DOCSLIB.ORG

Acute Kidney Injury and Chronic Kidney Disease: a Work in Progress

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Acute Kidney Injury and Chronic Kidney Disease: a Work in Progress Editorial Acute Kidney Injury and Chronic Kidney Disease: A Work in Progress Jason R. Bydash§ and Areef Ishani§¶ Clin J Am Soc Nephrol 6: 2555–2557, 2011. doi: 10.2215/CJN.09560911 Short-term outcomes of acute kidney injury (AKI), tients with diabetes who sought ambulatory and in- §¶Minneapolis Veterans such as length of hospital stay and inpatient mortal- patient treatment within the Veterans Affairs health- Affairs Health Care ity, are well documented. Recently, the impact of AKI care system between January 1, 1999, and December System, and § on long-term outcomes—a largely undefined body of 31, 2004, and followed them until December 31, 2008. Department of knowledge—has come into focus. Evidence associat- Prospective patients were identified as having diabe- Medicine, University of Minnesota, ing AKI in the inpatient setting with extended out- tes, based on ICD-9 codes, during at least one outpa- Minneapolis, Minnesota comes of mortality and the development of chronic tient clinic encounter. After excluding patients with kidney disease (CKD) has materialized. Several stud- fewer than three creatinine levels or an eGFR Ͻ30 Correspondence: Dr. ies have linked severity of AKI with increased likeli- ml/min per 1.73 m2 at the time of first creatinine Areef Ishani, Section of hood of mortality, developing end-ESRD, or chronic measurement, 3679 patients remained for evaluation. Nephrology, Minneapolis Veterans kidney disease (1–3). Others have found an associa- AKI was defined according to the Acute Kidney In- Affairs Medical Center tion between temporary dialysis support for AKI in jury Network criteria. A total of 1822 patients re- (111J), 1 Veterans CKD patients and progression to ESRD (4). quired at least one hospitalization, 530 of 1822 pa- Drive, Minneapolis, The detrimental effect of AKI episodes on the de- tients experienced one AKI episode, and 158 of 530 MN 55417. Phone: velopment and progression of CKD has been ex- patients experienced two or more AKI episodes. The 612-467-3279; Fax: 612-727-5640; plored in animal models. For instance, Nath et al. mean age of patients in the study was 61.7 years, E-mail: Isha0012@ found that repetitive nephrotoxic insults over time mean baseline creatinine was 1.10 mg/dl, and mean umn.edu results in chronic renal disease in rats (7). Further- time of observation was 61.2 months. The study’s more, Basile et al. found persistent changes at the gene findings reveal a significantly increased hazard of transcription level in the kidneys of rats subjected to developing stage 4 CKD and mortality in individuals ischemic insult, even after serum creatinine levels had suffering from AKI during hospitalization compared recovered to match those of untreated controls (8). with individuals without AKI. In addition, each ad- These findings support the clinical findings associat- ditional AKI episode (up to three total) was associated ing AKI episodes with progressive kidney disease. with an independent and cumulative increase in the A review of the recent literature reveals several risk for the development of stage 4 CKD (hazard studies linking AKI to the progression of kidney dis- ratio ϭ 2.02). ease, five of which are presented in Table 1. Of the There are several aspects of Thakar’s work that five presented, the length of studies ranged from 3.3 require special attention. First, the results of the mul- to 8 years in various settings. With regard to out- tivariable Cox proportional hazards model suggest comes, three out of five studies used ESRD as the that while AKI is a significant risk factor for stage 4 primary outcome, two used progression of CKD as CKD, it also has the same magnitude of risk as pro- the outcome, and one used incident CKD. In general, teinuria (defined as an either urinary microalbumin all studies demonstrate an increased risk of adverse concentration of Ͼ30 mg/g creatinine or a protein- renal outcomes, irrespective of how AKI was defined. creatinine ratio of Ͼ0.5 g/g, or a dipstick with Ͼ100 For example, of the studies using ESRD as their pri- mg/dl protein), a well defined risk factor for ESRD in mary outcome, the hazard associated with an AKI patients with diabetes. This finding suggests that de- episode ranged from 1.45 to 11.74 (2–6). Unfortu- termining a history of AKI in diabetic CKD patients nately, the role of recurrent AKI on development and may be on par with proteinuria