Chronic Kidney Disease: Detection and Evaluation
Chronic kidney disease (CKD) is a prevalent disease that continues to affect more than one-tenth of the American population. Early detection is essential to slow the natural progression of CKD. This can be accomplished by urine and blood screening tests, which are analyzed for creatinine, urine albumin, and urine protein. Screening is often indicated for individuals with known comorbidities such as cardiovascular disease, mineral and bone disorders, and diabetes. Asymptomatic patients with early renal disease can make detection problematic, requiring clinicians to recognize risk factors that may warrant further testing. When symptoms do appear, the renal manifestations are often broad, including changes in kidney size, electrolyte abnormalities, and proteinuria. Changes in biomarkers may be evaluated in the early stages of CKD before significant kidney damage. The current, most accurate determination of renal function is the estimated glomerular filtration rate (GFR), which must be less than 60 mL/min to prompt further testing for CKD. Novel biomarkers may allow for earlier diagnosis of CKD as they can be detected at lower levels than standard biomarkers. Biomarkers such as homocysteine, cystatin C, and kidney injury molecule-1 are predicted to become more prevalent in a clinical setting. The current gold standard for diagnosis of CKD is a renal biopsy, but MRI is a less invasive alternative. Proper staging of CKD allows for appropriate evaluation and treatment of the patient. The early stages of CKD should be treated to limit complications and to prolong the life and health of patients.