Chronic kidney disease: Difference between revisions
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===Medications=== | ===Medications=== | ||
====Angiotensin inhibition==== | ====Angiotensin inhibition==== | ||
[[Angiotensin]] can be inhibited with either [[angiotensin converting enzyme inhibitor]]s<ref name="pmid12965979">{{cite journal |author=Jafar TH, Stark PC, Schmid CH, ''et al'' |title=Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis |journal=Ann. Intern. Med. |volume=139 |issue=4 |pages=244–52 |year=2003 |pmid=12965979 |doi=}}</ref> or [[angiotensin II receptor antagonist]]s. | [[Angiotensin]] can be inhibited with either [[angiotensin converting enzyme inhibitor]]s<ref name="pmid12965979">{{cite journal |author=Jafar TH, Stark PC, Schmid CH, ''et al'' |title=Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis |journal=Ann. Intern. Med. |volume=139 |issue=4 |pages=244–52 |year=2003 |pmid=12965979 |doi=}}</ref> or [[angiotensin II receptor antagonist]]s. These medications can help patients with an elevated creatinine,<ref name="pmid11729254">{{cite journal |author=Ruggenenti P, Perna A, Remuzzi G |title=ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy |journal=J. Am. Soc. Nephrol. |volume=12 |issue=12 |pages=2832–7 |year=2001 |pmid=11729254 |doi=}}</ref> including those with a creatinine of 1.5 to 5.0 mg per deciliter.<ref name="pmid16407508">{{cite journal |author=Hou FF, Zhang X, Zhang GH, ''et al'' |title=Efficacy and safety of benazepril for advanced chronic renal insufficiency |journal=N. Engl. J. Med. |volume=354 |issue=2 |pages=131–40 |year=2006 |pmid=16407508 |doi=10.1056/NEJMoa053107}}</ref> | ||
Phosphate binders (calcium carbonate 650 mg tabs three times per day by mouth and calcitriol 0.25-0.5 µg once per day) are given once a patient has Stage 3 disease in order to prevent secondary [[hyperparathyroidism]]. | |||
==References== | ==References== | ||
Revision as of 23:39, 8 January 2008
Chronic kidney disease is defined as "kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) for 3 months or more, irrespective of cause. Kidney damage in many kidney diseases can be ascertained by the presence of albuminuria, defined as albumin-to-creatinine ratio >30 mg/g in two of three spot urine specimens."[1]
Classification
There are five stages:[1]
- Stage 1 - glomerular filtration rate is 90 ml/min/1.73 m2 or more
- Stage 2 - glomerular filtration rate is 60-89 ml/min/1.73 m2
- Stage 3 - glomerular filtration rate is 30-59 ml/min/1.73 m2
- Stage 4 - glomerular filtration rate is 15-29 ml/min/1.73 m2
- Stage 5 - glomerular filtration rate is less than 15 ml/min/1.73 m2 or on dialysis
Signs and symptoms
Uremia, "the illness accompanying kidney failure", may have subtle manifestations when the glomerular filtration rate falls below 60 ml/min/1.73 m2 [2]
Treatment
Medications
Angiotensin inhibition
Angiotensin can be inhibited with either angiotensin converting enzyme inhibitors[3] or angiotensin II receptor antagonists. These medications can help patients with an elevated creatinine,[4] including those with a creatinine of 1.5 to 5.0 mg per deciliter.[5]
Phosphate binders (calcium carbonate 650 mg tabs three times per day by mouth and calcitriol 0.25-0.5 µg once per day) are given once a patient has Stage 3 disease in order to prevent secondary hyperparathyroidism.
References
- ↑ 1.0 1.1 Levey AS, Eckardt KU, Tsukamoto Y, et al (2005). "Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)". Kidney Int. 67 (6): 2089–100. DOI:10.1111/j.1523-1755.2005.00365.x. PMID 15882252. Research Blogging.
- ↑ Meyer TW, Hostetter TH (2007). "Uremia". N. Engl. J. Med. 357 (13): 1316–25. DOI:10.1056/NEJMra071313. PMID 17898101. Research Blogging.
- ↑ Jafar TH, Stark PC, Schmid CH, et al (2003). "Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis". Ann. Intern. Med. 139 (4): 244–52. PMID 12965979. [e]
- ↑ Ruggenenti P, Perna A, Remuzzi G (2001). "ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy". J. Am. Soc. Nephrol. 12 (12): 2832–7. PMID 11729254. [e]
- ↑ Hou FF, Zhang X, Zhang GH, et al (2006). "Efficacy and safety of benazepril for advanced chronic renal insufficiency". N. Engl. J. Med. 354 (2): 131–40. DOI:10.1056/NEJMoa053107. PMID 16407508. Research Blogging.