Chapter 142: Chronic Kidney Disease and Uremia


The prevalence of chronic kidney disease (CKD), generally defined as a long-standing, irreversible impairment of kidney function, is substantially greater than the number of pts with end-stage renal disease (ESRD), now ≥500,000 in the United States. There is a spectrum of disease related to decrements in renal function; clinical and therapeutic issues differ greatly depending on whether the glomerular filtration rate (GFR) reduction is moderate (stage 3 CKD, 30–59 mL/min per 1.73 m2) (see Table 48-1), severe (stage 4 CKD, 15–29 mL/min per 1.73 m2), or “end-stage renal disease” (stage 5 CKD, <15 mL/min per 1.73 m2). Dialysis is usually required once GFR <10 mL/min per 1.73 m2. Common causes of CKD are outlined in Table 142-1.

TABLE 142-1: Common Causes of Chronic Renal Failure
Diabetic nephropathy
Hypertensive nephropathya
Renovascular disease (ischemic nephropathy)
Polycystic kidney disease
Reflux nephropathy and other congenital renal diseases
Interstitial nephritis, including analgesic nephropathy
HIV-associated nephropathy
Transplant allograft failure (“chronic rejection”)
aOften diagnosis of exclusion; very few pts undergo renal biopsy; may be occult renal disease with hypertension.

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