http://www.clevelandclinicmeded.

com/medicalpubs/diseasemanagement/nephrology/chronic-kidney-
disease/
Proteinuria
Microalbuminuria and proteinuria are well-recognized prognostic factors for the development
and progression of CKD. The MDRD study has shown that severe proteinuria (>3 g/day) is
associated with a higher rate of decline in GFR. Other studies have shown that this holds true for
the glomerular and nonglomerular forms of CKD. Interventions aimed at reducing proteinuria,
including ACE inhibition and dietary modifications, have been shown to predict outcomes better
in diabetic and nondiabetic CKD patients. Proposed mechanisms for the effects of proteinuria
include initiation and progression of tubulointerstitial fibrosis and inflammation through toxicity
from filtered compounds (e.g., transferrin-iron, albumin-bound fatty acids, inflammatory
cytokines).
Potassium Imbalance
Renal potassium excretion is preserved at near-normal levels in patients with CKD as long as
both the renin-angiotensin-aldosterone system (RAAS) and distal nephron flow are maintained.
Therefore, hyperkalemia generally develops in oliguric patients with a GFR lower than
10 mL/min/1.73 m
2
or in those who experience an additional alteration in potassium metabolism
because of increased intake or from certain medications (e.g., ACE inhibitors, ARBs,
nonsteroidal anti-inflammatory drugs). See elsewhere in this section for further information (
Hypokalemia and Hyperkalemia).
Dietary restriction is the mainstay of management of chronic hyperkalemia in these patients (40-
70 mEq/day). If it persists, the next step is the addition of a loop diuretic (more so if
hypertension or volume overload is an issue) to promote kaliuresis by increasing sodium delivery
to the distal nephron. If acidosis is present, sodium bicarbonate is helpful by increasing distal
nephron sodium delivery, inducing kaliuresis, and promoting intracellular potassium shift. An
additional alternative is the use of potassium-binding resins such as sodium polystyrene sulfonate
(Kayexalate) combined with sorbitol to avoid constipation, at smaller doses than those typically
used for the treatment of acute hyperkalemia, given daily or every other day.
https://www.kidney.org/professionals/kdoqi/guidelines_bp/guide_11.htm

http://www.patient.co.uk/doctor/chronic-kidney-disease-chronic-renal-failure

http://www.renal.org/guidelines/modules/detection-monitoring-and-care-of-patients-with-
ckd#sthash.dszUl8YX.dpbs
https://www.kidney.org/professionals/kdoqi/guidelines_ckd/ex2.htm

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/diabetic-
nephropathy/

http://www.womenshealthresearch.org/site/PageServer?pagename=hs_healthfacts_diabetes

http://www.hippokratia.gr/index.php/current/1075-prevalence-of-microalbuminuria-and-risk-factor-
analysis-in-type-2-diabetes-patients-in-albania-the-need-for-accurate-and-early-diagnosis-of-diabetic-
nephropathy