Friday, July 15, 2011

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Stages of Chronic Kidney Diseases


The table above shows how chronic kidney diseases are classified.

Risk factors include hypertension, diabetes mellitus, autoimmune disease, older age, African ancestry, a family history of renal disease, a previous episode of acute renal failure, and the presence of proteinuria, abnormal urinary sediment, or structural abnormalities of the urinary tract.

Stage 0
Not commonly included in many classifications but in this stage there is no kidney damage evident but patients have one or more risk factors mentioned above.

Stage 1
Kidney damage is there demonstrated by persistent proteinuria, abnormal urine sediment, abnormal blood and urine chemistry, abnormal imaging studies but GFR i.e kidney function will be normal.

Stage 2
Kidney damage is there and slight decrease in kidney funtion.

Stage 3-5
The older term chronic renal failure corresponds to these stages. It is characterized by a progressive, significant and irreversible kidney damage with a GFR < 60 for 3 months or more that eventually will result into End Stage Renal Disease (ESRD) i.e. stage 5.

In stages 1 to 3, the causes of the CKD are treated along with some lifestyle modifications.
In stage 4, treatment is continued along with preparation for kidney replacement therapy.
In stage 5, replacement therapy is essential for survival.

Thus if we use Cockcroft-Gault formula to estimate the creatinine clearance for a 45 year old male weighing 70 Kg, we should start preparing for kidney replacement therapy if his creatinine level reaches 270 μmol/L.
Dialysis to be done for survival if the creatinine level reaches 530 μmol/L or more.

2 comments:

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