Total Management of CKD
Department of Nephrology, Graduate School of Medicine, Nippon Medical School
One-eighth of adults are Chronic Kidney Disease (CKD) in Japan. Intensive multifactorical interventions are required to prevent the onset of End Stage Kidney Disease (ESKD) and Cardio Vascular Disease (CVD). In this report, we will describe hypertension, diabetes and hyperuricemia that are the maximal cause of CKD, as well as our findings.
The hypertension treatment target value of the CKD patient is still controversial. However, the prepotency of the Renin-Angiotensin-Aldosterone System (RAS) inhibitor is denied for the patient without proteinuria. The characteristic of hypertension to be found in the CKD patient is Na-sensitive hypertension and disorder of the circadian rhythm, whereas the improvement of the medication adherence is important, too. We showed that adherence improvement of long-action type Angiotensin II Receptor Blocker (ARB) olmesartan had good influences on renal function. Also, the decrease in albuminuria was found, too. However, we were not able to prove the renal protective effect for patients with CKD Stage 4 or more about the direct renin inhibitor aliskiren.
40% of patients with type II diabetes mellitus are CKD, and incretin related drug and Sodium Glucose Transporter-2 (SGLT-2) inhibitor were released, and the option of treatment expanded. Recently, it has been known that various mediators and nervous systems were involved between gastrointestinal tract and kidney. This is called Gut-Renal Axis. As for the incretin related drug, it is suggested by gastrointestinal tract for body fluid homeostasis maintenance in that through Glucagon-like peptide-1 (GLP-1) which is a main mediator to work to kidney. It is hoped that the incretin related drug prevents progress of diabetic nephropathy. We examined the effect to inflict for renal function of alogliptin and showed the possibility that alogliptin improved progression of diabetic nephropathy.
Hyperuricemia was associated with a cause and progress of CKD seriously, but available therapies were limited to the patient whom renal function decreased. We performed the change to febuxostat in the CKD patient whom the uric acid level did not decrease in allopurinol enough. As a result, the uric acid level achieved the goal, and the renal function was significantly improved, too.
The kidney links with various kinds of organs to maintain quantitative and qualitative homeostasis of the body fluid and finally manages the regulation. With the decrease of renal function, metabolic derangements such as water, electrolyte, sugar, uric acid, lipids, acid base, bone mineral, iron and erythropoiesis develops. The noumenon of CKD is organ linkage, and the viewpoint for it is important.
日医大医会誌 2016; 12(1), 7-14
chronic kidney disease, hypertension, diabetic nephropathy, hyperuricemia
Yukinao Sakai, Department of Nephrology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan