Module 1: Understanding Chronic Kidney Disease (ckd)

The kidneys have many functions

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• Endocrine function
• Produce renin for blood pressure control
• Produce erythropoietin which stimulates marrow production of red blood cells
• Activate 25(OH)D to 1,25 (OH)2D (active vitamin D)
• Metabolic function
• Gluconeogenesis
• Metabolize drugs and endogenous substances (e.g., insulin)

CKD usually means fewer functioning nephrons

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Fewer nephrons disrupt the balance

• Urine volume may not change
• Composition of the urine changes
• Reduced waste excretion
• May not be apparent until CKD is advanced
• Altered hormone production
• Anemia (erythropoietin) and mineral & bone disorders (vitamin D) may develop
• Reduced catabolism
• Examples: Insulin, glucagon, drugs

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Fewer nephrons disrupt the balance

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• Reduced renal clearance and accumulation of:
• Advanced glycation end products
• Pro-inflammatory cytokines
• Reactive oxygen species (oxidation)
• Metabolic acids
• Insulin resistance (even in people without diabetes)
• Reduces insulin-mediated glucose uptake in skeletal muscles
• May be associated with inflammation

Identify and monitor CKD

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• Identify and monitor CKD
• FUNCTIONAL ASSESSMENT

CKD is reduced kidney function and/or kidney damage

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• Chronic Kidney Disease
• Kidney function
• Glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 for > 3 months with or without kidney damage
• AND/OR
• Kidney damage
• > 3 months, with or without decreased GFR, manifested by either
• Pathological abnormalities
• Markers of kidney damage, i.e., albuminuria
• Urine albumin-to-creatinine ratio (UACR) > 30 mg/g

• Reference: Kidney International Supplements, 2013; 3(1): 5-14