Clinical Guide to Chronic Kidney Disease

Study Notes

Introduction to Chronic Kidney Disease (CKD)

CKD is a progressive disease resulting in gradual kidney function loss.
It impacts millions globally, with high rates of morbidity and mortality.
Healthcare costs associated with CKD are significant.
Classification is based on glomerular filtration rate (GFR), which measures kidney function.

Epidemiology of CKD

Approximately 10-15% of the adult population worldwide has CKD.
Prevalence increases with age; prevalent in individuals with hypertension, diabetes, and cardiovascular diseases.
Higher incidence observed in certain ethnic groups, notably African Americans, Hispanics, and Native Americans.

Etiology and Risk Factors

Common Causes:
- Diabetes Mellitus: Leading cause (30-40% of cases).
- Hypertension: Second most common (25-30% of cases).
- Glomerulonephritis: Inflammation of glomeruli.
- Polycystic Kidney Disease: Genetic disorder causing renal cysts.
- Obstructive Nephropathy: Resulting from kidney stones, tumors, or prostate enlargement.
- Chronic Infections: Includes recurrent urinary tract infections and chronic pyelonephritis.
Risk Factors:
- Age over 60 years.
- Family history of CKD.
- Obesity and smoking.
- Existing cardiovascular disease.
- Long-term use of nephrotoxic medications, such as NSAIDs.

Pathophysiology of CKD

CKD leads to progressive nephron function loss.
Damaged nephrons trigger compensatory mechanisms in remaining nephrons, causing hyperfiltration and hypertrophy.
Increased glomerular pressure and proteinuria from compensatory mechanisms result in further nephron injury.
Over time, fibrosis and scarring occur, contributing to worsening kidney function.

Classification and Staging of CKD

CKD classification is determined by estimated GFR (eGFR) and presence of albuminuria.
KDIGO classification is widely recognized:
- Stage 1: eGFR ≥90 mL/min/1.73 m² with kidney damage.
- Stage 2: eGFR 60-89 mL/min/1.73 m² with kidney damage.
- Stage 3a: eGFR 45-59 mL/min/1.73 m².
- Stage 3b: eGFR 30-44 mL/min/1.73 m².
- Stage 4: eGFR 15-29 mL/min/1.73 m².
- Stage 5: eGFR <15 mL/min/1.73 m² (often referred to as end-stage renal disease).

Description

This quiz provides an overview of chronic kidney disease (CKD), exploring its introduction, definition, and epidemiology. Learn about the prevalence of CKD and its impact on health and healthcare systems. Test your knowledge on the various stages of this progressive condition and its significance globally.