International Urology and Nephrology

, Volume 46, Issue 11, pp 2167–2174

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


    • Lenox Hill Hospital
  • Anjali Singla
    • Lenox Hill Hospital
  • Jin K. Kim
    • Lenox Hill Hospital
  • Xenia Sumin
    • Lenox Hill Hospital
  • Maria V. DeVita
    • Lenox Hill Hospital
  • Michael F. Michelis
    • Lenox Hill Hospital
Nephrology - Review

DOI: 10.1007/s11255-014-0762-6

Cite this article as:
Toor, M.R., Singla, A., Kim, J.K. et al. Int Urol Nephrol (2014) 46: 2167. doi:10.1007/s11255-014-0762-6


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.


Chronic kidney diseaseHypertension and chronic kidney diseaseProteinuriaParathyroid hormoneMetabolic acidosisHyperuricemia

Copyright information

© Springer Science+Business Media Dordrecht 2014