Chronic kidney disease
Conceptual model, defi nitions, and outcomes
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levey2012
Conceptual model, defi nitions, and outcomes
Figure 1 shows a conceptual model for the development, progression, and complications of chronic kidney disease. 1,4 The model includes antecedents associated with increased risk, disease stages, and complications including death. Risks can be categorised either as susceptibility to kidney disease because of sociodemographic and genetic factors, or as exposure to factors that can lead to disease. Early stages of disease are often asymptomatic, are detected during the assessment of comorbid disorders, and can be reversible. Rapidly progressive diseases can lead to kidney failure within months; however, most diseases evolve over decades and some patients do not progress during many years of follow-up. The defi nition of chronic kidney disease is based on the presence of kidney damage (ie, albuminuria) or decreased kidney function (ie, glomerular fi ltration rate [GFR] <60 mL/min per 1·73 m²) for 3 months or more, irrespective of clinical diagnosis (panel 1). 1,10,11 Because of the central role of GFR in the pathophysiology of complications, the disease is classifi ed into fi ve stages on the basis of GFR: more than 90 mL/min per 1·73 m² (stage 1), 60–89 mL/min per 1·73 m² (stage 2), 30–59 mL/min per 1·73 m² (stage 3), 15–29 mL/min per 1·73 m² (stage 4), and less than 15 mL/min per 1·73 m² (stage 5). Findings from experimental and clinical studies have suggested an important role for proteinuria in the pathogenesis of disease progression. 12 Epidemiological studies have shown graded relations between increased albuminuria and mortality and kidney outcomes in diverse study populations, in addition to, and independent of, low GFR and risk factors for cardiovascular disease. 13–18 In view of these fi ndings, an 60> Download 353.83 Kb. Do'stlaringiz bilan baham: |
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