Chronic kidney disease

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Chronic kidney disease
Alternative Names     Kidney failure -
chronic Renal failure - chronic Chronic renal
insufficiency Chronic kidney failure Chronic
kidney disease
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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.

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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 neartotal loss of
  kidney function, the patients need dialysis or
  transplantation to stay alive.

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STAGES OF CHRONIC KIDNEY DISEASE

• Stage 1 with normal or high GFR (GFR gt 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 lt15 ml/min)

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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.

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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 arteriole.

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Stage 1 CKD

• Slightly diminished function Kidney damage
  with normal or increased GFR (gt90 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.

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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

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• 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 lt15 mL/min/1.73
  m2, or permanent renal replacement therapy (RRT)

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Causes

• Diabetic nephropathy
• Hypertension
• Glomerulonephritis
• Renal artery stenosis
• Hemolytic-uremic syndrome
• Vasculitis
• Focal segmental glomerulosclerosis

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Diabetic nephropathy.

• Chronically elevated blood sugars damage blood
  vessels and filtering units in the kidneys, the
  condition is known as diabetic nephropathy.

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Pyelonephritis
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Causes

• IgG nephritis
• Lupus nephritis
• Polycystic kidney disease
• Reflux nephropathy
• Kidney stones and
• Prostate
• HIV infection

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Pathophysiology of uremia

• Diminished excretion of electrolytes and water,
• Reduced excretion of organic solutes,
• Decreased hormone production

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CKD developing atherosclerosis
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Clinical manifestations of kidney failure

• Electrolytes
• Edema,
• Hyponatremia,
• Hyperkalemia,
• Metabolic acidosis,
• Hyperuricemia,
• Hyperphosphatemia,
• Hypocalcemia

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Gastrointestinal

• Anorexia,
• nausea,
• vomiting,
• malnutrition

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Cardiovascular

• Accelerated atherosclerosis,
• systemic hypertension,
• pericarditis

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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
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Hematologic

• Anemia,
• immune dysfunction,
• platelet dysfunction

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Musculoskeletal

• Renal osteodystrophy,
• muscle weakness,
• growth retardation in children,
• amyloid arthropathy caused by beta2-microglobulin
  deposition

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Looser zone (arrow) in the distal fibula of a
child with renal osteodystrophy
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Neurologic

• Encephalopathy,
• seizures,
• peripheral neuropathy

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Endocrine

• Hyperlipidemia,
• glucose intolerance caused by insulin resistance,
  
• amenorrhea
• infertility in women,
• impotence

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Skin

• Pruritus

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Decreased hormone production

• The kidneys normally produce several hormones,
  including erythropoietin and calcitriol
  (1,25-dihydroxycholecalciferol), 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.

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Exams and Tests  

• Urinalysis
• Creatinine levels progressively increase.
• BUN is progressively increased.
• Creatinine clearance progressively decreases.

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• Potassium test
• Arterial blood gas
• blood chemistry
• Abdominal CT scan
• Abdominal MRI

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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.

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MANAGEMENT

• Potassium balance
• Sodium balance
• Water balance
• Metabolic acidosis
• Gastrointestinal complications
• Cardiovascular complications
• Hematologic complications
• Bone disease
• Hyperphosphatemia
• PTH suppression
• Neurologic complications

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HEMODIALYSIS
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HOME DIALYSIS
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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
  effective, noninvasive therapies

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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.

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THANK YOU