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Harrison's Principles of Internal Medicine, 18e
| Part 13. Disorders of the Kidney and Urinary Tract > |
Chapter 280. Chronic Kidney Disease
Sections: Chronic Kidney Disease: Introduction, Clinical and Laboratory Manifestations of Chronic Kidney Disease and Uremia, Evaluation and Management of Patients with CKD, Further Readings.
Topics Discussed: kidney failure, chronic.
Excerpt:"Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR). Table 280-1 provides a widely accepted classification, based on guidelines of the National Kidney Foundation [Kidney Dialysis Outcomes Quality Initiative (KDOQI)], in which stages of CKD are defined according to the estimated GFR.The pathophysiology of CKD involves two broad sets of mechanisms of damage: (1) initiating mechanisms specific to the underlying etiology (e.g., genetically determined abnormalities in kidney development or integrity, immune complex deposition and inflammation in certain types of glomerulonephritis, or toxin exposure in certain diseases of the renal tubules and interstitium) and (2) a set of progressive mechanisms, involving hyperfiltration and hypertrophy of the remaining viable nephrons, that are a common consequence following long-term reduction of renal mass, irrespective of underlying etiology (Chap. 278). The responses to reduction in nephron number are mediated by vasoactive hormones, cytokines, and growth factors. Eventually, these short-term adaptations of hypertrophy and hyperfiltration become maladaptive as the increased pressure..."
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