Abstract
Chronic kidney disease is a worldwide health problem. The incidence and prevalence of kidney failure is in constant increase, involving poor outcomes and high costs. The leading causes of kidney failure are type 2 diabetes and hypertension. The new initiative "Kidney Disease Improving Global Outcomes (KDIGO)" is a global public health approach to face this problem. A formal definition for chronic kidney disease and a staging of kidney diseases from kidney damage with preserved function to kidney failure, were proposed. We reviewed the main mechanisms involved in renal disease progression, with emphasis in the proteinuria and the intrarenal activation of renin angiotensin system. Moreover, the evidence in the literature of therapeutical interventions with proved efficacy in slowing the rate of reduction of renal function is discussed, particularly the optimal control of hypertension, reduction of proteinuria and renin angiotensin system blocking. Finally, we recommend a strategy for the clinical management of patients in the different stages of chronic kidney disease.
Highlights
Chronic kidney disease is a worldwide health problem
We reviewed the main mechanisms involved in renal disease progression, with emphasis in the proteinuria and the intrarenal activation of renin angiotensin system
41 KLAHR S, LEVEY AS, BECK GJ, CAGGIULA AW, HUNSICKER L, KUSEK JW ET AL
Summary
Actualmente, las principales causas de ERC son en primer lugar la diabetes y luego la hipertensión arterial, que en conjunto representan aproximadamente 60% de los pacientes en diálisis crónica. Con el fin de introducir una terminología uniforme, la National Kidney Foundation (NKFUSA), en su Iniciativa para la Mejoría de los Resultados Globales en Enfermedades Renales (Kidney Disease Improving Global Outcome - KDIGO)[5,6], ha propuesto recientemente una definición formal para la ERC. La evidencia del daño estructural potencialmente progresivo puede derivar de un estudio histológico o imagenológico, o de las alteraciones persistentes del examen de orina por un plazo superior a tres meses, particularmente la presencia de albuminuria. De acuerdo al KDIGO, una VFG inferior a 60 mL corresponde a una ERC, sin requerir evidencia adicional de daño renal estructural. Am J Kidney Dis 2002; 39 (suppl 1): S1-S266
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