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Chronic Kidney Disease What You Need to Know

Chronic Kidney Disease What You Need to Know. Phil Ramos, MD, MSCI Denver Nephrologists, P.C. Objectives. What are the kidneys and how do they work? What is Chronic Kidney Disease? What are the causes? How do I know if I have chronic kidney disease?

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Chronic Kidney Disease What You Need to Know

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  1. Chronic Kidney DiseaseWhat You Need to Know Phil Ramos, MD, MSCI Denver Nephrologists, P.C.

  2. Objectives • What are the kidneys and how do they work? • What is Chronic Kidney Disease? • What are the causes? • How do I know if I have chronic kidney disease? • How do I prevent this from happening to me?

  3. The Kidney • 2 bean-shaped organs • the human body’s internal filters • Main Job: Helps Make Urine! • Other important functions

  4. The Nephron • 1 million nephrons per kidney • Filters the blood keeping the good (proteins) and excreting the waste (toxins, drugs) • Regulation of electrolytes (sodium, potassium, calcium and phosphorus) • Regulation of Water

  5. Other Important Functions • Produces Hormones • Helps Red Blood Cells Develop (Erythropoietin) • Regulates Bone Health (calcium and phosphorus) by producing a special Vitamin D • Produces enzyme (Renin) which helps regulate salt balance and blood pressure

  6. Estimating Kidney Function • Measure blood (serum) creatinine • Estimated Glomerular Filtration Rate • eGFR • Sum of all the filtration rate of the “working” nephrons • The kidneys filter about 180 liters of blood per day (125 milliliters per minute) • Normal eGFR is 130 and 120 mL/min for men and women, respectively • used clinically to assess the degree of kidney impairment and to follow the course of the disease

  7. What is Chronic Kidney Disease • Kidney damage for 3 months • Defined by structural or functional abnormalities of the kidney, with or without decreased eGFR (protein and/or blood in the urine, multiple kidney cysts, small kidneys) • Reduced eGFR <60 mL/min for 3 months, with or without other evidence of kidney damage • Staging for chronic kidney disease (CKD) is primarily based on kidney function but also evidence of damage to the filtering units (glomeruli) National Kidney Foundation (NKF). Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.

  8. CKD Progresses in Stages (Defined by eGFR) NKF. Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.

  9. The Epidemic of CKD • Approximately 26 million Americans suffer from chronic kidney disease, many of whom are undiagnosed since symptoms of kidney disease are not obvious until the kidneys totally fail • Many more at risk… • Over 500,000 Americans suffer from end stage renal disease (ESRD) and this number continues to increase yearly.

  10. CKD Is a Growing Epidemic GFR (mL/min/1.73 m2) CKD Stage Number of Individuals* 1 903.6 million 2 60-896.5 million 3 30-59 15.5 million 4 15-29 700,000 5 <15 or dialysis 500,000 *Coresh et al. JAMA; 298 (17): 2038 (2007) United States Renal Data System, 2008

  11. Risk Factors for CKD • Diabetes • Hypertension • Vascular disease • Kidney stones • Chronic urinary tract infections • Exposure to certain drugs and Chinese herbs • High cholesterol • Obesity • Smoking

  12. Diabetic Kidney Disease

  13. Hypertension Kidney Disease

  14. Medication Risk Factors: NSAID’s • Non-Steroidal Anti-inflammatory Drugs (NSAID’s) • Almost 60% of community-dwelling adults use NSAID’s • Higher doses and longer exposure to NSAID’s are associated with an increased risk of kidney disease progression • For those with CKD due to another cause, NSAIDs can worsen kidney function quickly. Consult your doctor about this. Gooch, K. et. al. Am J Med 2007;120.

  15. NSAID’s • Motrin • Naprosyn • Ibuprofen • Aleve • BC Powder • Daypro, Celebrex, Feldene, Lodine, Anaprox, Dolobid, Voltaren

  16. Signs/Symptoms of CKD • You cannot “feel” CKD at the early stages • The amount of urination can be “normal”, decreased, or even increased with CKD • Worsening high blood pressure • increased swelling in the legs, hands or face • foamy or bloody urine

  17. Signs/Symptoms of End Stage Renal Disease (ESRD) • decreased appetite and malnutrition • metallic taste to food • nausea, vomiting, stomach pain • chest pain and shortness of breath • generalized itching • decreased concentration and memory • sleep disturbances • numbness in the hands and feet • worsening anemia • bone fractures

  18. Signs/Symptoms of End Stage Renal Disease (ESRD) • Most Common Cause of Sickness and Death in CKD and ESRD •  Cardiovascular Disease (heart attack, heart failure, stroke) • CKD/ESRD highly associated with cardiovascular disease compared to the non-kidney disease population

  19. Blood and Urine Results in CKD/ESRD • High blood urea nitrogen (BUN) and creatinine • Worsening anemia (decreased red blood cells) • High blood phosphorus and low calcium. High parathyroid hormone • High acid build up in blood and high blood potassium • Urine with microalbuminuria, proteinuria or hematuria

  20. Urinary Tract Obstruction • Blockade of the urinary tract from kidneys to urethra • Kidney stones • Enlarged prostate • Cancer • Abnormal Anatomy Renal Ultrasound to diagnose

  21. Kidney Cysts • Simple cysts not bad • Genetic diseases associated with multiple kidney cysts can cause ESRD

  22. Which Patients Should Be Screened for CKD? Levey et al. Ann Intern Med. 2003;139:137-147. USRDS. 1999 Annual Data Report. Available at: www.usrds.org.

  23. Primary Goals of Management in CKD • Diabetes Control • Hypertension control • Simplified BP goals: <130/80 • Reduction of proteinuria with ACE-Inhibitors or ARBs • High proteinuria through time scars the kidneys • Anemia control • Maintaining Bone Health (Secondary hyperparathyroidism) • Prevent progression with decreased phosphorous in the diet and vitamin D

  24. Primary Goals of Management in CKD • Quit Smoking • Control High Cholesterol • Avoid NSAIDs and adjust other medications for decreased renal function • Low-potassium diet for blood potassium high • Avoid iodine contrast injection in veins for certain procedures unless absolutely necessary • Avoid dehydration

  25. ESRD and Hemodialysis • When eGFR < 15 ml/min and feeling sick for kidney failure (UREMIA) • Three times a week for 3-4 hours at a time • Can be done at home and at night • Need arm “fistula” placed

  26. ESRD and Peritoneal Dialysis • Putting dialysis fluid into the abdominal space • Peritoneal catheter • Advantage of dialyzing continuously, at work and home. • Can perform at night

  27. Renal Transplantation • A great option • Can be put on waiting list for a cadaveric kidney • Can have a living related or unrelated person donate if they are healthy enough

  28. Prevention of CKDMost Important • Adhering to a low-fat, low-salt diet • Controlling blood pressure • Regular exercise • Avoid the on-set of diabetes • Avoid smoking • Regular annual check-ups with your Primary Care Provider to screen for kidney disease with urine and blood work

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