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CKD PDF

Chronic kidney disease is characterized by a progressive decline in kidney function over time. It has many potential causes that can initiate kidney damage and lead to a long-term reduction in renal mass. As kidney function declines, patients experience various complications affecting fluid and electrolyte balance, bone and mineral metabolism, cardiovascular health, and other organ systems. Proper management focuses on controlling risk factors, monitoring laboratory values, and determining if renal replacement therapy is needed.

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Nogra Carl
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326 views26 pages

CKD PDF

Chronic kidney disease is characterized by a progressive decline in kidney function over time. It has many potential causes that can initiate kidney damage and lead to a long-term reduction in renal mass. As kidney function declines, patients experience various complications affecting fluid and electrolyte balance, bone and mineral metabolism, cardiovascular health, and other organ systems. Proper management focuses on controlling risk factors, monitoring laboratory values, and determining if renal replacement therapy is needed.

Uploaded by

Nogra Carl
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CHRONIC KIDNEY

DISEASE

Marichel Cobcoban-Samporna
IM- Nephrology
Chronic Kidney Disease
v  a spectrum of different
pathophysiologic processes associated
with abnormal kidney function and a
progressive decline in GFR

v  ESRD UREMIC SYNDROME


Chronic Kidney Disease

v pathophysiology
1. inititiating mechanisms specific to the
underlying etiology

2. set of progressive mechanisms
(hyperfiltration and hypertrophy) with long
term reduction in renal mass
Leading Categories of Etiologies of CKD
KDIGO Classification of CKD

R I S K
v Cockcroft- Gault Formula
(140- Age) (wt. kg)
(72) (creatinine) * 0.85% for females
Classification of CKD
I. 35 yo II. 65 yo
male female
wt. 45 kgs 70 kgs
creatinine: 2 mg/dl 5 mg/dl
urine albumin: 500 mg/g 200 mg/g



Risk Factors for CKD
v  small for gestational weight
v  childhood obesity
v  hypertension
v  diabetes
v  autoimmune disease
v  advanced age
v  African ancestry
v  family hx of kidney disease
v  AKI
v Proteinuria/sediment
v  structural abnormalities
Classification of CKD
v  normal decline of GFR: 1 ml/min per year:
120 ml/min/m3



v  age 70: 70 ml/min/m3
Signs and Symptoms of CKD and Uremia:
HYPERNATREMIA

SODIUM Intake > urinary excretion

Sodium
Extracellular Fluid Volume Expansion
Retention

Nephron Injury Hypertension


Signs and Symptoms of CKD and Uremia:
HYPERKALEMIA
Increase dietary K intake
Protein Catabolism

Hemolysis/Hemorrhage
Transfusions

Metabolic Acidosis
Drugs
Calcium and Phosphate Metabolism

DECREASE GFR

DECREASE PO4 EXCRETION

FGF-23 PTH

DECREASE DECREASE
CALCITRIOL CALCIUM
Calcium and Phosphate Metabolism
Calcium and Phosphate Metabolism
Calcium and Phosphate Metabolism
Calcium and Phosphate Metabolism:
Calciphylaxis
v  calcific uremic arteriolopathy
v  exclusive on patients on advanced CKD
v  vascular occlusion with extensive vascular
and soft tissue calcification
v  hyperphosphatemia, hypercalcemia
v  oral calcium for phosphate binder
v  warfarin: decrease vitamin K dependent
regeneration of matrix GLA protein
Calcium and Phosphate Metabolism:
Calciphylaxis
Livedo reticularis
Patches of ischemic
necrosis
Legs, thighs, abdomen,
breast

Tx: hyperbaric O2
IV thiosulfate
discontinue drugs
Cardiovascular Abnormalities

v  10-200 fold
1.  Ischemic Heart Disease
* Cardiac troponin I
2. Heart Failure: uremic cardio, AMI, LVH
3. Hypertension and LVH
4. Pericardial Disease
* PR depression and diffuse ST segment
elevation
Hematologic Abnormalities
Interstitial fibroblast

TARGET Hb: 100-115 g/L


Neuromuscular Abnormalities
v  Peripheral Neuropathy

v  Restless Leg Syndrome


Dermatologic Abnormalities
v  Pruritus

v  Hyperpigmentation

v  Nephrogenic Fibrosing Nephropathy
MR contrast gadolinium
avoid: < 30 ml/min
*Hemodialysis after even if not on HD
Gastrointestinal Abnormalities

v  Uremic Fetor

v  Dysgeusia
Endocrine-Metabolic Abnormalities

v  Insulin
progressive dose reduction as renal
function deteriorates

v  Estrogen

v  Testosterone
Evaluation and Management with CKD

v  History and PE

v  Laboratory

v  Imaging studies

v  kidney Biopsy
Management with CKD

v  Goals
BP
Hb
Phosphorous
Calcium

v  Renal Replacement Therapy

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