Basics of the Management of Chronic Kidney Disease for the General Physician

Adaptive hyperfiltration is the main mechanism leading to progression of chronic kidney disease (CKD) after an insult/injury, even if this injury is cured. The kidney responds to an injury by increasing the Glomerular Filtration Rate (GFR) to the normal nephrons, this effect can keep the creatinine (Cr) at a normal level initially, but with time, the kidney function deteriorates due to the chronic high pressure in the nephrons induced by raised GFR, this deterioration is monitored by worsening proteinuria and decline in Cr level. The rationale of using medications like SGLT2/ACE inhibitors or ARB in CKD is based on this adaptive hyperfiltration mechanism, these medications help in reducing GFR and hence reducing proteinuria and intrarenal pressure and preserving the kidney function or at least minimizing the rate of decline in kidney function.