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Chronic Kidney Disease

Chronic Kidney Disease. Normal Physiology of the Kidney. Hormones – EPO, RAAS, 1-alpha-hydroxylase Metabolic – excretion of urea/creatinine etc. Homeostasis – acid base balance, electrolyte levels . Chronic Kidney Disease. A progressive decline in renal function

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Chronic Kidney Disease

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  1. Chronic Kidney Disease

  2. Normal Physiology of the Kidney • Hormones – EPO, RAAS, 1-alpha-hydroxylase • Metabolic – excretion of urea/creatinine etc. • Homeostasis – acid base balance, electrolyte levels

  3. Chronic Kidney Disease • A progressive decline in renal function • Present for at least 3 months • Marked by increased serum creatinine and a fall in GFR

  4. Aetiology Diabetes is the most important precursor to CKD. Consider the different disease processes: Vascular: increases in pressure, vasculitis Immunological: glomeruonephritis Infection: pylonephritis, UTI Congenital: polycystic disease Obstruction

  5. Clinical features • Pallor and malaise – due to anaemia • Pruritis – accumulation of urea + other metabolites • Polyuria, nocturia • Bone pain – metabolic bone disease • Sleep reversal, restless legs

  6. Staging

  7. Management • Aggressive BP control • ACEi, ARB, CCB • Aim <140/90 • Prevent hyperlipideamia • Statins • Vit D supplements

  8. Management of ESRD Renal replacement therapy: Haemodialysis: blood taken from patient and put through dialyser Peritoneal dialysis: tube inserted into peritoneal cavity and dialysate run through *Transplantation

  9. Questions 1. Describe how CKD can lead to metabolic bone disease (5 marks).

  10. Reduction in vitamin D means less Ca can be absorbed from gut • This stimulates parathyroid gland • PTH released • Stimulates Ca resorption from bone • Bones become weak, less crystalloid formation

  11. Thanks for listening!Any questions just email:K.Tomlinson@warwick.ac.uk

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