Definition:
↓ GFR (<60 mL\min) or kidney damage for > 3 months
| Stage 1 | Kidney damage + normal GFR | GFR > 90 |
| Stage 2 | Kidney damage + ↓ GFR | GFR: 60-89 |
| Stage 3 | Moderate ↓ GFR | GFR: 30-59 |
| Stage 4 | Severe ↓ GFR | GFR: 15-29 |
| Stage 5 | Kidney failure | GFR <15 or dialysis |
Causes:
- MCC is diabetes, followed by HTN
- Chronic GN
- Interstitial nephritis, polycystic kidney injury, obstructive uropathy
Clinical features:
- HTN: secondary to salt\water retention (↓ GFR -> stimulate renin-angiotensin -> ↑ aldo)
- CHF: due to volume overload, HTN, anemia
- Normocytic normochromic anemia: due to ineffective erythropoiesis
- ↓ renal clearance of phosphate -> hyperphosphatemia -> ↓ renal production of 1,25 dihydroxyl vit D -> hypocalcemia -> secondary hyperparathyroidism -> renal osteodystrophy
- Pruritus
- Electrolytes disturbances: hyperkalemia, hypermagnesemia, metabolic acidosis
Diagnosis:
- Same investigations done in AKI
- Renal US: small kidneys
Treatment:
- Diet: low protein (0.7-0.8 g\kg\d), low salt (if volume overload), restrict K, Mg, P
- ACEI: dilate efferent arterioles -> ↓ progression to ESRD
- For hyperphosphatemia -> give calcium citrate (phosphate binder)
Download the PDF version: here
References:
- Step up to medicine
- Master the boards