with regard to assess- progression of CKD remains underexplored in the ing risk. Second, the association between AKI and clinical realm. Most recent studies have examined progression of CKD is of similar magnitude irrespec- the impact of one episode of acute kidney injury on tive of baseline eGFR, suggesting that an AKI history, patient outcomes. In the current issue of CJASN, even in patients with preserved kidney function, may Thakar and colleagues examine the association be- be a risk marker for adverse renal outcomes. tween solitary and multiple AKI episodes and the While Thakar’s study demonstrates an association risk of chronic kidney disease in a cohort of diabetic between both solitary and multiple AKI episodes, and patients (9). an increased risk of reaching stage 4 CKD, it does Briefly, Thakar et al. studied a cohort of 4082 pa- have limitations. This study does not include infor- www.cjasn.org Vol 6 November, 2011 Copyright © 2011 by the American Society of Nephrology 2555 2556 Clinical Journal of the American Society of Nephrology Table 1. Recent studies linking AKI to long-term outcomes Length of Study Authors (Years) Setting Definition of AKI Outcomes Results, HR Newsome et al. (5) 4.1 (median) Acute MI Increase in serum creatinine ESRD 0.1 mg/dl increase, HR (increments of 0.1 mg/dl) from 1.45 baseline during hospitalization 0.2 mg/dl increase, HR for acute MI 1.97 0.3 to 0.5 mg/dl increase, HR 2.36 0.6 to 3.0 mg/dl, increase HR 3.26 James et al. (2) 3.3 (maximum) Coronary AKI stage 1, 2, or 3, according of ESRD AKI 1, HR 4.15 angiography Acute Kidney Injury Network AKI 2 to 3, HR 11.74 definitions within 7 days postcoronary angiography Hsu et al. (4) 8 (maximum) Hospitalization Ն50% increase in serum creatinine ESRD/death (combined) AKI, HR 1.30 compared with last outpatient value and receipt of dialysis during hospitalization in patients with baseline eGFR Ͻ45 ml/min per 1.73 m2 Lo et al. (3) 8 (maximum) Hospitalization Ն50% increase in serum creatinine Stage 4 or 5 CKD AKI, HR 28.1 compared with last outpatient value and receipt of dialysis during hospitalization in patients with baseline eGFR Ն45 ml/min per 1.73 m2 Ishani et al. (6) 5.1 (mean) Cardiac bypass Percent change in serum CKD (i), CKD (p) 1% to 24% increase; HR 1.4 creatinine comparing peak value (i), 1.5 (p) within 7 days postbypass with 25% to 49% increase; HR baseline value 1.9 (i), 1.7 (p) 50% to 99% increase; HR 2.3 (i), 1.7 (p) Ն100% increase; HR 2.3 (i), 2.4 (p) AKI, acute kidney injury; MI, myocardial infarction; HR, hazard ratio; eGFR, estimated GFR; CKD, chronic kidney disease; (i), incident; (p), progression. Clin J Am Soc Nephrol 6: 2555–2557, November, 2011 Acute Kidney Injury and Chronic Kidney Disease, Bydash and Ishani 2557 mation on whether patients with an AKI episode required Disclosures temporary dialysis or on its duration, a likely strong effect None. modifier. Also not reported is the number of individuals who progressed to ESRD and required chronic renal re- placement therapy by the end of the study, an outcome of References significant importance to both patients and clinicians. Fi- 1. Parikh CR, Coca SG, Wang Y, Masoudi FA, Krumholz HM: nally, it is likely that this study overestimates the risk of Long-term prognosis of acute kidney injury after acute myo- developing stage 4 CKD but not of mortality. Individuals cardial infarction. Arch Intern Med 168: 987–995, 2008 with CKD have fluctuations in their serum creatinine lev- 2. James MT, Ghali WA, Knudtson ML, Ravani P, Tonelli M, els, potentially resulting in temporary eGFR drops. These Faris P, Pannu N, Manns BJ, Klarenbach SW, Hemmelgarn BR: Associations between acute kidney injury and cardiovas- temporary declines of eGFR likely are not the result of cular and renal outcomes after coronary angiography. Circu- CKD stage progression, as they are not likely representa- lation 123: 409–416, 2011 tive of the patient’s true eGFR. It is possible that a number 3. Lo LJ, Go AS, Chertow GM, McCulloch CE, Fan D, Ordonez of individuals with these transient nonsustained dips in JD, Hsu C: Dialysis-requiring acute renal failure increases the kidney function, either from variation around their base- risk of progressive chronic kidney disease. Kidney Int 76: 893–899, 2009 line or from undergoing outpatient AKI episodes, are 4. Hsu C, Chertow GM, McCulloch CE, Fan D, Ordonez JD, Go flagged as having achieved stage 4 CKD, potentially mag- AS: Nonrecovery of kidney function and death after acute on nifying the risk attributable to AKI. Finally, it remains chronic renal failure. Clin J Am Soc Nephrol 4: 891–898, unknown how AKI episodes are associated with progres- 2009 sive CKD. Could it be that individuals with progressive 5. Newsome BB, Warnock DG, McClellan WM, Herzog CA, Kiefe CI, Eggers PW, Allison JJ: Long-term risk of mortality kidney disease have an increased risk of AKI, in which case and end-stage renal disease among the elderly after small the AKI episode is simply a marker of progressive kidney increases in serum creatinine level during hospitalization for disease? Alternatively, AKI may not be causal of progres- acute myocardial infarction.
