BACKGROUND

Chronic kidney disease is a major public health problem. However, no study to date has estimated the prevalence of chronic kidney disease base on the clinical guidelines established by the National Kidney Foundation and few studies have explored the rate of diagnoses by primary care providers.

PROGNOSIS

The prognosis of patients with chronic kidney disease is guarded as epidemiological data has shown that all cause mortality (the overall death rate) increases as kidney function decreases.

The leading cause of death in patients with chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5.

While renal replacement therapies can maintain patients indefinitely and prolong life, the quality of life is severely affected.

Renal transplantation increases the survival of patients with stage 5 CKD significantly when compared to other therapeutic options; however, it is associated with an increased short-term mortality (due to complications of the surgery).

Transplantation aside, high intensity home hemodialysis appears to be associated with improved survival and a greater quality of life, when compared to the conventional three times a week hemodialysis and peritoneal dialysis

COMMON CAUSES

The most common causes of CKD are diabetic nephropathy, hypertension, and glomerulonephritis. Together, these cause approximately 75% of all adult cases. Certain geographic areas have a high incidence of HIV nephropathy.
1.) Vascular, includes large vessel disease such as bilateral renal artery stenosis and small vessel disease such as ischemic nephropathy, hemolytic-uremic syndrome and vasculitis

2.) Glomerular, comprising a diverse group and subclassified into

• a.) Primary Glomerular disease such as focal segmental glomerulosclerosis and IgA nephritis


• b.) Secondary Glomerular disease such as diabetic nephropathy and lupus nephritis
  

3.) Tubulointerstitial including polycystic kidney disease, drug and toxin-induced chronic tubulointerstitial nephritis and reflux nephropathy

• a.) Polycystic kidney disease (PKD, also known as polycystic kidney syndrome) is a progressive, ciliopathic, genetic disorder of the kidneys. It occurs in humans and other organisms. PKD is characterized by the presence of multiple cysts (hence, "polycystic") in both kidneys. The disease can also damage the liver, pancreas, and rarely, the heart and brain. The two major forms of polycystic kidney disease are distinguished by their patterns of inheritance.


• b.) Reflux nephropathy, RN is a term applied when small and scarred kidneys (chronic pyelonephritis, CPN) are associated with vesico-ureteric reflux (VUR). CPN being the commonest cause, there are other causes including analgesic nephropathy and obstructive injury. Scarring is essential in developing RN and occurs almost during the first five years of life. The end results of RN are hypertension, proteinuria, CRF and eventually ESRD, end stage renal disease.

4.) Obstructive such as with bilateral kidney stones and diseases of the prostate

• a.) The prostate (from Greek p??st?t?? - prostates, literally "one who stands before", "protector", "guardian" is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Women do not have a prostate gland, although women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate.
  
  

The prostate differs considerably among species anatomically, chemically, and physiologically.

STAGES

• 1.) All individuals with a Glomerular filtration rate (GFR) <60>
  
• 2.) All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR. The rationale for including individuals with GFR 60 mL/min/1.73 m2 is that GFR may be sustained at normal or increased levels despite substantial kidney damage and that patients with kidney damage are at increased risk of the two major outcomes of chronic kidney disease: loss of kidney function and development of cardiovascular disease.