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How does early chronic kidney disease progress?
A Background Paper prepared for the UK Consensus Conference on Early Chronic Kidney Disease
Renal Unit, Royal Infirmary of Edinburgh
Correspondence to: Wendy Metcalfe. Email: Wendy.Metcalfe@luht.scot.nhs.uk
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Introduction |
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Chronic Kidney Disease (CKD) may arise due to a multitude of different insults to renal function. However despite the wide range of pathological processes that may induce renal injury, substantial loss of nephrons provokes a common syndrome characterized clinically by systemic hypertension, proteinuria and a progressive decline in glomerular filtration rate (GFR) and patho-physiologically by progressive interstitial fibrosis, peritubular capillary loss with hypoxia and destruction of functioning nephrons because of tubular atrophy [1]. Extensive studies suggest that the rate of loss of GFR, that is the rate of progression of CKD, may be largely due to common secondary factors, often unrelated to the initial disease [2].
Some of these factors such as age and race are not open to intervention. The majority, however, provide at least a potential for intervention in order to slow or halt the progression of early CKD.
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Factors influencing the progression of CKD |
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Intra-glomerular haemodynamic factors
In rat models, subtotal nephrectomy
Tubulo-interstitial disease
Clinically evident factors predicting accelerated progression of CKD
Other factors
Patient-specific factors
Lifestyle factors
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Conclusion |
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