Load more

Recommended publications
  • Inherited Renal Tubulopathies—Challenges and Controversies
    G C A T T A C G G C A T genes Review Inherited Renal Tubulopathies—Challenges and Controversies Daniela Iancu 1,* and Emma Ashton 2 1 UCL-Centre for Nephrology, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK 2 Rare & Inherited Disease Laboratory, London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Levels 4-6 Barclay House 37, Queen Square, London WC1N 3BH, UK; [email protected] * Correspondence: [email protected]; Tel.: +44-2381204172; Fax: +44-020-74726476 Received: 11 February 2020; Accepted: 29 February 2020; Published: 5 March 2020 Abstract: Electrolyte homeostasis is maintained by the kidney through a complex transport function mostly performed by specialized proteins distributed along the renal tubules. Pathogenic variants in the genes encoding these proteins impair this function and have consequences on the whole organism. Establishing a genetic diagnosis in patients with renal tubular dysfunction is a challenging task given the genetic and phenotypic heterogeneity, functional characteristics of the genes involved and the number of yet unknown causes. Part of these difficulties can be overcome by gathering large patient cohorts and applying high-throughput sequencing techniques combined with experimental work to prove functional impact. This approach has led to the identification of a number of genes but also generated controversies about proper interpretation of variants. In this article, we will highlight these challenges and controversies. Keywords: inherited tubulopathies; next generation sequencing; genetic heterogeneity; variant classification. 1. Introduction Mutations in genes that encode transporter proteins in the renal tubule alter kidney capacity to maintain homeostasis and cause diseases recognized under the generic name of inherited tubulopathies.
    [Show full text]
  • Aldosterone Resistance; a Rare Differential Diagnosis for Persistent Hyperkalemia
    MOJ Women’s Health Case Report Open Access Aldosterone resistance; a rare differential diagnosis for persistent hyperkalemia Abstract Volume 5 Issue 5 - 2017 In the human body, Aldosterone is an important hormone for sodium conservation in the kidneys, salivary glands, sweat glands and colon. Aldosterone is synthesized Muhammad Umair, Afsoon Razavi, Zehra exclusively in the zona glomerulosa of the adrenal gland. Significance of aldosterone Tekin, Issac Sachmechi production along with its appropriate action on the receptors is undeniable as far as Department of Medicine, Icahn School of Medicine, USA hemostasis of intracellular and extracellular electrolytes is concerned. Destruction or dysfunction of the adrenal gland in conditions such as primary adrenal insufficiency, Correspondence: Muhammad Umair, Department of congenital adrenal hypoplasia, isolated mineralocorticoid deficiency, acquired Medicine, Icahn School of Medicine at Mount Sinai/NYC Health secondary aldosterone deficiency (hyporeninemic hypoaldosteronism), acquired + Hospital/Queens Jamaica, Diabetes center, 4th floor, Suit primary aldosterone deficiency and inherited enzymatic defects in aldosterone P-432, pavilion building, Queens hospital center, 82-68 164th street, Jamaica, New York, USA, Tel +15163436454, biosynthesis cause clinical symptoms and laboratory characteristics owing to Email [email protected] aldosterone deficiency. Pseudohypoaldosteronism is an aldosterone resistance syndrome i.e. a condition due to insensitivity of target tissues to aldosterone resulting Received: July 25, 2017 | Published: August 09, 2017 in hyponatremia, hyperkalemia and metabolic acidosis. For a proper diagnosis of Aldosterone resistance; serum Sodium levels, serum Potassium levels, ACTH levels, plasma Renin and Aldosterone activity along with serum Cortisol levels play key roles. High doses of Fludrocortisone therapy helps in overcoming aldosterone resistance and assist in maintaining electrolyte balance in the body.
