Chronic Kidney Disease
Chronic kidney disease (CKD) is a pathological status characterized by decreased glomerular filtration rate (GFR) due to various reasons and with potentially fatal outcome. It affects more than 25 % of the population aged 60 years or older in the United S
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Introduction to Chronic Kidney Disease Chronic kidney disease (CKD) is a pathological status characterized by decreased glomerular filtration rate (GFR) due to various reasons and with potentially fatal outcome. It affects more than 25 % of the population aged 60 years or older in the United States. The most common causes of CKD are diabetes (see chapter “Diabetes mellitus”) and hypertension (see chapter “Hypertension”) collectively being responsible for about 75 % of patients requiring renal replacement therapy. There is a decline in renal function that occurs in the general population with advancing age, with an approximate loss of GFR of 1 ml/min/ year of age after about 30 (starting at a GFR of 100–120 ml/min/1.73 m2). As expected, the loss is greater among subjects with underlying risk. Proteinuria is a marker renal injury and may contribute to loss of renal function further injuring the kidney directly. CKD is diagnosed and clas-
G. Odabaei • S. Ananthakrishnan Division of Nephrology, University of California-Davis, 4150 V Street, Suite 3500, Sacramento, CA 95817, USA e-mail: [email protected]; [email protected] G.A. Kaysen (*) Division of Nephrology, Department of Biochemistry and Molecular Medicine, University of California-Davis, GBSF 451 East Health Sciences Drive, Davis, CA 95616, USA e-mail: [email protected]
sified into five stages according to the GFR, and its clinical symptoms are presented in Table 1. CKD is often diagnosed due to fatigue caused by anemia and azotemia, but these symptoms only appear late in the course of progression (usually stage IV or greater). This chapter will expand on metabolic issues associated with CKD and its management.
Pathophysiology of Chronic Kidney Disease and Metabolic Alterations CKD results in pathological metabolic changes, namely, increased risk of cardiovascular disease (see chapter “Atherosclerotic heart disease”), disturbances in mineral and electrolyte metabolism, anemia, and uremia, corresponding to the disease stage.
Cardiovascular Disease The kidney performs an essential role in maintenance of volume and electrolyte homeostasis (see chapter “Overview” under the part “Kidney”). The part of the extracellular fluid that is in the arterial system leading to perfusion of the tissues is called the effective circulating volume [1]. It is regulated neurologically and hormonally by natriuretic peptides (atrial and brain natriuretic factors, see chapter “Overview” under the part “Heart”) and the renin-angiotensin-aldosterone system (RAAS, originating in the kidney) to
E. Lammert, M. Zeeb (eds.), Metabolism of Human Diseases, DOI 10.1007/978-3-7091-0715-7_50, © Springer-Verlag Wien 2014
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346 Table 1 Stages of chronic kidney disease Stage GFR (ml/min/1.73 m2) Clinical features
1 2 60–90 >90 Subtle, asymptomatic
3 4 15–30 30–60 Anemia, risk of CVD, disturbed electrolytes and minerals
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