Definition

[1]
Chronic Kidney Disease (also CKD, Chronic Renal Failure, CRF) is reduced renal function (GFR<60) for a period of more than three months.

Prevalence

[2]
It is estimated that approximately 10% of people have CKD

Age

Increased risk with age

Gender

Males 1.5x more likely[3]

Aetiology

[4]

Risk Factors

[5]

Signs and Symptoms

[6]

Pathophysiology

[7]
While there are many triggers for Chronic Renal Failure similar pathology occurs thereafter.
  • The kidney attempts to increase hydrostatic pressure to overcome reduced filtration
  • This increases permeability of the glomerulus to growth factors and pro-inflammatory markers
  • This causes cell proliferation and fibrosis.
  • Kidney Injury also leads to Angiotensin II and growth factor release which also causes fibrosis.
  • Fibrosis is also linked with other cellular and biochemical changes

Investigations

[8]

Diagnosis

[9]
Diagnosis relies on evidence of kidney damage (proteinuria or haematuria) or reduced eGFR.

Classification

Usually only stages IV and V are symptomatic
Stage
eGFR (mL/hr/1.73m^2)
I
60-89
II
45-59
III
30-44
IV
16-29
V
<15 (End Stage Kidney Disease)

Differentials to rule out

Acute Kidney Injury

Treatment

[10]

Non-pharmacological

  • Dialysis (ESKD - End Stage Kidney Disease)
  • Activated Charcoal for itch

Pharmacological

Surgical

  • Kidney Transplant (End Stage Kidney Disease)

Management

[11]
  • Treat complications
  • Monitor every 12 months - patients with risk factors
  • Monitor every 6-12 months patients with stage III disease
  • Monitor every 3-6 months patients with stage IV disease
  • Monitor every 1-3 months patients with stage V disease

Complications

[12]

Prognosis

[13]
Chronic Kidney Disease has no cure and will eventually lead to end-stage kidney disease. Its progression can be slowed though glycaemic control and risk factor management.

See Also

BMJ Best Practice - Chronic Renal Failure

[14]
  1. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  3. ^ http://www.kidney.org.au/LinkClick.aspx?fileticket=WfW5Z6H5Rt4%3D&tabid=846&mid=1962
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  5. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  11. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  12. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  13. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html
  14. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/84.html