    [Show full text]
  • Uremic Toxins Affect Erythropoiesis During the Course of Chronic
    cells Review Uremic Toxins Affect Erythropoiesis during the Course of Chronic Kidney Disease: A Review Eya Hamza 1, Laurent Metzinger 1,* and Valérie Metzinger-Le Meuth 1,2 1 HEMATIM UR 4666, C.U.R.S, Université de Picardie Jules Verne, CEDEX 1, 80025 Amiens, France; [email protected] (E.H.); [email protected] (V.M.-L.M.) 2 INSERM UMRS 1148, Laboratory for Vascular Translational Science (LVTS), UFR SMBH, Université Sorbonne Paris Nord, CEDEX, 93017 Bobigny, France * Correspondence: [email protected]; Tel.: +33-2282-5356 Received: 17 July 2020; Accepted: 4 September 2020; Published: 6 September 2020 Abstract: Chronic kidney disease (CKD) is a global health problem characterized by progressive kidney failure due to uremic toxicity and the complications that arise from it. Anemia consecutive to CKD is one of its most common complications affecting nearly all patients with end-stage renal disease. Anemia is a potential cause of cardiovascular disease, faster deterioration of renal failure and mortality. Erythropoietin (produced by the kidney) and iron (provided from recycled senescent red cells) deficiencies are the main reasons that contribute to CKD-associated anemia. Indeed, accumulation of uremic toxins in blood impairs erythropoietin synthesis, compromising the growth and differentiation of red blood cells in the bone marrow, leading to a subsequent impairment of erythropoiesis. In this review, we mainly focus on the most representative uremic toxins and their effects on the molecular mechanisms underlying anemia of CKD that have been studied so far. Understanding molecular mechanisms leading to anemia due to uremic toxins could lead to the development of new treatments that will specifically target the pathophysiologic processes of anemia consecutive to CKD, such as the newly marketed erythropoiesis-stimulating agents.
    [Show full text]
  • Glomerulonephritis Management in General Practice
    Renal disease • THEME Glomerulonephritis Management in general practice Nicole M Isbel MBBS, FRACP, is Consultant Nephrologist, Princess Alexandra lomerular disease remains an important cause Hospital, Brisbane, BACKGROUND Glomerulonephritis (GN) is an G and Senior Lecturer in important cause of both acute and chronic kidney of renal impairment (and is the commonest cause Medicine, University disease, however the diagnosis can be difficult of end stage kidney disease [ESKD] in Australia).1 of Queensland. nikky_ due to the variability of presenting features. Early diagnosis is essential as intervention can make [email protected] a significant impact on improving patient outcomes. OBJECTIVE This article aims to develop However, presentation can be variable – from indolent a structured approach to the investigation of patients with markers of kidney disease, and and asymptomatic to explosive with rapid loss of kidney promote the recognition of patients who need function. Pathology may be localised to the kidney or further assessment. Consideration is given to the part of a systemic illness. Therefore diagnosis involves importance of general measures required in the a systematic approach using a combination of clinical care of patients with GN. features, directed laboratory and radiological testing, DISCUSSION Glomerulonephritis is not an and in many (but not all) cases, a kidney biopsy to everyday presentation, however recognition establish the histological diagnosis. Management of and appropriate management is important to glomerulonephritis (GN) involves specific therapies prevent loss of kidney function. Disease specific directed at the underlying, often immunological cause treatment of GN may require specialist care, of the disease and more general strategies aimed at however much of the management involves delaying progression of kidney impairment.
