Kidney disease, chronic staging

Zemplar (paricalcitol) injection is a synthetically manufactured selective vitamin D receptor activator (SVDRA) indicated for the prevention and treatment of secondary hyperparathyroidism associated with chronic kidney disease (CKD) stage 5. The U.S. Food Drug Administration (FDA) approved a capsule form of Zemplar for development to satisfy a need for an oral formulation. The objective of study M04-693 was to assess the bioequivalencies of several dosage strengths of paricalcitol capsules under fasting conditions. 

For diabetic patients with chronic kidney disease (CKD) stages 1-11 (Creatinine clearance betwem normal and 60 mL/min/1.73 m ), stage-independent actions such as control of cardiovascular risk factors (hypertension, hyperlipidemia, and smoking), avoidance of drug toxicity and diagnostic injury, control of progression, and reduction of proteinuria are essential. 

A 72-year-old diabetic woman suffered from haemorrhagic stroke, pericardial effusion and chronic kidney disease (CKD) stage IV. She developed hyponatraemia (serum sodium level, 125 mmol/L), compatible with the syndrome of inappropriate antidiuretic hormone (SIADFl), and received oral salt supplement of 3 g three times a day for 4 days. On day 3, her heart rate increased to 120 beats per minute and on day 4, her serum sodium increased to... 

Disorders of lipoprotein metabolism involve perturbations which cause elevation of triglycerides and/or cholesterol, reduction of HDL-C, or alteration of properties of lipoproteins, such as their size or composition. These perturbations can be genetic (primary) or occur as a result of other diseases, conditions, or drugs (secondary). Some of the most important secondary disorders include hypothyroidism, diabetes mellitus, renal disease, and alcohol use. Hypothyroidism causes elevated LDL-C levels due primarily to downregulation of the LDL receptor. Insulin-resistance and type 2 diabetes mellitus result in impaired capacity to catabolize chylomicrons and VLDL, as well as excess hepatic triglyceride and VLDL production. Chronic kidney disease, including but not limited to end-stage... 

Creatinine clearance < 60 mL/min/1.73 m2 (stages III-V chronic kidney disease), diabetes mellitus (with renal insufficiency), hypertension, chronic heart failure, cirrhosis, nephrosis, age >75 yr, cholesterol emboli syndrome, multiple myeloma (questionable)... 

Father with a history of type 2 diabetes mellitus, hypertension, and stage 5 chronic kidney disease he died from a myocardial infarction at age 68 mother with a history of hypertension she died from injuries sustained in a motor vehicle accident at the age of 52... 

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

HIV infection1 12 13 CD4+T lymphocyte count Diabetes, heart disease, chronic pulmonary disease, chronic alcoholism Asplenia12 (Including elective splenectomy and terminal complement component deficiencies) Chronic liver disease Kidney failure, end-stage renal disease, receipt of hemodialysis... 

Chronic Kidney Disease Stage 3 Stage 4 Stage 5... 

TABLE 76-4 Dosing Recommendations for Vitamin D in Patients with Stage 5 Chronic Kidney Disease and Those on Hemodialysis0 ... 

The pathophysiology, clinical manifestations, diagnosis, and treatment of acute renal failure and chronic kidney disease (CKD) or end-stage renal disease are discussed in Chaps. 75 and 76, respectively. 

Sica DA, Gehr TWB Diuretic use in stage 5 chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens 2003 12 483. [PMID 12920394]... 

Quarles LD Cinacalcet HCI A novel treatment for secondary hyperparathyroidism in stage 5 chronic kidney disease. Kidney Int Suppl 2005 Jul(96) S24. 

Among the various primary and secondary glomerular diseases, diabetic nephropathy represents the most common cause of stage 5 chronic kidney disease accounting for about 44% of all patients on dialysis. One important mediator of glomerular injury in diabetic... 

U.S. Renal Data System, USRDS 2007 Annual Data Report Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2007. 

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. 

Altmann P, Barnett ME, Finn WE SPD405-307 Lanthanum Carbonate Study Group. Cognitive function in Stage 5 chronic kidney disease patients on hemodialysis noadverseeffectsoflanthanumcarbonatecompared with standard phosphate-bindertherapy. Kidney Int 2007 71 252-259. 

Chronic kidney disease and end-stage renal disease... 

Diseases of the kidney that are discussed in this section include (1) the uremic syndrome, (2) chronic kidney disease, (3) end-stage renal disease, (4) diabetic nephropathy, (5) hypertensive nephropathy, (6) glomerular diseases, (7) interstitial nephritis, (8) polycystic Iddney disease, (9) polycystic kidney disease, (10) toxic nephropathy, (11) obstructive uropathy, (12) tubular diseases, (13) renal calculi, and (14) cystinuria. In addition, this section also includes discussions on (1) prostaglandins and NS AIDS in kidney disease, (2) monoclonal light chains and kidney disease, and (3) urinary osmolality. 

For patients with chronic kidney disease (CKD) the stage of disease should be determined based on the level of kidney function, independent of etiology, according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF K/DOQI) CKD classification system. 

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