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The management of hypertension in renal disease is best understood by classifying patients according to the stage of their chronic kidney disease (CKD). Many of the pathophysiological mechanisms are common to all patients, but in post-transplant recipients there are additional factors to be considered. The benefits of good blood pressure control in CKD 3/4 are a slowing in the rate of progression...
The assessment of patients with renal disease is an important clinical skill as these patients can present to any hospital department, or in the community. This article provides the reader with a straightforward and logical approach to patients presenting with renal disease, by dividing them into three categories: acute kidney injury (AKI), sub-acute or intrinsic renal disease, such as glomerulonephritis,...
Kidney function is typically assessed by measuring the glomerular filtration rate (GFR) and many approaches have been used. Accuracy demands complex techniques involving the use of exogenous filtration markers (e.g. inulin, iohexol, 99m Tc-diethylenetriaminepentaacetic acid, 125 I-iothalamate, and 51 Cr-ethylenediaminetetraacetic acid). For most clinical purposes, accuracy...
Chronic kidney disease (CKD) is common and increasingly recognized as a risk factor for premature cardiovascular disease (CVD). In patients with end stage renal disease (ESRD) requiring dialysis the risk of CVD is even greater, approximately 20 times that of the general population. Conventional cardiovascular risk factors such as diabetes, hypertension, smoking and hyperlipidaemia exacerbate both...
Chronic kidney disease (CKD) is a common condition that has significant implications for patients’ health and healthcare budgets. CKD is diagnosed if evidence of kidney damage has been present for more than 3 months; it is divided into five stages depending on the glomerular filtration rate (GFR). CKD is asymptomatic and determining its prevalence relies on screening populations, so the reported prevalence...
Sustained loss of kidney function leads to the evolution of progressive secondary hyperparathyroidism associated with a characteristic high-turnover form of metabolic bone disease. The drivers to hyperparathyroidism include the failure of renal bioactivation of vitamin D, phosphate retention and, in some cases, hypocalcaemia. As renal impairment becomes more severe, some patients, particularly under...
Management of chronic kidney disease (CKD) requires a systematic approach that includes all components of the chronic disease model. National guidelines are now available for the identification, management and referral of CKD. Some causes of CKD require specific additional management directed at the underlying cause. For many patients, control of cardiovascular risk factors is the most important intervention,...
Anaemia is a common complication of chronic kidney disease. Of the various contributory factors, the most important is an inappropriately low circulating concentration of erythropoietin, a hormone largely produced by the peritubular cells of the kidney. Chronic anaemia causes debilitating symptoms, particularly if severe, including tiredness and lethargy, muscle fatigue, reduced exercise capacity...
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