CANNOT MAKE THE DIAGNOSIS?

Abdul Saadi essadii at GMAIL.COM
Wed Apr 9 21:14:49 UTC 2014


I am glad somebody brought this up. If we are talking defintions may I take
it a little further and advance a motion here,  to revise the nomenclature
as a whole.

The actual disgnation Chronic kidney disease is an overstatement in this
occasion of decling kidney function in the elderly.

It gives the listener especially the unintiated, the patient /consumer
/participant a sense of a process that had been ongoing for a awhile,
"chronic" and a "disease" meaning there is an actual pathophysiology where
in fact it is a condition that is solely based on a creatinine number, age
and a formula. On the other hand it gives the doctor grounds to intervene
and do something it is like the war on kidneys (cf war on drugs).

We will have to ask ourselves the question what do we really achieve with
this designation? ..very little are there any nephrological practises that
could reverse CKD of the elderly ?

Not uncommonly, I will have this comment from my patient: wait a minute
what you mean I have kidney disease ? and can we do something to stop it or
reverse ? or the worst ..why haven't my PCP done anything about it ? . And
of course I try to explain.

The proper term should be something like "kidney aging" or something to
emphasise aging not pathology. Something more descriptive and less heroic
and actionable. Only then will everybody relax. Because it is aging it is
not a "chronic disease of the kidneys"

Thanks

Abdul Saadi, MD
Philadelphia
On Apr 9, 2014 3:21 PM, "robert bell" <rmsbell at esedona.net> wrote:

> Thanks Alan.
>
> Agree, agree.
>
> Also, it seems to me that the diagnostic definitions are, in the main,
> proposed by Specialty Societies who MAY be biased for economic reasons. I
> am not sure if this is the case and would welcome comment. If it is the
> case, shining lights might help.
>
> The other issue would seem to be that if there is a condition/disease that
> is not well defined with current parameters would a list of these published
> by IMPROVEDX be of any value so that others can refine things? After all,
> looking for Errors in diagnosis becomes hard if there are no good defined
> diagnostic criteria for certain diseases (which supports your thesis Alan).
>
> Fine, kind, courteous medical/scientific interaction with Specialty
> Societies would be a great way to grow the organization, impart  the
> importance of the mission, and make an impact for all!
>
> Position papers could make a big statement.
>
> Rob Bell
>
>
>
> On Apr 9, 2014, at 11:23 AM, Alan Morris <Alan.Morris at IMAIL.ORG> wrote:
>
>   Those of you who have paid attention to my past suggestions about
> standardization might see in this exchange the problems that surface when
> standards are absent.  Some would assign to chronic renal insufficiency
> those whom others think normal.
>  Have  a nice day.
>
>     Alan H. Morris, M.D.
> Professor of Medicine
> Adjunct Prof. of Medical Informatics
> University of Utah
>
>  Director of Research
> Director Urban Central Region Blood Gas and Pulmonary Laboratories
> Pulmonary/Critical Care Division
> Sorenson Heart & Lung Center - 6th Floor
> Intermountain Medical Center
> 5121 South Cottonwood Street
> Murray, Utah  84157-7000, USA
>
>  Office Phone: 801-507-4603
> Mobile Phone: 801-718-1283
> Fax: 801-507-4699
> e-mail: alan.morris at imail.org
> e-mail: alanhmorris at gmail.com
>
>   From: Harold Szerlip <hszerlip at GMAIL.COM>
> Reply-To: Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Harold Szerlip <hszerlip at GMAIL.COM>
> Date: Wednesday, April 9, 2014 10:03 AM
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?
>
>   I think you should look at the KDIGO definition of CKD.  CKD 3 A (eGFR
> 45-60) without proteinuria, which would be the majority of the CKD in the
> elderly has a minimal increased cardiovascular risk. It is proteinuria that
> is associated with an increase in risk. This is likely secondary to
> underlying endothelia dysfunction.  The PREVEND study supports this.
>
>  Harold Szerlip, MD, FACP, FCCP, FASN, FNKF
>
>  On Apr 9, 2014, at 9:55 AM, Hayward, Rodney (Rod) <rhayward at MED.UMICH.EDU>
> wrote:
>
>  For the vast majority, the most important implication of CKD is elevated
> CV risk. In this regard, the current classification is suboptimal in that
> early stage 3 CKD (eGFR 45-60) only elevates CV risk moderately, but
> advanced stage 3 (eGFR 30-45) results in a dramatic increase in CV risk.
>
>  ------------------------------
> *From:* Carroll, Thomas [Thomas_Carroll at URMC.ROCHESTER.EDU]
> *Sent:* Wednesday, April 09, 2014 9:23 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?
>
>    It seems to me that the definition of CKD (especially in the elderly,
> but I suppose in everyone) really only matters in the context of an
> individual's expected survival.  If they're very unlikely to outlive their
> kidney function, then it doesn't matter and vice versa.
>
>
>  Thomas M. Carroll M.D., Ph.D.
>  Assistant Professor, General Medicine & Palliative Care
>  University of Rochester
> thomas_carroll at urmc.rochester.edu
> Pager 5-1616 #3872
>  Tel: 585-275-7424 (General Medicine Office)
>  Tel: 585-273-1154 (Palliative Care Office)
>
>
>   *From:* robert bell [mailto:rmsbell at ESEDONA.NET <rmsbell at ESEDONA.NET>]
> *Sent:* Wednesday, April 09, 2014 1:12 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?
>
>
>  There are a group of diagnoses where we do not have enough
> data/information to make a firm diagnosis.
>
>
>   This link relates to age and renal failure
> http://www.medscape.com/viewarticle/753447_5[medscape.com]<https://urldefense.proofpoint.com/v1/url?u=http://www.medscape.com/viewarticle/753447_5&k=lmxj0uloiQslubycBXSv7A%3D%3D%0A&r=2K3rpxY%2F727qla%2FHDALAeTaA5t9cwqTMwcT7I%2FCCLB4yjtjSPaS5yPdWSZE2V06X%0A&m=1zYzMxWTkoQiB7gLrE62tYUgQ3O12LX%2BG81cFIbClVs%3D%0A&s=eaf0b349a89245375c2074b66b7706749c53ec585245383530cfd0826a4dfc18>
>
>
>   It is said here: "Therefore, it is not clear to what extent a decline
> in GFR with age is physiological and what level of GFR should be considered
> abnormal in older people."
>
>
>   So how can we say some elderly people definitely have Chronic Renal
> Failure?
>
>
>   So should the first thing be to clarify better what is Chronic Renal
> failure in elderly people.
>
>
>   Could there be Errors in Diagnosis here because the renal failure
> standards are incorrect?!
>
>
>   Rob Bell
>
>
>  ------------------------------
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