    [Show full text]
  • Urinalysis and Kidney Disease: What You Need to Know
    URINALYSIS AND KIDNEY DISEASE What You Need To Know www.kidney.org About the Information in this Booklet Did you know that the National Kidney Foundation (NKF) offers guidelines and commentaries that help your healthcare provider make decisions about your medical treatment? The information in this booklet is based on those recommended guidelines. Stages of Kidney Disease There are five stages of kidney disease. They are shown in the table below. Your healthcare provider determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your kidney function. Your treatment is based on your stage of kidney disease. Speak to your healthcare provider if you have any questions about your stage of kidney disease or your treatment. STAGES OF KIDNEY DISEASE Glomerular Stage Description Filtration Rate (GFR)* Kidney damage (e.g., protein 1 90 or above in the urine) with normal GFR Kidney damage with mild 2 60 to 89 decrease in GFR 3 Moderate decrease in GFR 30 to 59 4 Severe reduction in GFR 15 to 29 5 Kidney failure Less than 15 *Your GFR number tells your healthcare provider how much kidney function you have. As chronic kidney disease progresses, your GFR number decreases. What is a urinalysis (also called a “urine test”)? A urinalysis is a simple test that looks at a small sample of your urine. It can help find conditions that may need treatment, including infections or kidney problems. It can also help find serious diseases in the early stages, like chronic kidney disease, diabetes, or liver disease.
    [Show full text]
  • High Blood Pressure and Chronic Kidney Disease: for People
    HIGH BLOOD PRESSURE AND CHRONIC KIDNEY DISEASE For People with CKD Stages 1–4 www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-KDOQI™) has guidelines and commentaries that help your doctor and healthcare team make important decisions about your medical treatment? The information in this booklet is based on the NKF- KDOQI recommended guidelines and commentaries. What is your stage of kidney disease? There are five stages of kidney disease. They are shown in the table below. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your level of kidney function. Your treatment is based on your stage of kidney disease. Speak to your doctor if you have any questions about your stage of kidney disease or your treatment. STAGES of KidNEY DISEASE AGES of KidNEY DISEASE STAGES OF KIDNEY DISEASE Stage Description Glomerular Filtration Rate (GFR)* Kidney damage (e.g., protein 1 90 or above in the urine) with normal GFR Kidney damage with mild 2 60 to 89 decrease in GFR 3 Moderate decrease in GFR 30 to 59 4 Severe reduction in GFR 15 to 29 5 Kidney failure Less than 15 *Your GFR number tells your doctor how much kidney function you have. As chronic kidney disease progresses, your GFR number decreases. 2 NATIONAL KIDNEY FOUNDATION TABLE of ConTEntS Did you know? ...............................4 What is chronic kidney disease? ................5 What is high blood pressure? ...................6 How are high blood pressure and kidney disease related? ..............................6 How do I know if my blood pressure is too high? ..................................7 How is blood pressure measured? How often should it be checked? ...............8 I have high blood pressure but am not sure if I have CKD.
    [Show full text]
  • Role of Urinalysis in the Diagnosis of Chronic Kidney Disease (CKD)
    Research and Reviews Role of Urinalysis in the Diagnosis of Chronic Kidney Disease (CKD) JMAJ 54(1): 27–30, 2011 Kunitoshi ISEKI*1 Abstract As of the end of Year 2008, 1 out of 450 people was a dialysis patient in Japan, and patients with chronic kidney disease (CKD) at stages 3 and 4 accounted for nearly 10% of the total population. An epidemiological study in Okinawa that used the introduction of dialysis treatment as the outcome revealed that the 10-year cumulative incident rate of end-stage renal disease (ESRD) was about 3% of the participants who were positive (Ն 1ϩ) for both proteinuria and hematuria, while there was hardly any difference between those who were positive for hematuria alone and those who were negative for both proteinuria and hematuria. When the incidence of ESRD (dialysis introduction) was examined in relation to the severity of proteinuria (5 grades ranging from [Ϫ] to [Ն 3ϩ]) as determined by dipstick, the cumulative incidence rate during the 17-year observation period was 16% for proteinuria (Ն 3ϩ) and about 7% for proteinuria (2ϩ). In contrast, among participants who were negative for proteinuria, the rate of dialysis introduction in 10 years is about 1 out of 1 million. The CKD Practice Guide of the Japanese Society of Nephrology recommends referral to a nephrologist when a case meets any of the following 3 criteria: 1) 0.5g/g creatinine or higher, or proteinuria (Ն 2ϩ), 2) an estimated glomerular filtration rate of less than 50ml/min/1.73m2, or 3) positive results (Ն 1ϩ) for both proteinuria and hematuria tests.
