From the Guidelines
Impaired renal function, as indicated by a decreased Glomerular Filtration Rate (GFR), can be caused by a variety of factors including acute kidney injury, chronic conditions such as diabetes and hypertension, and age-related decline. The causes of impaired renal function can be categorized into prerenal, renal, and postrenal factors, with prerenal factors including impaired blood flow from any cause, such as hypotension, hypovolemia, decreased cardiac output, or renal artery occlusion 1.
Key Causes of Impaired Renal Function
- Acute kidney injury from dehydration, sepsis, or nephrotoxic medications like NSAIDs, aminoglycosides, and contrast dye
- Chronic conditions that progressively damage the kidneys, including diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease, and lupus nephritis
- Urinary tract obstruction (from kidney stones, tumors, or enlarged prostate)
- Renal artery stenosis restricting blood flow
- Repeated urinary tract infections
- Age-related decline, which naturally reduces GFR by approximately 1 mL/min/1.73m² annually after age 40
- Certain medications taken long-term, heavy metal exposure, and genetic disorders like Alport syndrome
- Heart failure, which decreases cardiac output and kidney perfusion
- Liver cirrhosis, which alters hemodynamics affecting kidney function According to the most recent guidelines, maintaining adequate hydration, controlling blood pressure and blood sugar, avoiding nephrotoxic substances, and regular monitoring of kidney function are essential preventive measures, especially for those with risk factors or existing kidney disease 1.
Prevention and Management
- Regular monitoring of kidney function
- Maintaining adequate hydration
- Controlling blood pressure and blood sugar
- Avoiding nephrotoxic substances
- Early identification and treatment of underlying causes of impaired renal function It is essential to note that the definition of chronic kidney disease is the same, regardless of age, and that decreased GFR in the elderly is an independent predictor of adverse outcomes, such as death and cardiovascular disease 1.
Importance of Early Detection and Treatment
- Early detection and treatment of impaired renal function can help prevent progression to kidney failure
- Regular monitoring of kidney function can help identify individuals at risk of impaired renal function
- Prompt treatment of underlying causes of impaired renal function can help improve outcomes and reduce morbidity and mortality.
From the FDA Drug Label
Impaired renal function decreases elimination of lisinopril, which is excreted principally through the kidneys, but this decrease becomes clinically important only when the glomerular filtration rate is below 30 mL/min.
The causes of impaired renal function, as indicated by a decreased Glomerular Filtration Rate (GFR), include:
- Decreased renal function due to various factors, but the specific causes are not directly stated in the provided drug labels.
Key points to consider:
- Renal impairment can affect the elimination of certain drugs, such as lisinopril.
- Glomerular filtration rate is an important indicator of renal function.
- The provided drug labels do not explicitly state the causes of impaired renal function, but they do discuss the impact of renal impairment on drug elimination 2.
From the Research
Causes of Impaired Renal Function
The causes of impaired renal function, as indicated by a decreased Glomerular Filtration Rate (GFR), can be attributed to several factors. Some of the key causes include:
- Hypertension: High blood pressure can damage the blood vessels in the kidneys, leading to a decline in GFR 3, 4.
- Diabetes: Type 2 diabetes mellitus has been shown to be associated with a faster decline in eGFR, particularly if proteinuria and glycemia are not well-controlled 5, 6.
- Age: Older age has been identified as a risk factor for fast GFR decline and incident chronic kidney disease (CKD) 5.
- Race: African-American race has been associated with fast GFR decline and incident CKD 5.
- Socioeconomic status: Lower neighborhood socioeconomic status has been linked to fast GFR decline 5.
- Smoking: Current smoking has been identified as a risk factor for fast GFR decline 5.
- Proteinuria: The presence of proteinuria has been shown to be a predictor of GFR decline 7, 6.
- Serum phosphate and PTH levels: Elevated serum phosphate and PTH levels have been correlated with a faster decline in eGFR 7.
Risk Factors for GFR Decline
Several risk factors have been identified as contributing to a decline in GFR, including:
- Baseline eGFR: A lower baseline eGFR has been associated with a faster decline in eGFR 5, 7.
- Duration of diabetes: A longer duration of type 2 diabetes mellitus has been linked to a faster decline in eGFR 6.
- Glycosylated hemoglobin level: Elevated glycosylated hemoglobin levels have been associated with a faster decline in eGFR 6.
- Malay race: Malay race has been identified as a risk factor for faster decline in eGFR 6.