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KEY CONCEPTS

KEY CONCEPTS

  • image The stage of chronic kidney disease (CKD) should be determined for all individuals based on the level of kidney function, independent of etiology, in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) classification system.

  • image Persistent proteinuria indicates the presence of CKD and is associated with mortality and risk of end-stage renal disease (ESRD).

  • image Quantitation of urine protein excretion, such as the measurement of a spot urine albumin-to-creatinine ratio, is critical for determining the severity of CKD and monitoring the rate of disease progression.

  • image The glomerular filtration rate (GFR) is the single best indicator of kidney function.

  • image Measurement of the GFR is most accurate when performed following the exogenous administration of iohexol, iothalamate, or radioisotopes such as technetium-99m diethylenetriamine pentaacetic acid (99mTc-DTPA).

  • image Equations to estimate creatinine clearance (CLcr) or GFR are commonly used in ambulatory and inpatient settings, and incorporate patient laboratory and demographic variables such as serum creatinine concentration (Scr), cystatin C, age, sex, weight, and ethnicity.

  • image Longitudinal assessment of GFR and albuminuria is important for monitoring the efficacy of therapeutic interventions, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which are used to slow or halt the progression of kidney disease.

  • image Assessments of kidney structure and function, such as radiography, computed tomography, magnetic resonance imaging, sonography, and biopsy, are predominantly used for determining the diagnosis of a given condition.

Chronic kidney disease (CKD) is an increasingly alarming worldwide health concern, with nearly 2 million people in the United States estimated to require hemodialysis or kidney transplantation by 2030.1 In response to this widespread problem, standardized approaches are now used for the identification of individuals with CKD and their subsequent stratification into risk categories for the development of end-stage kidney disease (ESKD or ESRD) (see Chapter 44).1,2 These efforts have heightened the awareness of the need for early identification of patients with CKD and the importance of monitoring the progression of kidney disease.

Assessment of kidney function using both qualitative and quantitative methods is an important part of the evaluation of patients and an essential characterization of individuals who participate in clinical research investigations. Estimation of creatinine clearance (CLcr) has been considered the clinical standard for assessment of kidney function for nearly 50 years, and continues to be used as the primary method of stratifying kidney function in drug pharmacokinetic studies submitted to the United States Food and Drug Administration (FDA).3,4 New equations to estimate glomerular filtration rate (GFR) are now used in many clinical settings to identify patients with CKD, and in large epidemiology studies to evaluate risks of mortality and progression to stage 5 CKD, that is, ESKD.5,6 Other tests, such as urinalysis, radiographic procedures, and biopsy, are also valuable tools in the assessment of kidney disease, and these qualitative assessments are useful for determining the pathology and etiology ...

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