CKD Dr;BASHARDOOST

CKD –SOME DEFINITIONS IRREVERSIBLE LOSS OF GFR CKD results when a disease process damages the structural or functional integrity of the kidney. This is clinically detected using either physical exam (hypertension), laboratory (hematuria, proteinuria, microalbuminuria) or imaging studies (CT, MRI, IVP or renal ultrasound). Almost all patients with a GFR <60 ml/min/1.73m2 have CKD. However, since GFR declines normally with age (approximately 1ml/min/1.73 m2 /year after age 20), a GFR between ml/min/1.73m2 in the elderly may not be indicative of the presence of CKD.

Pathophysiology of Anemia in CKD  Inadequate erythropoietin production  Blood loss (i.e. repeat phlebotomy)  Reduced life span of RBCs  Iron deficiency  decreased intake (loss of appetite)  decreased absorption of iron  repeat phlebotomy leading to iron loss

bone, phosphate, and calcium abnormalities

Feedback Loops in SHPT Ca = calcium; CVD = cardiovascular disease; P = phosphorus. Courtesy of Kevin Martin, MB, BCh.  PTH Bone Disease Fractures Bone pain Marrow fibrosis Erythropoietin resistance  Serum P  1,25D Calcitriol Renal Failure  PTH Systemic Toxicity CVD Hypertension Inflammation Calcification Immunological  25D  Ca ++ Decreased Vitamin D Receptors and Ca-Sensing Receptors © 2005 The Johns Hopkins University School of Medicine.