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  • Image not available. The prevalence of chronic kidney disease (CKD) is estimated at nearly 25 million people in the United States.
  • Image not available. Because the development of CKD is a complex phenomenon, the Kidney Disease Outcomes Quality Initiative (K/DOQI) has recommended categorizing risk factors associated with CKD as susceptibility, initiation, and progression factors.
  • Image not available. Reduction of kidney mass, development of glomerular hypertension, and intratubular proteinuria are key mechanisms responsible for the progression of CKD.
  • Image not available. CKD is classified into five stages based on the presence of kidney structural damage (e.g., proteinuria) and/or kidney function (glomerular filtration rate). Stage 1 is indicative of mild structural changes with “normal” kidney function, while stage 5 is analogous to end-stage renal disease when patients are approaching the need for dialysis or kidney transplantation.
  • Image not available.Serum creatinine concentration is not a reliable marker of kidney function among the elderly, the malnourished, and children. Therefore, it is important to estimate the glomerular filtration rate rather than just measuring the serum creatinine, especially in these three populations.
  • Image not available. Stage 5 CKD manifests as asterixis, pruritus, dysgeusia, nausea, vomiting, anorexia, weight loss, and susceptibility to bleeding. These signs and symptoms of uremia drive the decision to implement kidney replacement therapy.
  • Image not available. The progression of CKD can be slowed by optimizing blood pressure control and among diabetics blood glucose control.
  • Image not available. Diabetic patients with or without hypertension who demonstrate persistent microalbuminuria despite intensive insulin therapy should have their angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) dose titrated to achieve maximal suppression of urinary albumin excretion to halt or slow CKD progression.
  • Image not available. ACEIs and ARBs are key pharmacologic treatments of chronic kidney disease because of their hemodynamic and blood pressure reduction effects, which help to limit kidney disease progression.
  • Image not available. Dietary protein restriction, lipid-lowering interventions, cessation of smoking, and symptom control of anemia have been suggested to slow the rate of progression of CKD; however, the utility of these interventions remains unclear.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the epidemiology of chronic kidney disease including its prevalence and cost to health care.
  • 2. Discuss the susceptibility, initiation, and progression factors that contribute to the progression of kidney disease.
  • 3. Explain the pathophysiology associated with the progression of kidney disease.
  • 4. Define the stages of kidney disease and the signs and symptoms that accompany them.
  • 5. Recommend appropriate screening for microalbuminuria and/or proteinuria and evaluate the results.
  • 6. Determine the desired goals of therapy for patients with progressive kidney disease.
  • 7. Compare and contrast the various antihypertensive agents and their effects on the kidney.
  • 8. Select appropriate blood pressure medications for kidney disease patients with and without diabetes.
  • 9. Evaluate the goal protein intake for patients with chronic kidney disease.
  • 10. Describe the renal benefits from specific treatment regimens in important clinical trials.
  • 11. Discuss the role of lipids in the progression of chronic kidney disease.
  • 12. Identify the impact of smoking and obesity in the progression of kidney disease.
  • 13. ...

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