Chronic Kidney Disease: Diagnosis and Treatment [1st ed. 2020] 978-981-32-9130-0, 978-981-32-9131-7

Table of contents :
Front Matter ....Pages i-x
Front Matter ....Pages 1-1
Chronic Kidney Disease: Overview (Yang Zhou, Junwei Yang)....Pages 3-12
Pathophysiology of Chronic Kidney Disease (Jiafa Ren, Chunsun Dai)....Pages 13-32
Diabetic Kidney Disease (Ting Cai, Junwei Yang)....Pages 33-43
Hypertensive Kidney Disease (Xiaobing Ji)....Pages 45-56
Pregnancy in Chronic Kidney Disease (Weichun He)....Pages 57-69
Aging and Chronic Kidney Disease (Tao Zhang)....Pages 71-82
Acute Kidney Injury and Chronic Kidney Disease (Yu Chen, Weichun He)....Pages 83-97
Advanced Image Techniques in Chronic Kidney Disease (Zhuo Xu)....Pages 99-108
Front Matter ....Pages 109-109
Cardiovascular Disease in Chronic Kidney Disease (Jining Wu, Wenjin Liu, Hongdi Cao)....Pages 111-121
Anemia in Chronic Kidney Disease (Yi Fang, Weichun He)....Pages 123-139
Chronic Kidney Disease-Mineral and Bone Disorder, Vitamin D Deficiency, and Secondary Hyperparathyroidism (Mingxia Xiong)....Pages 141-151
Immune Deficiency and Infection in Chronic Kidney Disease (Lei Jiang, Ping Wen)....Pages 153-159
Nervous System Disorders in Chronic Kidney Disease: Neurocognitive Dysfunction, Depression, and Sleep Disorder (Wenjin Liu)....Pages 161-169
Front Matter ....Pages 171-171
Nutritional Management of Chronic Kidney Disease (Li Fang)....Pages 173-186
Medication in Chronic Kidney Disease (Hongdi Cao)....Pages 187-198
Initiation Timing and Modality Option for Renal Replacement Therapy (Ping Wen)....Pages 199-207
Hemodialysis (Hong Ye, Hao Ding, Wei Gan, Ping Wen, Yang Zhou, Hongdi Cao et al.)....Pages 209-231
Peritoneal Dialysis (Jia Di)....Pages 233-240
Transplantation (Hao Ding, Junwei Yang)....Pages 241-253

Citation preview

Chronic Kidney Disease Diagnosis and Treatment Junwei Yang Weichun He  Editors

123

Chronic Kidney Disease

Junwei Yang  •  Weichun He Editors

Chronic Kidney Disease Diagnosis and Treatment

Editors Junwei Yang Centre for Kidney Disease Second Affiliated Hospital Nanjing Medical University Nanjing Jiangsu China

Weichun He Centre for Kidney Disease Second Affiliated Hospital Nanjing Medical University Nanjing Jiangsu China

ISBN 978-981-32-9130-0    ISBN 978-981-32-9131-7 (eBook) https://doi.org/10.1007/978-981-32-9131-7 © Springer Nature Singapore Pte Ltd. 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Preface

Chronic kidney disease (CKD) is a global health problem with an increasing morbidity and mortality. The last decade has seen significant improvement in perception of the epidemiology, etiology, pathogenesis, and complications of CKD due in major part to the development of definitions of CKD by the Kidney Disease Outcomes Quality Initiative (KDOQI) and the Kidney Disease Improving Global Outcomes (KDIGO). The increased recognition of CKD led to the awareness of the importance and urgency of familiarizing clinicians with its diagnosis and treatment which are essential to the well-­ being of the patients. The purpose of the work is to guide general practitioners and residents, more than just nephrologists, and to provide them with a comprehensive and systematic review of the latest available concept concerning clinical diagnosis and therapeutics over a wide spectrum of clinically important CKD. Our goal of the work is to provide a concise, well-organized exposition of the knowledge base of CKD to the readers. Thus, the book is designed to consist of 19 chapters divided into three parts. As compared with the previous books concerning kidney diseases and CKD, the number of chapters in each part is limited, and the length of each chapter is streamlined. Chapters in Part I cover hot topics of particular concern, such as diabetic kidney disease, hypertensive kidney disease, pregnancy in CKD, CKD in the elderly, and the association between acute kidney injury and CKD. It also contains pathophysiology of CKD and advanced image techniques for diagnosis of CKD.  Part II contains major complications of CKD, e.g., cardiovascular disease, anemia, mineral bone disorder, vitamin D deficiency and secondary hyperparathyroidism, immune deficiency and infection, and nervous system disorders. Part III include several crucial aspects of management of CKD, which is nutritional intervention, medication, initiation timing and modality option for renal replacement therapy, and three modalities of renal replacement therapy, i.e., hemodialysis, peritoneal dialysis, and transplantation. Based on this framework, the book is organized to be a practical guide to clinical management of great majority of CKD, and it should prove useful and valuable to clinicians. It is our hope that the reader will become acquainted with the most important topics in CKD from this book. We wish to thank all authors of this book for taking considerable time and effort to ensure that all chapters bring state-of-the-art knowledge. In the course of compiling this book, each author has consulted the latest literatures v

