Transcript Chronic kidney disease

Chronic kidney disease
Alternative Names
Kidney failure - chronic
Renal failure - chronic
Chronic renal insufficiency
Chronic kidney failure
Chronic kidney disease
KIDNEY FAILURE AND KIDNEY DISEASE
KIDNEY FAILURE
 Kidney failure occurs when the kidneys partly or
completely lose their ability to carry out normal functions.
 This is dangerous because water, waste, and toxic
substances build up that normally are removed from the
body by the kidneys.
 It also causes other problems such as anemia, high blood
pressure, acidosis (excessive acidity of body fluids),
disorders of cholesterol and fatty acids, and bone disease in
the body by impairing hormone production by the kidneys.
CHRONIC KIDNEY DISEASE
Chronic kidney disease is
when one suffers from gradual
and usually permanent loss of
kidney function over time.
This happens gradually over
time, usually months to years.
Chronic kidney disease is
divided into five stages of
increasing severity . For the
total or near–total loss of
kidney function, the patients
need dialysis or transplantation
to stay alive.
STAGES OF CHRONIC KIDNEY DISEASE
 Stage 1 with normal or high GFR (GFR > 90
ml/min)
 Stage 2 Mild CKD (GFR = 60-89 ml/min)
 Stage 3 Moderate CKD (GFR = 30-59 ml/min)
 Stage 4 Severe CKD (GFR = 15-29 ml/min)
 Stage 5 End Stage CKD (GFR <15 ml/min)
Stages of Chronic Kidney Disease
Glomerular filtration rate (GFR) is the volume
of fluid filtered from the renal (kidney) glomerular
capillaries into the Bowman's capsule per unit time.
Clinically, this is often measured to determine renal
function. Compare to filtration fraction.
NORMAL RANGES
The normal ranges of GFR, adjusted for
body surface area, are:
Males: 70 ± 14 mL/min/m2
Females: 60 ± 10 mL/min/m2
(125ml/mt)
GFR can increase due to hypoproteinemia
because of the reduction in plasma oncotic
pressure. GFR can also increase due to
constriction of the efferent arteriole but
decreases due to constriction of the afferent
Stage 1 CKD
Slightly
diminished
function; Kidney damage
with normal or increased
GFR (>90 mL/min/1.73
m2). Kidney damage is
defined
as
pathologic
abnormalities or markers
of
damage,
including
abnormalities in blood or
urine test or imaging
studies.
Stage 2 CKD
Mild reduction in GFR
(60-89
mL/min/1.73
m2)
with
kidney
damage. Kidney damage
is defined as pathologic
abnormalities or markers
of damage, including
abnormalities in blood
or urine test or imaging
studies
Stage 3 CKD
Moderate reduction in GFR
(30-59 mL/min/1.73 m2)
Stage 4 CKD
Severe reduction in GFR (15-29
mL/min/1.73 m2)
Stage 5 CKD
Established kidney failure
(GFR <15 mL/min/1.73 m2,
or permanent renal
replacement therapy (RRT)
Causes
Diabetic nephropathy
Hypertension
Glomerulonephritis
Renal artery stenosis
Hemolytic-uremic syndrome
Vasculitis
Focal segmental glomerulosclerosis
Diabetic nephropathy.
Chronically
elevated blood
sugars damage
blood vessels and
filtering units in the
kidneys, the
condition is known
as diabetic
nephropathy.
Pyelonephritis
Causes
IgG nephritis
Lupus nephritis
Polycystic kidney disease
Reflux nephropathy
Kidney stones and
Prostate
HIV infection
Pathophysiology of uremia
 Diminished excretion of electrolytes and
water,
 Reduced excretion of organic solutes,
 Decreased hormone production
CKD developing atherosclerosis
Clinical manifestations of kidney
failure
Electrolytes
Edema,
Hyponatremia,
Hyperkalemia,
Metabolic acidosis,
Hyperuricemia,
Hyperphosphatemia,
Hypocalcemia
Gastrointestinal
 Anorexia,
 nausea,
 vomiting,
 malnutrition
Cardiovascular
 Accelerated atherosclerosis,
 systemic hypertension,
 pericarditis
Calcification of the left coronary artery in a patient with
chronic kidney disease receiving dialysis as seen on a
computerized tomography (CT) scan. The extensive deposition
of mineral (arrowed) results in a radio-opaque vessel with a
density similar to that of bone
Hematologic
 Anemia,
 immune dysfunction,
 platelet dysfunction
Musculoskeletal
 Renal osteodystrophy,
 muscle weakness,
 growth retardation in children,
 amyloid arthropathy caused by beta2-
microglobulin deposition
Looser zone (arrow) in the distal fibula
of a child with renal osteodystrophy
Neurologic
 Encephalopathy,
 seizures,
 peripheral neuropathy
Endocrine
 Hyperlipidemia,
 glucose intolerance caused by insulin
resistance,
 amenorrhea
 infertility in women,
 impotence
Skin
Pruritus
Decreased hormone
production
The kidneys normally
produce several hormones,
including
erythropoietin
and
calcitriol
(1,25dihydroxycholecalciferol),
the active form of vitamin
D.
The
decreased
production of these two
hormones
plays
an
important role in the
development of anemia
and
bone
disease,
respectively.
Exams and Tests
Urinalysis
Creatinine levels progressively increase.
BUN is progressively increased.
Creatinine clearance progressively
decreases.
Potassium test
Arterial blood gas
blood chemistry
Abdominal CT scan
Abdominal MRI
Systemic complications and their
treatment
Uremic syndrome consists of an array of
complex symptoms and signs that occur when
advanced kidney failure prompts the malfunction
of virtually every organ system. However, the
onset of uremia is slow and insidious, beginning
with rather nonspecific symptoms such as malaise,
weakness, insomnia, and a general feeling of
being unwell. Patients may lose their appetite and
complain of morning nausea and vomiting.
Eventually, signs and symptoms of multisystem
failure are evident.
MANAGEMENT
 Potassium balance:
 Sodium balance:
 Water balance:
 Metabolic acidosis:
 Gastrointestinal complications
 Cardiovascular complications
 Hematologic complications
 Bone disease
 Hyperphosphatemia
 PTH suppression
 Neurologic complications
HEMODIALYSIS
HOME DIALYSIS
A gene that protects from kidney
disease
Scientists from the European
Molecular Biology Laboratory
(EMBL) and the University of
Michigan have discovered a
gene that protects us against a
serious kidney disease. In the
current online issue of Nature
Genetics they report that
mutations in the gene cause
nephronopthisis (NPHP) in
humans and mice. NPHP is a
disease marked by kidney
degeneration during childhood
that leads to kidney failure
requiring organ transplantation.
The insights might help develop
Enzyme For Treatment Of Diabetic
Kidney Disease
Northwestern University
Feinberg School of
Medicine scientists have
observed that an enzyme
called ACE2 may hold the
potential to treat diabetic
kidney disease, the most
common form of kidney
disease.