What is Chronic Kidney Disease (CKD)?
The non-communicable CKD based on prolonged kidney dysfunction is categorized under multiple kidney function stages (Fraser, 2016). The functional status of the kidney is determined through the glomerular filtration rate (GFR). The conditions including metabolic diseases, anemia, hypertension, and cardiovascular disease potentially elevate the risk of GFR reduction and kidney dysfunction. The kidney function assessment warrants regular investigation of estimated glomerular filtration rate (eGFR) based on serum creatinine. The nephron loss in kidneys under the impact of chronic/acute disease insults potentially elevates the burden of the healthy nephrons that are forced to undergo adaptive hyperfiltration. This episode, if sustained for a longer duration, leads to irreversible glomerular deterioration. Eventually, the progressive loss of kidney function and proteinuria elevate clinical complications to an unprecedented level. The clinicians advocate the need for early identification of CKD in the context of reducing the risk of acute kidney injury (AKI) and its clinical complications. The functional assessment of the kidney is based on the following standard parameters configured by KDIGO (Kidney Disease Improving Global Outcomes). The standard unit of GFR is ml/min/1.73meter square in the context of the following parameters (Fraser, 2016).
The normal stage of kidney function (G1) is determined by the GFR of greater than 90.
The mildly reduced stage of kidney function (G2) is indicated by the GFR within the range of 60-89.
The mildly/moderately reduced stage of kidney function (G3a) is revealed by a GFR of 45-59.
The moderately to severely reduced stage of kidney function (G3b) is affirmed by a GFR of 30-44.
The severely reduced stage of kidney function (G5) is testified by a GFR of 15-29.
The kidney failure (G5) stage is revealed by a GFR of less than 15.
The persistent albuminuria (A1) category of kidney function is determined by the albumin level of greater than 30mg/g or less than 3mg/mmol. A1 category reveals mildly elevated or normal urine albumin levels.
The persistent albuminuria (A2) category reveals a moderately elevated urine albumin level of 30-300 mg/g or 3-30mg/mmol.
The persistent albuminuria (A3) category testifies a severely elevated urine albumin level of greater than 300 mg/g or 30mg/mmol.
The individuals at a reduced risk of kidney dysfunction do not exhibit albuminuria or sometimes exhibit a little albuminuria and a mildly reduced or normal eGFR (i.e. A1 and/or G2 or G1).
Individuals with a moderate albuminuria and eGFR of greater than 60 ml/min/1.73meter square experience an elevated risk of kidney dysfunction.
The measurement of albuminuria is based on ACR (urinary albumin/creatinine ratio)
Both albuminuria and eGFR independently determine a range of non-renal and renal outcomes based on AKI, cardiovascular disease, and end-stage renal disease (ESRD)
CKD affirmation is based on the following standard parameters (Fraser, 2016).
A marked reduction in GFR below 60ml per minute per 1.73 square meters in the absence of other renal deterioration for greater than three months.
Presence of proteinuria, which is a kidney damage marker.
The functional and structural deterioration of kidney for greater than three months with or without glomerular filtration rate reduction, with associated pathological abnormalities and kidney damage markers (affirmed through imaging tests and urine/blood findings).
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