Name two major risk factors for CKD progression.

• A. Age and gender.
• B. Obesity and hypothyroidism.
• C. Diabetes mellitus and hypertension.
• D. Smoking and hyperlipidemia.

Answer: (C)

Two major risk factors for CKD progression are diabetes mellitus and hypertension. Diabetes damages the kidneys through diabetic nephropathy, where chronic high blood glucose drives pathways that cause glomerular hyperfiltration, thickening of the glomerular basement membrane, mesangial expansion, and eventual scarring that reduces filtration capacity and increases protein leakage. Hypertension accelerates kidney injury by raising intraglomerular pressure, promoting arteriosclerosis and ischemic damage to nephrons, which speeds up the decline in GFR. When these conditions occur together, they amplify each other’s harmful effects and hasten progression toward kidney failure.

Controlling blood glucose and blood pressure is key to slowing this progression, with therapies like ACE inhibitors or ARBs offering kidney protection beyond blood pressure reduction. While age, gender, obesity, hypothyroidism, smoking, and hyperlipidemia can influence kidney health, they do not drive CKD progression as strongly or consistently as diabetes and hypertension.