hronic kidney disease (CKD) affects between 8% and 16% of the population worldwide and is often underrecognized by patients and clinicians. [1][2][3][4] Defined by a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m 2 , albuminuria of at least 30 mg per 24 hours, or markers of kidney damage (eg, hematuria or structural abnormalities such as polycystic or dysplastic kidneys) persisting for more than 3 months, 5 CKD is more prevalent in low-and middle-income than in highincome countries. 6 Globally, CKD is most commonly attributed to diabetes and/or hypertension, but other causes such as glomerulonephritis, infection, and environmental exposures (such as air pollution, herbal remedies, and pesticides) are common in Asia, sub-Saharan Africa, and many developing countries. 4 Genetic risk factors may also contribute to CKD risk. For example, sickle cell trait and the presence of 2 APOL1 risk alleles, both common in people of African ancestry but not European ancestry, may double the risk of CKD. 4,[7][8][9][10] In the United States, the average rate of GFR decline is approximately 1 mL/min/1.73 m 2 per year in the general pop-ulation, 11,12 and the lifetime risk of developing a GFR of less than 60 mL/min/1.73 m 2 is more than 50%. 13 Early detection and treatment by primary care clinicians is important because progressive CKD is associated with adverse clinical outcomes, including endstage kidney disease (ESKD), cardiovascular disease, and increased mortality. [14][15][16][17] Recent professional guidelines suggest a risk-based approach to the evaluation and management of CKD. 5,[18][19][20] This review includes discussion of new calculators for determining risk of CKD progression that may be useful in clinical practice (eg, https://kidneyfailurerisk.com/) and focuses on the diagnosis, evaluation, and management of CKD for primary care clinicians. Considerations for referral to a nephrologist and dialysis initiation are also covered. MethodsA literature search to April 2019 was conducted using Medline and PubMed with search terms including CKD, chronic renal failure, IMPORTANCE Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death.OBSERVATIONS Defined as a persistent abnormality in kidney structure or function (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m 2 or albuminuria Ն30 mg per 24 hours) for more than 3 months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is most commonly attributed to diabetes and hypertension. However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies. Optimal management of CKD includes cardiovascular ...

was the Garabed Eknoyan Award recipient at the 2015 National Kidney Foundation Spring Clinical Meetings. This award was created to recognize an individual who has made exceptional contributions to promote the mission of the National Kidney Foundation in making lives better for people with kidney disease.

Disseminated strongyloidiasis is a potentially life-threatening infection in organ transplant recipients that typically occurs within the first 6 months of transplantation. We discuss a patient from the Appalachia region of Virginia who appeared to acquire Strongyloides stercoralis domestically years after kidney transplantation and then develop disseminated strongyloidiasis.