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Important causes of chronic kidney disease in South Africa

M R Moosa1, I Van der Walt, S Naicker

  • 1Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. rmm@sun.ac.za.

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|August 22, 2015
PubMed

Insights

Hypertensive patients with chronic kidney disease (CKD) require stricter blood pressure control (≤130/80 mmHg), especially with proteinuria. Careful monitoring of medications like ACE inhibitors and ARBs is crucial for managing kidney function and preventing complications.

Area of Science:

  • Nephrology
  • Cardiology
  • Infectious Diseases

Background:

  • Hypertension management differs significantly in patients with and without chronic kidney disease (CKD).
  • Proteinuria is a key factor in determining blood pressure (BP) targets for CKD patients.
  • HIV infection presents a complex spectrum of renal complications.

Purpose of the Study:

  • To outline current guidelines for managing hypertension in patients with CKD.
  • To highlight specific considerations for medication use in advanced CKD stages.
  • To review the renal manifestations of HIV infection and its treatment.

Main Methods:

  • Review of existing clinical guidelines and literature on hypertension and CKD management.
  • Analysis of recommendations for antihypertensive and antidiabetic medications in CKD.
  • Summary of renal complications associated with HIV infection and antiretroviral therapy.

Main Results:

  • Target BP for hypertensive patients with CKD and proteinuria (≥0.5 g/day) is ≤130/80 mmHg.
  • Lifestyle modifications (low salt, adequate potassium, weight control) are essential.
  • Caution is advised with ACE inhibitors/ARBs in advanced CKD (stages 4-5), particularly in older patients with diabetes or atherosclerosis, due to hyperkalemia risk.
  • Metformin is contraindicated in stages 4-5 CKD.
  • HIV infection can lead to various kidney issues, including acute kidney injury and HIV-associated nephropathy.

Conclusions:

  • Stricter BP control and careful medication management are vital for hypertensive patients with CKD.
  • Regular monitoring and home BP measurement are recommended for optimal management.
  • Understanding the diverse renal effects of HIV is critical for patient care.

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