Preface

vi

and textbooks with a rigorous attitude of scholarly study, thus ensuring the scientificity and referential property of the book. We hope that the readers achieve the same level of acquisition of new knowledge and enjoyment as we have attained by editing the book. Nanjing, China Nanjing, China 

Junwei Yang Weichun He

Contents

Part I Chronic Kidney Disease 1 Chronic Kidney Disease: Overview������������������������������������������������   3 Yang Zhou and Junwei Yang 2 Pathophysiology of Chronic Kidney Disease ��������������������������������  13 Jiafa Ren and Chunsun Dai 3 Diabetic Kidney Disease������������������������������������������������������������������  33 Ting Cai and Junwei Yang 4 Hypertensive Kidney Disease����������������������������������������������������������  45 Xiaobing Ji 5 Pregnancy in Chronic Kidney Disease ������������������������������������������  57 Weichun He 6 Aging and Chronic Kidney Disease������������������������������������������������  71 Tao Zhang 7 Acute Kidney Injury and Chronic Kidney Disease����������������������  83 Yu Chen and Weichun He 8 Advanced Image Techniques in Chronic Kidney Disease������������  99 Zhuo Xu Part II Complications of Chronic Kidney Disease 9 Cardiovascular Disease in Chronic Kidney Disease �������������������� 111 Jining Wu, Wenjin Liu, and Hongdi Cao 10 Anemia in Chronic Kidney Disease������������������������������������������������ 123 Yi Fang and Weichun He 11 Chronic Kidney Disease-Mineral and Bone Disorder, Vitamin D Deficiency, and Secondary Hyperparathyroidism���������������������������������������������������������������������� 141 Mingxia Xiong

vii

viii

12 Immune Deficiency and Infection in Chronic Kidney Disease���������������������������������������������������������������������������������������������� 153 Lei Jiang and Ping Wen 13 Nervous System Disorders in Chronic Kidney Disease: Neurocognitive Dysfunction, Depression, and Sleep Disorder�������������������������������������������������������������������������������������������� 161 Wenjin Liu Part III Management of Chronic Kidney Disease 14 Nutritional Management of Chronic Kidney Disease������������������ 173 Li Fang 15 Medication in Chronic Kidney Disease������������������������������������������ 187 Hongdi Cao 16 Initiation Timing and Modality Option for Renal Replacement Therapy���������������������������������������������������������������������� 199 Ping Wen 17 Hemodialysis������������������������������������������������������������������������������������ 209 Hong Ye, Hao Ding, Wei Gan, Ping Wen, Yang Zhou, Hongdi Cao, and Weichun He 18 Peritoneal Dialysis���������������������������������������������������������������������������� 233 Jia Di 19 Transplantation�������������������������������������������������������������������������������� 241 Hao Ding and Junwei Yang

Contents

Contributors

Ting  Cai, PhD Candidate  Nanjing Medical University, Nanjing, Jiangsu, China Hongdi  Cao, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Yu  Chen, MD, PhD Division of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China Chunsun  Dai, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Jia  Di, MD, PhD Division of Nephrology, Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu, China Hao Ding, MD, PhD  Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Li  Fang, MD, PhD Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China Yi  Fang, MD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Wei  Gan, MD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Weichun  He, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Xiaobing  Ji, MD, PhD Division of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Lei Jiang, MD, PhD  Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Wenjin  Liu, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Jiafa  Ren, MD, PhD Division of Nephrology, Department of Medicine, Duke University and Durham VA Medical Centers, Durham, NC, USA Ping Wen, MD, PhD  Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China ix

x

Jining  Wu, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Mingxia  Xiong, MD, PhD  Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Zhuo Xu, MD, PhD  Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Junwei  Yang, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Hong  Ye, MD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Tao Zhang, MD, PhD  Division of Nephrology, Department of Geriatrics, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Yang  Zhou, MD, PhD Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China

