Kidney disease

Chronic kidney disease (CKD) affects renal drug elimination and other important processes involved in drug disposition, including absorption, drug distribution and non-renal clearance. As a result, the reduced renal excretion of a drug or its metabolites can cause toxicity and the sensitivity to some drugs is increased even if elimination is unimpaired.

Chronic kidney disease (CKD) is characterised by irreversible renal scarring. Nephrologists draw the distinction between primarily glomerular scarring (glomerulosclerosis) and scarring centred on the kidney tubules (chronic tubulointerstitial nephritis). However, in clinical practice, glomerulosclerosis is by far the most common pattern in CKD and this article will focus on this type of renal injury.

Diagnosing chronic kidney disease (CKD) and monitoring kidney function are key steps in improving management. This article reviews the recommendations on making a diagnosis of CKD, including staging patients, and the tests available for monitoring kidney function, with explanations of how to test patients, what the findings mean, and how to act on the findings.

Chronic kidney disease (CKD) is a cardiovascular condition, with cardiovascular causes and consequences. The kidney complications are relatively uncommon. Until recently, many clinicians, let alone the public, were unaware of the high prevalence of the disease and its accompanying morbidity. The National Institute for Health and Clinical Excellence (NICE), through the National Collaborative Centre for Chronic Conditions, recently reviewed the available evidence and published a guideline to assist early identification and management of CKD.

Chronic kidney disease (CKD) is now recognised as a significant public health problem and various mechanisms have been put in place to identify people at risk. CKD overlaps with other chronic diseases, including diabetes and hypertension, and should not be managed in isolation. Vascular risk assessments are coming into place for the general population and there are strong links with vascular and kidney disease. CKD is becoming an integral part of chronic disease management.

Chronic kidney disease (CKD) is an important cause of mortality and morbidity, especially in people with cardiovascular disease. Interventions that can be delivered in primary care have the potential to slow the progression of the disease. People with CKD can be identified readily and reliably from GP computer systems. To report the baseline quality of CKD management. Pseudonymised routinely collected data from a representative sample of 14 practices across Surrey were extracted as part of a quality improvement study. The crude and adjusted prevalences of stage 3 to 5 CKD are 6.3% and 5.8%, respectively. More than twice as many females (8.8%) as males (3.9%) have this condition. Hypertension, diabetes, ischaemic heart disease and other cardiovascular disease and anaemia are much more common with deteriorating renal function. The reported prevalence is lower than suggested by previous studies but this may reflect the lower levels of cardiovascular disease associated with a healthier lifestyle in the Southeast. However, there is scope to further improve the quality of CKD management in Surrey. Programmes carefully targeted at high-risk groups could slow the progression of CKD and therefore reduce the need for renal replacement therapy.