss of renal function over days to weeks. Chronic kidney disease (CKD)", also called chronic renal insufficiency (CRI) by some, is defined as a progressive loss of function occurring over several months to years, and is characterized by the gradual replacement of normal kidney architecture with interstitial fibrosis. Progressive kidney disease or nephropathy is... 

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