I PART. Chronic Kidney Disease (CKD1-5)

The lecture presents material on the definition of CKD, the stage of CKD, and links to a calculator. During the lecture, the student will need to complete 2 tasks: 1 task - calculate your own glomerular filtration rate, taking into account serum creatine, age and gender, and also determine whether there are signs of CKD; Task 2 - assess the degree of progression of CKD.

Chapter 1. Definition of CKD, criteria for the diagnosis

Chronic kidney disease is defined as an abnormality of kidney structure or function with implications on the health of an individual, and it is present for more than three months Chronic kidney disease is a general term for heterogeneous disorders affecting kidney structure and function with variable clinical presentation. Rational approach
to the diagnosis and evaluation of CKD involves simultaneous assessment and monitoring of renal function (through estimated glomerular filtration rate (eGFR), serum creatinine) and kidney damage (albuminuria and/or proteinuria):
Markers of kidney damage (one or more)* 1. Albuminuria (AER ≥ 30 mg/24 hours; ACR ≥ 3 mg/mmol)
                                                                2. Urine sediment abnormalities
                                                                3. Electrolyte and other abnormalities due to tubular disorders
                                                                4. Abnormalities detected by histology
                                                                5. Structural abnormalities detected by imaging
                                                                6. History of kidney transplantation
Decreased GFR*                                       GFR < 60 mL/min/1.73 m2 (GFR categories G3a - G5)
*Either of the following should be present for > 3 months.
AER - albumin excretion rate. ACR - albumin-to-creatinine ratio. GFR - glomerular filtration rate.
(KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, Suppl 2013;3:1-150.)

One of the prominent criteria for the diagnosis of CKD is decreased GFR value (< 60 mL/min/1.73m2). GFR is widely accepted as the best index of kidney function. The normal value in young adult men and woman is approximately 125 mL/min/1.73m2.  Values below 15 mL/min/1.73m2 indicate kidney failure and the person can be identified as a candidate for dialysis or renal replacement therapy/kidney transplantation.  The role of laboratoryк medicine in diagnosis and management of CKD is of great importance because a very simple test can identify people who are at risk of developing CKD.  All that is required is measuring the concentration of serum creatinine and reporting of eGFR, using the available predictive equations.
(iljak VR, Honović L, Matica J, Krešić B, Vojak SŠ. The role of laboratory testing in detection and classification of chronic kidney disease: national recommendations. Biochem Med (Zagreb). 2017 Feb 15;27(1):153-176. doi: 10.11613/BM.2017.019. PMID: 28392738; PMCID: PMC5382859.)