Kidney Disease: Chronic Kidney Disease

Chronic kidney disease (CKD) affects 37 million US adults. It is characterized by damage to the renal glomeruli, vascular supply, and/or tubulointerstitium through complex processes involving inflammation, fibrosis, and hyperfiltration. CKD typically is asymptomatic but may be detected incidentally via urinalysis showing proteinuria or blood test results showing an elevated creatinine level. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most accurate creatinine-based method for estimating glomerular filtration rate (GFR) in routine practice. Cystatin C level measurement can be considered if patients have factors that might make creatinine-based equations inaccurate (eg, high or low muscle mass). CKD is defined as a GFR less than 60 mL/min/1.73 m2 or persistent evidence of kidney damage on imaging, biopsy, or urinalysis that persists for longer than 3 months. CKD is classified into stages based on estimated GFR, degree of proteinuria, and the cause. Screening guidelines vary. Screening should be considered if patients are at high risk of CKD (eg, patients with diabetes, hypertension, cardiovascular disease, family history of kidney failure). After CKD is identified, is it important to identify and reduce or eliminate exposure to nephrotoxic drugs. Management goals include mitigation of CKD risk factors to slow disease progression, including optimizing management of underlying conditions (eg, hypertension, diabetes).