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CHRONIC KIDNEY DISEASE PROGRESSION
Progression of Chronic Kidney Disease
The
rate of progression varies considerably between patients and
diseases, generally being faster in chronic glomerulonephritides
than in tubulointerstitial nephritides.
Factors
Influencing
The
Rate
of
Progression
Proteinuria
The
degree of proteinuria correlates with the rate of progression of
the underlying nephropathy and is the most reliable prognostic
factor in chronic kidney disease. In chronic glomerulonephritis,
persistent heavy proteinuria (greater than 3 g/24 h) predicts a
poor outcome. In patients with diabetes or tubulointerstitial
nephropathy, such as reflux nephropathy, the onset of
significant proteinuria (greater than 1 g/24 h) usually predicts
a decline in kidney function. Proteinuria may be a marker of
severe kidney disease, but it is possible that the filtration
and overloading of the tubules with protein may itself damage
the nephron.
Hypertension
The
most important factor influencing the rate of progression is
systemic hypertension, which appears early in the course of
kidney diseases and long precedes the onset of end-stage kidney
failure. As with proteinuria, hypertension is a marker of more
severe kidney disease, but there is good evidence that the
raised arterial pressure is itself pathogenetic.
Other factors,include:
Ethnicity and Genes
Certain major histocompatibility antigens have been associated
with a poor outcome in some forms of glomerulonephritis, for
example in membranous nephropathy. In adult polycystic kidney
disease, patients with type 1 (abnormal gene on chromosome 16)
have an earlier onset and a faster rate of decline compared to
those with type 2 (whose abnormal gene is on chromosome 4).
Afro- and Hispanic Americans suffer a faster rate of progression
when compared to Caucasians. Diabetic nephropathy progresses
more rapidly in Afro- and native Americans.
Gender
Renal function deteriorates faster in males with adult
polycystic kidney disease, mesangial IgA disease, and membranous
nephropathy. In Western societies, males tend to have a higher
blood pressure than age-matched females, which may explain this
difference.
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