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Staging of Chronic Kidney Disease

Staging of Chronic Kidney Disease. I.N. Slotki, MD Division of Adult Nephrology Shaare Zedek Medical Center. Reasons for diagnosing CKD. Common- >10% of population (US) Largely unidentified or ignored Rx available to prevent or delay progression Probably largest single risk factor for CVD

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Staging of Chronic Kidney Disease

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  1. Staging of Chronic Kidney Disease I.N. Slotki, MD Division of Adult Nephrology Shaare Zedek Medical Center

  2. Reasons for diagnosing CKD • Common- >10% of population (US) • Largely unidentified or ignored • Rx available to prevent or delay progression • Probably largest single risk factor for CVD • >50% of CKD patients die from CVD • Rx of ESRD is expensive • Numbers of patients reaching ESRD are steadily increasing

  3. Global maintenance dialysis population 1990-2010 2095 Thousands of patients 1065 426 Lysaght JASN 2002

  4. People at increased risk of CKD • Normal GFR + markers of kidney damage • Risk factors for adverse outcomes of CKD

  5. Risk factors for CKD and its outcomes Susceptibility Initiation Progression End-stage

  6. Risk factors for CKD and its outcomes • Factors that susceptibility to kidney damage • Age • Family history • Kidney mass • Low birthweight • Low income/education Susceptibility

  7. Risk factors for CKD and its outcomes • Factors that directly initiate kidney damage • Diabetes • HTN • Hereditary diseases • Autoimmune diseases • Systemic infections • UTIs • Lower tract obstruction • Drug toxicity Initiation

  8. Risk factors for CKD and its outcomes • Factors that cause worsening kidney damage & faster decline in kidney function • proteinuria • BP • Poor glycemic control in diabetics • Smoking • ?Hyperlipidemia Progression

  9. Risk factors for CKD and its outcomes • Factors that morbidity & mortality in kidney failure • Anemia • albumin • dialysis dose • Temporary vascular access End-stage • Late nephrology referral

  10. Markers of kidney damage • Kidney damage for 3 months • Proteinuria (albumin/creatinine ratio >30 mg/g in spot urine) • Abnormal sediment • Abnormal blood or urine chemistry • Abnormal imaging studies • Kidney function for 3 months

  11. Reasons for staging renal disease • Confusion in terminology • Chronic renal • failure • insufficiency • disease • Advanced renal failure • ESRD • Pre-dialysis Mild/Moderate/Severe

  12. Stages of CKD

  13. Estmating GFR הנוסחה ע"ש Cockroft & Gault (140-age) x Weight x 0.85 בנשים Plasma creatinine x 72

  14. Optimal Care of Chronic Kidney Disease

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