From the Research
The change in the "perpetuating process" stage of chronic kidney disease (CKD) that does NOT belong is early, accelerated nephrosclerosis. The perpetuating process stage of CKD is characterized by ongoing kidney damage that occurs after the initial injury, and includes glomerular filtration membrane changes, increased vasoconstriction, and hypertrophy of nephrons. These three processes represent compensatory mechanisms and pathological changes that occur as CKD progresses. Early, accelerated nephrosclerosis, however, is more appropriately categorized as an initiating factor or early manifestation of kidney disease rather than a perpetuating process. Nephrosclerosis refers to hardening of the renal arterioles, which can be a cause of CKD, particularly in hypertensive patients. The perpetuating processes typically involve mechanisms that worsen kidney function after the initial damage has occurred, such as the adaptive hyperfiltration in remaining nephrons (hypertrophy), structural changes to the filtration membrane, and vascular changes leading to increased vasoconstriction, all of which create a cycle of ongoing damage, as discussed in the context of CKD management with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers 1.
Some key points to consider in the management of CKD include:
- The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing the risk of kidney failure and cardiovascular events 1, 2
- The importance of blood pressure control in slowing CKD progression 3
- The potential benefits and harms of continuing or discontinuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in advanced CKD 4, 2
- The need for individualized treatment decisions based on patient-specific factors, such as age, eGFR, albuminuria, and history of diabetes 2
Overall, the management of CKD requires a comprehensive approach that takes into account the complex interplay of factors that contribute to disease progression and cardiovascular risk. By prioritizing the most recent and highest-quality evidence, clinicians can make informed decisions that optimize patient outcomes and minimize the risk of adverse events, as seen in the most recent study on the topic 2.