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    Chronic Kidney Disease-Step23C - 1

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    DEBJIT SARKAR
    Chronic kidney disease is a slow decline in kidney function over time that eventually leads to kidney failure requiring dialysis or transplantation in many patients. The most common causes are diabetes and hypertension. It is staged based on glomerular filtration rate, with stage 5 being kidney failure. Risks include progression to kidney failure, cardiovascular disease, and infection. Treatment involves slowing progression with medications, managing complications, and renal replacement therapy like hemodialysis or peritoneal dialysis for kidney failure patients.

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    Chronic Kidney Disease-Step23C - 1

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    DEBJIT SARKAR
    10 views22 pages
    Chronic kidney disease is a slow decline in kidney function over time that eventually leads to kidney failure requiring dialysis or transplantation in many patients. The most common causes are diabetes and hypertension. It is staged based on glomerular filtration rate, with stage 5 being kidney failure. Risks include progression to kidney failure, cardiovascular disease, and infection. Treatment involves slowing progression with medications, managing complications, and renal replacement therapy like hemodialysis or peritoneal dialysis for kidney failure patients.

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    Chronic kidney disease is a slow decline in kidney function over time that eventually leads to kidney failure requiring dialysis or transplantation in many patients. The most common causes are diabetes and hypertension. It is staged based on glomerular filtration rate, with stage 5 being kidney failure. Risks include progression to kidney failure, cardiovascular disease, and infection. Treatment involves slowing progression with medications, managing complications, and renal replacement therapy like hemodialysis or peritoneal dialysis for kidney failure patients.

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    © All Rights Reserved
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    10 views22 pages

    Chronic Kidney Disease-Step23C - 1

    Uploaded by

    DEBJIT SARKAR
    Chronic kidney disease is a slow decline in kidney function over time that eventually leads to kidney failure requiring dialysis or transplantation in many patients. The most common causes are diabetes and hypertension. It is staged based on glomerular filtration rate, with stage 5 being kidney failure. Risks include progression to kidney failure, cardiovascular disease, and infection. Treatment involves slowing progression with medications, managing complications, and renal replacement therapy like hemodialysis or peritoneal dialysis for kidney failure patients.

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    of 22

    Chronic Kidney Disease

    Jason Ryan, MD, MPH


    Chronic Kidney Disease
    • Slow, steady fall in creatinine clearance
    • Blood tests show ↑ BUN/Cr
    • Eventually progresses to dialysis for many patients
    • Most common causes diabetes and hypertension
    • Diabetic nephropathy
    • Hypertensive nephrosclerosis
    • Rarely other causes:
    • Glomerulonephritis
    • Cystic kidney disease
    Stages of Chronic Kidney Disease
    • Stage 1 → GFR > 90 (↑BUN/Cr, proteinuria)
    • Stage 2 → GFR 60-89
    • Stage 3 → GFR 30-59
    • Stage 4 → GFR 15-29 (approaching dialysis)
    • Stage 5 → GFR < 15 (usually on dialysis)
    Chronic Kidney Disease
    Risks
    • Progression to dialysis
    • Cardiovascular disease
    • Stroke, MI
    • CKD → accelerated atherosclerosis
    • Most common cause of death in adults
    • Infection
    • Most common cause of death in children
    • Most common cause of death with transplants

    myupchar.com/Public Domain
    Renal Replacement Therapy
    • GFR < 5 ml/min
    • GFR 5 – 15 ml/min with AEIOU
    • Acidemia
    • Electrolytes (hyperkalemia)
    • Intoxication (overdose dialyzable substance)
    • Overload of fluid (CHF)
    • Uremic symptoms (pericarditis, encephalopathy)
    • Most common indications: hyperkalemia and volume overload
    Dialyzable Substances
    • Salicylates (aspirin)
    • Lithium
    • Isopropyl alcohol
    • Magnesium laxatives
    • Ethylene glycol

    Bodhi Peace/Wikipedia
    Dialysis Methods
    Hemodialysis
    • Requires vascular access
    • Blood pumped from body → filter → back to body
    • Done in “sessions” of few hours at a time
    • Usually 3 days per week
    • Can be done emergently
    • Risk of hypotension

