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Chronic_Kidney_Disease

chronic renal failure

LAKSHMINARAYANA2
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Chronic_Kidney_Disease

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  1. ChronicKidneyDisease Dr. Lakshminarayana GR

  2. WhatisCKD? • Presence of markers of kidney damage for three months, as defined by structural or functional abnormalities of the kidney with or without decreased GFR, manifest by either pathological abnormalities or other markers of kidney damage, including abnormalities in the composition of blood or urine, or abnormalities inimaging tests. • The presence of GFR <60 mL/min/1.73 m2for threemonths,withorwithoutothersignsofkidney damageas describedabove. • AmJKidneyDis2002;39:S1

  3. StagesofCKD • Stage1*:GFR>=90mL/min/1.73m2 • NormalorelevatedGFR • Stage2*:GFR60-89(mild) • Stage3:GFR30-59(moderate) • Stage4:GFR15-29(severe;pre-HD) • Stage5:GFR<15(kidneyfailure) • AmJKidneyDis2002;39(S2):S1-246

  4. Otheretiologies • Renovasculardisease • Glomerulonephritis • Nephroticsyndrome • Hypercalcemia • Multiplemyeloma • ChronicUTI

  5. Signs&Symptoms • General • Fatigue&malaise • Edema • Ophthalmologic • AVnicking • Cardiac • HTN • Heartfailure • Pericarditis • CAD • GI • Anorexia • Nausea/vomiting • Dysgeusia • Skin • Pruritis • Pallor • Neurological • MSchanges • Seizures

  6. Hypertension • TargetBP • <130/80mmHg • <125/75mmHg • ⯈ptswithproteinuria(>1 g/d) • Consider several anti-HTN medications with differentmechanismsofactivity • ACEs/ARBs • Diuretics • CCBs • HCTZ(lesseffectivewhenGFR<20)

  7. Proteinuria • Singlebestpredictorofdiseaseprogression • Normalalbuminexcretion • <30mg/24hours • Microalbuminuria • 20-200g/minor30-300mg/24hours • Macroalbuminuria • >300mg/24hours • Nephroticrangeproteinuria • >3g/24hours AmJKidneyDis2002;39(S2):S1-246

  8. EvaluationforCKD • Blood • CBCwithdiff • SMA-7withCa2+and phosphorous • PTH • HBA1c • LFTsandFLP • UricacidandFe2+ studies • Urine • Urinalysis with microscopy • Spoturinefor microalbumin • 24-urine collection for proteinand creatinine • Ultrasound

  9. Metabolicchanges with CKD • Hemoglobin/hematocrit • Bicarbonate • Calcium • Phosphate • PTH • Triglycerides

  10. Anemia • CommoninCKD • HDpts have increased rates of: • Hospitaladmission • CAD/LVH • Reducedqualityoflife • Canimproveenergylevels,sleep,cognitive function, and quality of life in HD pts

  11. Metabolicchanges… • Monitor and treat biochemicalabnormalities • Anemia • Metabolicacidosis • Mineralmetabolism • Dyslipidemia • Nutrition

  12. TreatingAnemia • Epoetinalfa(rHuEPO;Epogen/Procrit) • HD:50-100U/kgIV/SC3x/wk • Non-HD:10,000Uqwk • Darbepoetinalfa(Aranesp) • HD:0.45g/kgIV/SCqwk • Non-HD:60gSCq2wks

  13. Metabolicacidosis • Musclecatabolism • Metabolicbonedisease • Sodiumbicarbonate • Maintain serumbicarbonate >22meq/L • 0.5-1.0meq/kgperday • Watchforsodiumloading • ⯈Volumeexpansion • ⯈HTN

  14. Mineralmetabolism • Calcium and phosphatemetabolism abnormalities associated with: • Renalosteodystrophy • Calciphylaxisandvascularcalcification • 14 of 16 ESRD/HD pts (20-30 yrs) had calcification on CT scan • 3of60inthe control group NEJM2000;342(20):1478-83

  15. Dyslipidemia • Abnormalitiesinthelipidprofile • Triglycerides • Totalcholesterol • NCEPrecommendsreducinglipidlevelsin high-riskpopulations • Targets forlipid-loweringtherapyconsidered the same as those for the secondary preventionofCVdisease JAMA1993;269(23):3015-23

  16. Nutrition • Thinkabouturemia • Catabolicstate • Anorexia • Decreasedproteinintake • Considerassistancewitharenaldietician

  17. Management • Identify and treat factorsassociatedwith progressionof CKD • HTN • Proteinuria • Glucosecontrol

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