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Chronic kidney disease

Nature Reviews Disease Primers volume 3, Article number: 17088 (2017) Cite this article

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Abstract

Chronic kidney disease (CKD) is defined by persistent urine abnormalities, structural abnormalities or impaired excretory renal function suggestive of a loss of functional nephrons. The majority of patients with CKD are at risk of accelerated cardiovascular disease and death. For those who progress to end-stage renal disease, the limited accessibility to renal replacement therapy is a problem in many parts of the world. Risk factors for the development and progression of CKD include low nephron number at birth, nephron loss due to increasing age and acute or chronic kidney injuries caused by toxic exposures or diseases (for example, obesity and type 2 diabetes mellitus). The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin–angiotensin system and disease-specific interventions are the cornerstones of therapy. CKD complications such as anaemia, metabolic acidosis and secondary hyperparathyroidism affect cardiovascular health and quality of life, and require diagnosis and treatment.

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Figure 1: The KDIGO classification of CKD.
Figure 2: Global prevalence of renal replacement therapy.
Figure 3: GFR with ageing and effect of LBW on progression of CKD.
Figure 4: Injury, hyperfiltration and hypertrophy of the nephron.
Figure 5: Interstitial fibrosis.
Figure 6: Contributing factors to nephron loss.
Figure 7: The earlier, the better.
Figure 8: Haemodialysis and peritoneal dialysis.
Figure 9: Targeting kidney regeneration.

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Acknowledgements

P.R. is supported by the European Research Council under the Consolidator Grant RENOIR (ERC-2014-CoG), grant number 648274. G.R. and H.-J.A. have received support from the European Union's research and innovation programme (under grant agreement Horizon 2020, NEPHSTROM No. 634086). Z.M. has received research grants from the French government (the Investisssement d'Avenir programme). H.-J.A. has received support from the Deutsche Forschungsgemeinschaft (AN372/16-2, 23–1 and 24–1). The views expressed here are the responsibility of the authors only. The EU Commission takes no responsibility for any use made of the information set out.

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  1. Department of Experimental and Biomedical Sciences “Mario Serio” and Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy

    Paola Romagnani

  2. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy

    Giuseppe Remuzzi

  3. Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy

    Giuseppe Remuzzi

  4. Department of Biomedical and Clinical Science, L. Sacco, University of Milan, Milan, Italy

    Giuseppe Remuzzi

  5. Department of Medicine, David Geffen School of Medicine at UCLA, Laguna Niguel, California, USA

    Richard Glassock

  6. Division of Nephrology, University of British Columbia, Vancouver, Canada

    Adeera Levin

  7. Department of Medical Informatics, European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) Registry, Academic Medical Center, Amsterdam, The Netherlands

    Kitty J. Jager

  8. Division of Nephrology and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada

    Marcello Tonelli

  9. Division of Nephrology, Ambroise Paré University Hospital, Assistance Publique – Hôpitaux de Paris, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France

    Ziad Massy

  10. INSERM U1018 Team5, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), University of Versailles-Saint-Quentin-en-Yvelines, University Paris Saclay, Villejuif, France

    Ziad Massy

  11. Department of Medicine, Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany

    Christoph Wanner

  12. Medizinische Klinik and Poliklinik IV, Klinikum der Ludwig Maximilians University (LMU) München – Innenstadt, Ziemssenstr. 1, München, 80336, Germany

    Hans-Joachim Anders

Authors
  1. Paola Romagnani
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  2. Giuseppe Remuzzi
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  3. Richard Glassock
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  4. Adeera Levin
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  5. Kitty J. Jager
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  6. Marcello Tonelli
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  7. Ziad Massy
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  8. Christoph Wanner
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  9. Hans-Joachim Anders
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Contributions

All authors contributed equally to all sections of the Primer, with H.-J.A. coordinating the project.

Corresponding author

Correspondence to Hans-Joachim Anders.

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Competing interests

R.G. has received speaker honoraria from Genentech and consultancy honoraria from Bristol Myers Squibb; he has conducted compensated editorial tasks for the American Society of Nephrology and Karger and Wolters-Kluwer; and he owns stock in Reata. Z.M. has received grants for research from Amgen, Baxter, Dohme-Chibret, Fresenius Medical Care, GlaxoSmithKline, Lilly, Merck Sharp, Otsuka, and Sanofi-Genzyme; and has received personal fees and grants to charities from Amgen, Bayer and Sanofi-Genzyme. The other authors declare no competing interests.

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Romagnani, P., Remuzzi, G., Glassock, R. et al. Chronic kidney disease. Nat Rev Dis Primers 3, 17088 (2017). https://doi.org/10.1038/nrdp.2017.88

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  • DOI: https://doi.org/10.1038/nrdp.2017.88

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