Contributors

Part I Chronic Kidney Disease

1

Chronic Kidney Disease: Overview Yang Zhou and Junwei Yang

Abstract

Chronic kidney disease (CKD) is a condition characterized by gradual loss of kidney function over time. The major role of the kidney is excretion of water-soluble waste products. Meanwhile, the kidneys respond continually to changes in blood volume as well as osmolality, and adjust the levels of water, electrolyte, and acid-base balance by selectively excreting or reabsorbing them. In addition, the kidneys are main site of production for a number of hormones, chiefly renin and erythropoietin. Millions of adults have CKD and others who have diabetes, hypertension, and family history of renal failure are at high risk. Glomerular filtration rate is the best estimate of kidney function, combining with proteinuria is used for staging of CKD. Patients with CKD may develop complications like cardiovascular disease, anemia, mineral and bone disorders, and nervous system diseases. Those who develop kidney failure require dialysis or kidney transplantation. The cost of treatment for this growing epidemic represents an enormous burden on healthcare systems worldwide. In this chapter, we will

Y. Zhou (*) · J. Yang (*) Centre for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China e-mail: [email protected]; [email protected]

overview definition, epidemiology, cost, and outcomes of CKD.  The detailed diagnosis and treatment will be discussed in the following chapters.

1.1

Introduction

Chronic kidney disease (CKD) has become a global public health problem with an increasing prevalence and high mortality [1]. Owing to the growing elderly population and the increasing prevalence of hypertension and diabetes as well as the improving treatment strategies, the prevalence of CKD will inevitably continue to increase in the near future. Glomerular filtration rate (GFR) and albuminuria are proposed as the best indicators of kidney function, with low GFR and increased albuminuria being associated with a high risk of kidney failure requiring renal replacement therapy and of cardiovascular disease, anemia, mineral and bone disorder, and other complications. On account of the significant development of CKD definitions by the Kidney Disease: Improving Global Outcomes (KDIGO), the recognition of CKD has greatly improved in the last few years [2]. Increased awareness of and uniform classification criteria for CKD have led to greater focus on the development of methods to slow CKD progression,

© Springer Nature Singapore Pte Ltd. 2020 J. Yang, W. He (eds.), Chronic Kidney Disease, https://doi.org/10.1007/978-981-32-9131-7_1

3

Y. Zhou and J. Yang

4

increased emphasis on the early recognition and prevention of complications associated with CKD, and better understanding of the economic burden of CKD and accompanying illnesses. Despite the progress, therapies and clinical trials on which to base recommendations remain remarkably limited.

1.2

Definition

CKD is defined as abnormalities of kidney structure or function, present for >3  months [3]. Table 1.1 summarizes the criteria for CKD, either of which should be present for >3 months.

1.3

Assign causes based on observed or presumed pathological–anatomical findings within the kidney and presence or absence of systemic disease. Assign GFR categories as shown in Table 1.2. Assign albuminuria categories as shown in Table 1.3. Alternatively, protein or urinary reagent strip results can be substituted (Table 1.4).

Staging

The KDIGO 2012 Clinical Practice Guideline suggested that CKD could be classified according to cause, GFR category, and albuminuria category (CGA) [3].

Table 1.1  Criteria for CKD (either of the following should be present for >3 months)

1.4

Diabetes and hypertension are the leading causes of CKD in all industrialized countries and several underdeveloped countries. However, glomerulonephritis and unknown causes are more common in Asian and Sub-Saharan African countries. Table 1.5 lists the risk factors for CKD [1–3]. In China, the current leading causes of CKD are glomerular disease, diabetic kidney disease, and hypertension. IgA nephropathy is one of the most common glomerular diseases.

Table 1.2  GFR categories in CKD GFR category G1 G2

• Albuminuria (AER ≥30 mg/24 h; ACR ≥30 mg/g [≥3 mg/mmol]) •  Urinary sediment abnormality • Electrolyte and other abnormalities due to tubular disorders •  Abnormalities detected by histology •  Structural abnormalities detected by imaging •  History of kidney transplantation •  GFR