    [Show full text]
  • Chronic Kidney Disease (Ckd)
    CHRONIC KIDNEY DISEASE ISSUE BRIEF prevent and control progressiveawareness obesity untreated end-stage renal disease kidney failure heart disease high blood pressure lifestyle changes stages complications family history damage to kidneys diabetes CKD few signs or symptoms PROGRESSION OF CHRONIC KIDNEY DISEASE (CKD) RISK FACTORS FOR CKD MAY INCLUDE ■ Heart Disease ■ Lupus ■ Diabetes ■ Family History of CKD ■ High Blood Pressure ■ Age ■ Obesity ■ High Cholesterol REDUCED INCREASED KIDNEY KIDNEY NORMAL KIDNEY RISK DAMAGE FUNCTION FAILURE Preventing CKD and its complications is possible by managing risk factors and treating the disease to slow its progression and reduce the risk of complications PROGRESSION OF CHRONIC KIDNEY DISEASE (CKD) What Is Chronic Kidney Disease? Fast Fact: Kidney diseases are the 9th leading cause of death in the United States. ■ Chronic kidney disease (CKD) is a condition in which a person has damaged kidneys or reduced kidney function for more than 3 months. During this time, the kidneys cannot properly filter waste out of the blood. If not detected and treated early, CKD can cause many health problems and even lead to kidney failure and early death. ■ CKD can start at any age, but the chances of developing it increase as people get older. It is most common among adults aged 70 years or older. ■ Once a person has CKD, it usually gets worse over time and lasts for the rest of the person’s life. Kidney failure—also called end-stage renal disease—is the final stage of CKD, when the kidneys stop working completely. How Big Is the CKD Problem and Who Is at Risk? Fast Fact: CDC estimates that more 6% than 20 million US adults aged 20 Unknown years or older have CKD—or more than 10% of the US adult population.
    [Show full text]
  • Chronic Kidney Disease: an Inherent Risk Factor for Acute Kidney Injury?
    Mini-Review Chronic Kidney Disease: An Inherent Risk Factor for Acute Kidney Injury? Prabhleen Singh, Dena E. Rifkin, and Roland C. Blantz Division of Nephrology-Hypertension, Department of Medicine, School of Medicine, University of California, San Diego, San Diego, California; and the Veterans Affairs San Diego Healthcare System, San Diego, California Epidemiologic evidence suggests that chronic kidney disease (CKD) is a risk factor for acute kidney injury (AKI) due to the prevalence of CKD in patients who have episodes of AKI. However, the high burden of comorbidities such as age, diabetes, peripheral vascular, cardiovascular, and liver disease accompanying CKD, and the difficulties of defining AKI in the setting of CKD make these observations difficult to interpret. These comorbidities not only could alter the course of AKI but also may be the driving force behind the epidemiologic association between CKD and AKI because of systemic changes and/or increased exposure to potential nephrotoxic risks. Here, we contend that studies suggesting that CKD is a risk factor for AKI may suffer from residual confounding and reflect an overall susceptibility to illness rather than biologic susceptibility of the kidney parenchyma to injury. In support of our argument, we discuss the clinical evidence from epidemiologic studies, and the knowledge obtained from animal models on the pathophysiology of AKI and CKD, demonstrating a preconditioning influence of the previously impaired kidneys against subsequent injury. We conclude that, under careful analysis, factors apart from the inherent pathophysiology of the diseased kidney may be responsible for the increased frequency of AKI in CKD patients, and the impact of CKD on the risk and severity of AKI needs further investigation.
