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Preventing the progression of chronic kidney disease: two case reports and review of the literature

  • Nephrology - Review
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Abstract

A variety of therapeutic modalities are available to alter the abnormalities seen in patients with chronic kidney disease (CKD). A comprehensive plan can now be developed to slow the progression of CKD. Two clinical cases of delay in the need for renal replacement therapy are described. This delay was achieved by using recognized recommendations for optimal diabetes therapy (HbA1c target 7 %), goals for blood pressure levels, reduction of proteinuria, and the proper use of ACEI/ARB therapies. Recent recommendations include BP <140/90 mmHg for patients <60 years old and <150/90 mmHg for older patients unless they have CKD or diabetes. Limits on dietary sodium and protein intake and body weight reduction will decrease proteinuria. Proper treatment for elevated serum phosphorous and parathyroid hormone levels is now appreciated as well as the benefits of therapy for dyslipidemias and anemia. Concerns regarding unfavorable outcomes with excess ESA therapy have led to hemoglobin goals in the 10–12 g/dL range. Finally, new therapeutic considerations for the treatment of acidosis and hyperuricemia are presented with data available to suggest that increasing serum bicarbonate to >22 mmol/L is beneficial, while serum uric acid therapeutic goals are still uncertain. Also, two as yet insufficiently understood approaches to altering the course of CKD (FGF-23 level reduction and balancing gut microbiota) are noted.

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Acknowledgments

The authors would like to express our appreciation and indebtedness to the late Dr. Dimitrios G. Oreopoulos who tirelessly developed programs and supported efforts directed at prevention of the progression of kidney disease.

Conflict of interest

The authors of this manuscript declare that they have no conflict of interest.

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Authors and Affiliations

  1. Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10075, USA

    Muhammad R. Toor, Anjali Singla, Jin K. Kim, Xenia Sumin, Maria V. DeVita & Michael F. Michelis

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  1. Muhammad R. Toor
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  2. Anjali Singla
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Correspondence to Muhammad R. Toor.

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Toor, M.R., Singla, A., Kim, J.K. et al. Preventing the progression of chronic kidney disease: two case reports and review of the literature. Int Urol Nephrol 46, 2167–2174 (2014). https://doi.org/10.1007/s11255-014-0762-6

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