Bagchi Soumita, Prieto Luis, Nitsch Dorothea
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
BMC Nephrol. 2025 Jul 1;26(1):320. doi: 10.1186/s12882-025-04258-1.
Chronic kidney disease (CKD) of undetermined etiology (CKDu) is an important public health problem. It is a diagnosis of exclusion and the diagnostic approach varies widely across geographies. We aimed to systematically examine criteria used to diagnose CKDu in published literature.
PubMed, Medline, Embase, and Web of Science were searched systematically for published studies and conference abstracts pertaining to CKDu using relevant search terms. Systematic reviews/meta-analyses and reviews were screened to identify additional studies. Findings are presented in tables and figures and discussed critically.
60 studies were identified which mention the definition used to diagnose CKDu. A combination of pre-specified estimated glomerular filtration rate (eGFR) and proteinuria/albuminuria cut-offs was used as diagnostic criteria in only 18 studies (30%), while another 11 studies (18.3%) relied solely on proteinuria/albuminuria cut-offs.Nineteen studies classified all CKD patients without any identifiable cause as CKDu irrespective of level of proteinuria/albuminuria. 18 studies excluded patients with significant proteinuria/albuminuria, although cut-offs used for exclusion varied. Limited studies mention the criteria used to exclude diabetes(n = 22) and hypertension(n = 23) related kidney disease, the two most common causes of CKD with wide variability.
There is considerable variability in diagnostic criteria used to define CKDu in epidemiologic studies, especially in excluding proteinuria and other causes of kidney disease. Such heterogeneity may cause misclassification and erroneous estimation of disease burden making comparisons between studies difficult.
Not applicable.
病因不明的慢性肾脏病（CKDu）是一个重要的公共卫生问题。它是一种排除性诊断，且不同地区的诊断方法差异很大。我们旨在系统地研究已发表文献中用于诊断CKDu的标准。
使用相关检索词在PubMed、Medline、Embase和Web of Science中系统检索与CKDu相关的已发表研究和会议摘要。筛选系统评价/荟萃分析及综述以识别其他研究。研究结果以表格和图表形式呈现并进行批判性讨论。
共识别出60项提及用于诊断CKDu定义的研究。仅18项研究（30%）将预先设定的估计肾小球滤过率（eGFR）和蛋白尿/白蛋白尿临界值的组合用作诊断标准，另有11项研究（18.3%）仅依赖蛋白尿/白蛋白尿临界值。19项研究将所有无明确病因的CKD患者归类为CKDu，而不考虑蛋白尿/白蛋白尿水平。18项研究排除了有显著蛋白尿/白蛋白尿的患者，尽管用于排除的临界值各不相同。有限的研究提及了用于排除糖尿病（n = 22）和高血压（n = 23）相关肾病的标准，这两种是CKD最常见的病因，差异很大。
在流行病学研究中，用于定义CKDu的诊断标准存在很大差异，尤其是在排除蛋白尿和其他肾病病因方面。这种异质性可能导致错误分类和疾病负担的错误估计，使得不同研究之间难以进行比较。
不适用。
