Chronic Kidney disease Blake Briggs, Class of 2017

Introduction CKD 1 in 10 Americans! CKD is defined as worsening GFR >3 months. Most common cause is Diabetes, followed by hypertension, followed by various primary glomerulonephropathies. It is critical to know the complications and treatment of CKD, as early detection and treatment can significantly improve mortality and delay dialysis.

Diagnosis Clinical mainly. Ultrasound is performed to assess kidney size. Every cause of renal failure causes the kidneys to atrophy. Only three exceptions to this rule: diabetes, amyloidosis, and polycystic kidney disease. Biopsy is performed if the symptoms/signs are not consistent or if there is anything unclear.

Complications Worsening hypertension Uremia Hyperkalemia Overactivation of RAAS Uremia Bleeding Anemia Skin “frost” Pericarditis Encephalopathy Hyperkalemia

Complications Volume Overload CKD- Mineral bone disease Loss of albumin CKD- Mineral bone disease Secondary Hyperparathyroidism- High PTH, high PO4, low Calcium, low Vit D Renal osteodystrophy- Osteitis fibrosa cystica and increased fracture risk. Calciphylaxis: deposition of calcium-phosphate from bone into vessel walls and skin leading to inflammation and tissue necrosis. Vasculitis and skin necrosis.

Complications Anemia Cardiovascular disease and stroke Loss of EPO Number 1 cause of death in those with CKD Top 2 causes of kidney disease are major risk factors for CAD Patients with Nephrotic syndrome also have loss of AT III and hypercholesterolemia

Stages

Treatment Worsening HTN: ACEI/ARB Hyperkalemia: monitor routinely. Diuresis or emergent dialysis may be needed in the setting of life threatening hyperkalemia. Uremia: monitor closely. If pericarditis or encephalopathy, emergent dialysis is indicated. Volume Overload: diuresis with loops typically. Caution! CKD-MBD: Phosphate binders, Calcitriol, Calcium supplements Anemia: exogenous EPO CAD and stroke risk: aspirin

Thanks for listening Email me with questions (even after I graduate): brigbc271@gmail.com Check out my review book: 201 Pathophysiology Questions https://www.amazon.com/201-Pathophysiology-Questions-Systems- Students/dp/1535543868/ref=redir_mobile_desktop?ie=UTF8&keywords=201%20patho physiology%20questions&qid=1473644611&ref_=mp_s_a_1_1&sr=8-1 Subscribe to my podcasts: https://www.patreon.com/bombsofknowledge