CKDMMM 150717231019 Lva1 App6892 PDF
CKDMMM 150717231019 Lva1 App6892 PDF
CKDMMM 150717231019 Lva1 App6892 PDF
Disease
• CKD IS CONFIRMED
EVALUATION OF CKD
• urinalysis to detect hematuria or pyuria ,
urine microscopy to detect RBC casts or
WBC casts.
• Ultrasound to assess kidney structure for
kidney shape,size, symmetry and
evidence of obstruction
• Serum and urine electrolytes to assess
renal tubular disorders
DEFINITION AND IDENTIFICATION
OF CKD
PROGRESSION
• BLOOD PRESSURE
• diabetic and non diabetic adults with
CKD and urine albumin excretion <
30mg/24 hours treated with BP-
lowering drugs to maintain a BP that is
consistently<140mm and diastolic <90.
• CKD and with urine albumin excretion of
>30mg/24 hours maintain a BP
<130/80mmhg
• Use of ARB or ACE-I in both diabetic and
non-diabetic adults with CKD and urine
albumin excretion >300 mg/24 hours
• If diabetic, albuminuria 30-300mg /24 hrs
is indicated for ACE/ARBI
• electrolyte disorders, acute deterioration in
kidney function, orthostatic hypotension
and drug side effects has be given close
attention in CKD to prevent adverse effects
of antihypertensive therapy.
CKD and risk of AKI
• All CKD patients are at risk for AKI
• All reversible precipitating factors has to
be avoided
Protein intake in CKD
• protein intake restriction to 0.8
g/kg/day in adults with diabetes or
without diabetes and GFR <30 ml/min/
1.73 m2.
• avoid high protein intake (1.3 g/kg/day)
in adults with CKD at risk of progression
Diabetic control
• Glycemic control improves outcomes in people
with diabetes with or without CKD
• In people with CKD and diabetes, glycemic
control should be part of a multifactorial
intervention
• Blood pressure control and cardiovascular risk,
ACE-I,ARBS,Statins and antiplatelet therapy to
be used where clinically indicated
• Recommended target (HbA1c)at 7.0% and not
less to prevent hypoglycaemia and to delay
progression of the microvascular complications
of diabetes, including diabetic kidney disease
Salt intake
• Salt lowering intake to <2 g per day of
sodium (corresponding to 5 g of sodium
chloride) in adults, unless
contraindicated.
• Individuals with CKD should receive
expert dietary advice and information as
a education program, based on severity
of CKD and the need to intervene on
salt,phosphate, potassium, and protein
intake where indicated.
• Patients with CKD be encouraged to
undertake physical activity compatible
with cardiovascular health and tolerance
(aiming for at least 30minutes 5 times
per week),
• BMI - 20 to 25, and
• Stop smoking
COMPLICATIONS ASSOCIATED WITH LOSS OF KIDNEY
FUNCTION
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