7/28/2019 Chronicles in Cholesterol Volume 4 Issue 2

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CHRONICLES IN CHOLESTEROLAn Insiders Guide to State of The Art Cardiovascular

Prevention Laboratory Testing Available From

Everest Clinical Laboratories

26 million American adults have CKD and millions of others

are at increased risk.

Early detection can help prevent the progression of kidney

disease to kidney failure.

Heart disease is the major cause of death for all people with

CKD.

Glomerular filtration rate (GFR) is the best estimate of

kidney function.

Hypertension causes CKD and CKD causes hypertension.Persistent proteinuria (protein in the urine) means CKD is

present.

High risk groups include those with diabetes, hypertension

and family history of kidney disease.

African Americans, Hispanics, Pacific Islanders, Native

Americans and Seniors are at increased risk.

Three simple tests can detect CKD: blood pressure, urine

albumin and serum creatinine.

The two main causes of chronic kidney disease are diabetes

and high blood pressure, which are responsible for up to

two-thirds of the cases.

GFRglomerular filtration rate is the best test to measure

level of kidney function and determine the stage of kidney

disease. It can be calculated from the blood creatinine, age,

race, gender and other factors.

Overestimation by older serum creatinine methods resulted

in an underestimation of creatinine clearance, which

provided a less biased estimate of GFR. Both GFR and

CCr may be accurately calculated by comparative

measurements of substances in the blood and urine, or

estimated by formulas using just a blood test result

March, 2013 VOL 4 ISSUE 2

In This Issue: Glomerular Filtration Rate

26 million American adults have CKDand millions of others are at

increased risk.

Three simple tests can detect CKD:blood pressure, urine albumin andserum creatinine.

26 million American adults have CKDand millions of others are atincreased risk.

7/28/2019 Chronicles in Cholesterol Volume 4 Issue 2

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Other conditions that affect the kidneys are:

Glomerulonephritis, signifies cause inflammationand damage to the kidney's filtering units. Thesedisorders are the third most common type ofkidney disease.

Inherited diseases, such as polycystic kidney

disease, which causes large cysts to form in thekidneys and damage the surrounding tissue.

Malformations that occur as a baby develops in itsmother's womb. For example, a narrowing mayoccur that prevents normal outflow of urine andcauses urine to flow back up to the kidney. Thiscauses infections and may damage the kidneys.

Lupus and other connective tissue diseases.

Obstructions caused by problems like kidneystones, tumors or an enlarged prostate gland inmen.

Repeated urinary infections.

The severity of chronic kidney disease (CKD) is describedby six stages; the most severe three are defined by theMDRD-eGFR value, and first three also depend on whetherthere is other evidence of kidney disease (e.g., proteinuria):

0) Normal kidney function GFR above90mL/min/1.73m2 and no proteinuria.1) CKD1 GFR above 90mL/min/1.73m2 with evidence ofkidney damage2) CKD2 (Mild) GFR of 60 to 89 mL/min/1.73m2 withevidence of kidney damage3) CKD3 (Moderate) GFR of 30 to 59 mL/min/1.73m24) CKD4 (Severe) GFR of 15 to 29 mL/min/1.73m25) CKD5 Kidney failure - GFR less than 15mL/min/1.73m2 Some people add CKD5D for those stage

5 patients requiring dialysis; many patients in CKD5 are notyet on dialysis.

The calculation for eGFR is intended to be used whenkidney function, and creatinine production, is stable. If acreatinine level is measured when the kidney function ischanging rapidly, such as with acute renal failure, then itwill not give a useful estimate of the filtration rate. A slightlydifferent equation should be used to calculate the eGFR forthose under the age of 18. An eGFR test may not be asuseful for those who differ from normal creatinineconcentrations. This may include people who havesignificantly more muscle (such as a body builder) or lessmuscle (such as a muscle-wasting disease) than the norm,those who are extremely obese, malnourished, follow a

strict vegetarian diet, ingest little protein, or who takecreatine dietary supplements. Likewise, the eGFRequations are not valid for those who are 75 year of age orolder because muscle mass normally decreases with age.

By Spencer Kroll MD PhD

National Lipid Association Board Certified

Board of Directors, Northeast Lipid Association

March, 2013 VOL 4 ISSUE 2

GFR over 90mls/min/1.73m2is normalunless there

is other evidence of kidney disease, in which caseCKD is stage 1.

Other evidence of kidney disease may include:Proteinuria or haematuria

A genetic diagnosis of kidney disease (e.g.known to be have a disease such aspolycystic kidney disease)

Evidence of structurally abnormal kidneys(e.g. reflux nephropathy, renal dysgenesis).

If any of these are present, CKD stage is 1.