Chronic Kidney Disease
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چکیده
Chronic kidney disease (CKD) refers to the myriad problems that follow loss of kidney function. It results from a large number of diseases that either are systemic and damage the kidney or are intrinsic to the kidney ( Table 131-1 ). CKD has two characteristics. First, there is chronicity because the kidney damage of CKD is rarely repaired and loss of function persists, unlike the course of acute kidney failure. Second, loss of kidney function generates even more kidney damage so that CKD progressively worsens even if the disorder that caused it becomes inactive. CKD is the preferred term because another widely used one, chronic renal failure or insufficiency, is not as easily identifiable by patients as a disorder that affects the kidney. In addition, chronic renal failure suggests that the kidneys have lost all of their function, whereas CKD covers the spectrum of clinical problems beginning with abnormalities detectable only by laboratory testing to a late stage, labeled uremia. Uremia literally means “urine in the blood” and represents the toxic state principally resulting from accumulation of unexcreted waste products derived from metabolism of protein. When the kidney fails to perform most of its function, the clinical state is labeled end-stage renal disease (ESRD), and dialysis or transplantation is required to sustain life. The progressive and chronic nature of CKD is emphasized because treatment can slow or even halt the loss of kidney function, and many symptoms of uremia can be ameliorated or eliminated.
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