Is all chronic kidney disease created equal?

Area of Science:

• Nephrology
• Urology
• Gerontology

Background:

• Current definition of chronic kidney disease (CKD) primarily relies on estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m², often overlooking the cause and structural damage.
• Recent guidelines broaden the CKD definition to include kidney structure or function abnormalities present for over 3 months.
• The implications of CKD in the context of renal surgery require further review.

Purpose of the Study:

• To review recent literature on chronic kidney disease (CKD) and its specific implications for patients undergoing renal surgery.
• To evaluate the evolving definition of CKD and its impact on clinical management.
• To compare the progression and survival outcomes of CKD based on its etiology.

Main Methods:

• Review of recent scientific literature pertaining to chronic kidney disease (CKD) and renal surgery.
• Analysis of studies comparing CKD progression and survival rates based on different causes (e.g., aging, surgery vs. medical conditions).
• Examination of alternative methods for assessing renal function in specific CKD populations.

Main Results:

• Many individuals with eGFR < 60 ml/min/1.73 m² may not exhibit other clinical signs of CKD.
• Nephron loss from aging or renal surgery (CKD-S) may be associated with a lower risk of CKD progression and potentially better survival compared to CKD from medical causes.
• Patients with mild to moderate CKD due to surgical nephron loss might benefit from alternative renal function assessments like cystatin-C-derived or directly measured GFR.

Conclusions:

• Chronic kidney disease (CKD) encompasses a heterogeneous patient group with varying causes of reduced glomerular filtration rate (GFR).
• Classifying CKD by GFR, albuminuria, and etiology is crucial for improved patient management.
• Certain causes of CKD, such as aging and nephrectomy, appear linked to a relatively low risk of disease progression.