Fast Five Quiz: Is Your Knowledge of Chronic Kidney Disease Sufficient?

Vecihi Batuman, MD

Disclosures

April 20, 2018

Causes of CKD include the following:

  • Diabetic kidney disease

  • Hypertension

  • Vascular disease

  • Glomerular disease (primary or secondary)

  • Cystic kidney diseases

  • Tubulointerstitial disease

  • Urinary tract obstruction or dysfunction

  • Recurrent kidney stone disease

  • Congenital (birth) defects of the kidney or bladder

  • Unrecovered acute kidney injury

Most cases of CKD are acquired rather than inherited, although CKD in a child is more likely to have a genetic or inherited cause. Well-described genetic syndromes associated with CKD include autosomal dominant polycystic kidney disease (ADPKD) and Alport syndrome. Other examples of specific single-gene or few-gene mutations associated with CKD include Dent disease, nephronophthisis, vesicoureteral reflux (VUR), and atypical hemolytic uremic syndrome (HUS).

In the National Health and Nutrition Examination Survey (NHANES), the distribution of estimated glomerular filtration rates (GFRs) for the stages of CKD was similar in both sexes. However, in the United States Renal Data System (USRDS) 2011 Annual Data Report, the incidence rate of ESRD cases at the initiation of hemodialysis was higher for males, with 415.1 per million population compared with 256.6 for females.

Hyperkalemia usually does not develop until the GFR falls to less than 20-25 mL/min/1.73 m², at which point the kidneys have decreased ability to excrete potassium. Hyperkalemia can be observed sooner in patients who ingest a potassium-rich diet, patients who have type 4 renal tubular acidosis with or without low serum aldosterone levels, and patients prescribed potassium-sparing diuretics. Common sources of low aldosterone levels are diabetes mellitus and the use of angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), or beta-blockers. Hyperkalemia in CKD can be aggravated by an extracellular shift of potassium, such as occurs in the setting of acidemia or from lack of insulin. Hypokalemia is uncommon but can develop in patients with very poor intake of potassium, gastrointestinal or urinary loss of potassium, or diarrhea or in patients who use diuretics.

For more on the etiology and epidemiology of CKD, read here.

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