    Wikipedia/Public Domain
    Dialysis Methods
    Peritoneal Dialysis
    • Fluid cycled through peritoneal cavity
    • Peritoneum used as dialysis membrane
    • Cycles for 4-6 hours per day
    • Usually done at home during sleep
    • Major risk: peritonitis

    Burce Blaus/Public Domain


    Dialysis Methods
    Hemofiltration
    • Constant filtering of blood
    • Usually done at bedside for critically-ill patients

    Ringer21/Slideshare.net
    Vascular Access
    • For acute dialysis, central line can be placed
    • Ideal method is fistula
    • Connection between artery and vein
    • Placed surgically, usually in arm
    • Lowest rates of thrombosis, infection
    • Fistula must “mature” for use
    • Ideally placed several months before dialysis

    Kbk/Wikipedia
    Complications CKD
    • Anemia
    • Loss of EPO
    • Bleeding
    • Abnormal platelet function
    • Infection
    • Abnormal neutrophil function

    Jessica Polka/Wikipedia
    Complications CKD
    • Dyslipidemia
    • Mostly triglycerides
    • Protein loss in urine → stimulation of liver synthesis
    • Impaired clearance of chylomicrons and VLDL
    • Sexual dysfunction
    • Erectile dysfunction
    • Anovulation
    • Abnormal calcium and phosphate
    Calcium-Phosphate in CKD
    Sick Kidneys

    ↑ Phosphate ↓1,25-OH2 Vitamin D

    ↓Ca from plasma ↓Ca from gut

    Hypocalcemia

    ↑PTH
    Calcium-Phosphate in CKD
    • Secondary hyperparathyroidism
    • Parathyroid stimulation in renal failure
    • Tertiary hyperparathyroidism
    • Autonomous hormone release from constant stimulation
    • VERY high PTH levels
    • Calcium becomes elevated
    • Often requires parathyroidectomy

    Lee Health/Vimieo
    Bone Disease in CKD
    • Untreated hyperparathyroidism leads to renal osteodystrophy
    • Bone pain (predominant symptom)
    • Fracture (weak bones 2° chronic high PTH levels)
    • Osteitis fibrosa cystica
    • Untreated, severely elevated PTH levels
    • Bone cysts
    • Brown tumors (osteoclasts w/fibrous tissue)
    Chronic Kidney Disease
    Treatment
    • ACE Inhibitors
    • Used in early CKD
    • Limit progression
    • Renal diet
    • Advanced CKD
    • Low protein (limits urea production)
    • Low potassium, phosphate and magnesium
    • Low salt if HTN, CHF or oliguria

    pxhere.com/Public Domain
    Chronic Kidney Disease
    Treatment
    • Vitamin D and calcium supplementation
    • Phosphate binders
    • Bind phosphate in GI tract
    • Calcium carbonate
    • Calcium acetate (Phoslo)
    • Sevelamer (Renagel)
    • Lanthanum
    Drugs and Renal Function
    • Many drugs worsen renal function
    • Decrease GFR
    • Associated with ↑ BUN/Cr
    • Loop, Thiazide, and K-sparing diuretics
    • NSAIDs

    Pixabay/Public Domain
    Contrast Nephropathy
    • CT radiocontrast dye may lead to acute kidney injury
    • Avoided in patients with CKD
    Calciphylaxis
    Calcific Uremic Arteriopathy
    • Seen in chronic hyperphosphatemia in CKD
    • Excess phosphate taken up by vascular smooth muscle
    • Smooth muscle osteogenesis
    • Vascular wall calcification
    • Increased systolic blood pressure
    • Small vessel thrombosis
    • Painful nodules, skin necrosis

    Niels Olsen/Wikipedia
    Nephrogenic Systemic Fibrosis
    • Diffuse fibrosis of skin
    • Induration, thickening, hardening
    • “Brawny” hyperpigmentation
    • Shiny skin
    • Gadolinium: MRI contrast agent
    • Renal disease + exposure to gadolinium
    • Gadolinium contraindicated in CKD patients
    • No treatment

    Public Domain
    Kidney Transplantation
    • Reduces mortality compared with dialysis
    • Improves quality of life
    • Usually reserved for younger patients (< 55)
    • Requires post-transplant immunosuppression therapy

    BruceBlaus/Wikipedia

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