    [Show full text]
  • Hematuria Is a Risk Factor Towards End-Stage Renal
    Nephrology and Renal Diseases Research Article Hematuria is a risk factor towards end-stage renal disease - A propensity score analysis Tomoko Shima* Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan Abstract Background: It remains unclear whether microscopic hematuria accelerates the progression of chronic kidney disease (CKD). Since the risk of microscopic hematuria was expected very weak, we employed a propensity score analysis. Methods: A retrospective CKD cohort of 803 participants in a single institution was analyzed. The degree of microscopic hematuria was scaled as 0, 0.5, 1, 2, 3 for negative, ±, 1+, 2+, 3+ in the urinary qualitative analysis by dipstick, respectively. Time-averaged microscopic hematuria (TA-MH) was calculated by trapezoidal rule. The propensity score was estimated using 23 baseline covariates by multivariate binary logistic regression for the threshold of TA-MH at ≥ 0.5 or ≥ 1.0. Kaplan-Meier analysis after propensity score matching was also examined. Results: The incidence rate of end-stage renal disease (ESRD) was 33.9 per 1,000 person-years over median follow-up of 4.3 years. A Cox regression analysis stratified by quintile on the propensity scores showed that TA-MH ≥ 0.5 was a risk for ESRD (HR 1.72, 95% CI 1.08-2.75, p = 0.023) but not TA-MH ≥ 1.0 (HR 1.34, 95% CI 0.76-2.40, p = 0.315). Kaplan-Meier analysis after propensity score matching reproduced the similar results (TA-MH ≥ 0.5, HR 1.80, 95% CI 1.03-3.12, p = 0.046; TA-MH ≥ 1.0, HR 1.73, 95% CI 0.84-3.54, p = 0.145).
    [Show full text]
  • 2012 CKD Guideline
    OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease VOLUME 3 | ISSUE 1 | JANUARY 2013 http://www.kidney-international.org KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease KDIGO gratefully acknowledges the following consortium of sponsors that make our initiatives possible: Abbott, Amgen, Bayer Schering Pharma, Belo Foundation, Bristol-Myers Squibb, Chugai Pharmaceutical, Coca-Cola Company, Dole Food Company, Fresenius Medical Care, Genzyme, Hoffmann-LaRoche, JC Penney, Kyowa Hakko Kirin, NATCO—The Organization for Transplant Professionals, NKF-Board of Directors, Novartis, Pharmacosmos, PUMC Pharmaceutical, Robert and Jane Cizik Foundation, Shire, Takeda Pharmaceutical, Transwestern Commercial Services, Vifor Pharma, and Wyeth. Sponsorship Statement: KDIGO is supported by a consortium of sponsors and no funding is accepted for the development of specific guidelines. http://www.kidney-international.org contents & 2013 KDIGO VOL 3 | ISSUE 1 | JANUARY (1) 2013 KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease v Tables and Figures vii KDIGO Board Members viii Reference Keys x CKD Nomenclature xi Conversion Factors & HbA1c Conversion xii Abbreviations and Acronyms 1 Notice 2 Foreword 3 Work Group Membership 4 Abstract 5 Summary of Recommendation Statements 15 Introduction: The case for updating and context 19 Chapter 1: Definition, and classification
    [Show full text]
  • Chronic Kidney Disease Objective
    Clinical Practice Guidelines Chronic Kidney Disease Objective Guide the appropriate diagnosis and management of Chronic Kidney Disease. Guideline MDwise supports chronic kidney disease management recommendations from the National Kidney Foundation National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis 39:S1-S266, 2002 (suppl 1) KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update Guidelines are included in the MDwise Provider Manual and posted on the MDwise Web site. They are available individually as requested. Diagnosis and Staging Asthma is a heterogeneous disease usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and intensity, together with variable expiratory limitation. Medication Options DIAGNOSIS: (1) CKD defined as either kidney damage or GFR <60 mL/min/1.73m2 for ≥ 3 months; kidney damage refers to pathological abnormalities or markers of damage, including lab abnormalities (2) definitive diagnosis: biopsy or imaging studies; usually only needed if not well-defined clinical presentation and minimal identified causal factors (3) factors that may guide diagnosis include: symptoms during urination, infections, diabetes, heart failure, cirrhosis, hypertension, other disease states, family history of kidney disease. FIVE STAGES OF CKD: Stage 1: (1) kidney damage with normal OR increased
    [Show full text]