Abstract

MOOSA, M R; VAN DER WALT, I; NAICKER, S  and  MEYERS, A M. Important causes of chronic kidney disease in South Africa. SAMJ, S. Afr. med. j. [online]. 2015, vol.105, n.4, pp.320-320. ISSN 2078-5135.  http://dx.doi.org/10.7196/SAMJ.9535.

In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at <140/90 mmHg. When CKD is present, especially where there is proteinuria of >0.5 g/day, the goal is a BP of <130/80 mmHg. Lifestyle measures are mandatory, especially limitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefully monitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitored and, where possible, home BP-measuring devices are recommended for optimal control. Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients with stages 4 - 5 CKD. There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV.

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