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Secondary factors and progression of chronic kidney disease

Authors
George L Bakris, MD
John P Forman, MD, MSc
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

A variety of chronic kidney diseases progress to end-stage renal disease (ESRD), including chronic glomerulonephritis, diabetic nephropathy, and polycystic kidney disease. Although the underlying problem often cannot be treated, extensive studies in experimental animals and humans suggest that progression in chronic kidney disease (CKD) may be largely due to secondary factors that are sometimes unrelated to the activity of the initial disease. These include systemic and intraglomerular hypertension, glomerular hypertrophy, the intrarenal precipitation of calcium phosphate, hyperlipidemia, and altered prostanoid metabolism (table 1) [1-5].

The major histologic manifestation of these secondary causes of renal injury is focal segmental glomerulosclerosis, which is called secondary FSGS [2]. Thus, glomerular damage and proteinuria typically occur with progressive renal failure, even in primary tubulointerstitial diseases such as chronic pyelonephritis due to reflux nephropathy. (See "Epidemiology, classification, and pathogenesis of focal segmental glomerulosclerosis", section on 'Secondary FSGS'.)

The use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptors blockers to treat some of these secondary mechanisms and slow disease progression are discussed separately. (See "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults".)

CLINICAL PREDICTORS OF ACCELERATED PROGRESSION

A large amount of data exist concerning the general clinical characteristics of patients in whom the progression of renal dysfunction is accelerated [5-14]. As an example, multivariate analysis of the Modification of Diet in Renal Disease Study database of 840 patients with diverse renal diseases found that the following clinical characteristics were independent predictors of a faster decline in glomerular filtration rate (GFR) [6]:

Greater proteinuria

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Jan 21 00:00:00 GMT 2016.
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