1. Darshika Chhabra, MD, MPH
CKD for “Newbies”
Darshika Chhabra, MD, MPH
Medical Director and Primary Transplant Nephrologist
Scott Wheaton, BSN, RN
Living Donor and Transplant Coordinator
September 16, 2017

2. Overview What do kidneys do? What is Chronic Kidney disease?
Causes of kidney disease
Symptoms of kidney disease
Prevention
Options for advanced kidney disease

3. What do my kidneys do? Get rid of waste Maintain water balance
Regulate Blood pressure
Prevent anemia
Maintain acid/base balance

4. What is Chronic Kidney Disease?
Kidneys stop working as well as they should
Not able to:
filter the blood and remove waste and
remove excess salt and water
Definition:
“Kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months”

5. Causes of Kidney Disease

6. What causes Kidney Disease?
Source: Health, United States, 2011: table 51. End-stage renal disease patients, by selected characteristics: United States, selected years 1980–2010. Centers for Disease Control and Prevention website. (PDF, 25 KB)*. Updated Accessed December 20, 2013.

7. Causes of CKD Diabetes High Blood Pressure
Inherited conditions like polycystic kidney disease (PKD)
Autoimmune diseases like lupus
Obesity
Glomerulonephritis

8. More Causes of CKD Obstructions like kidney stones or cysts
Infections like strep throat or repeat urinary tract infections
Drugs and toxins
Trauma
Kidney cancer
Preeclampsia

10. Signs and Symptoms of CKD

11. Early Signs May have none Laboratory abnormalities alone
May have abnormal cells or protein spilling in the urine
Weight gain and ankle swelling (edema) may occur
May use the bathroom more at night
Blood pressure may get too high

12. Late signs Abnormal blood tests Nausea, vomiting, poor appetite
Weakness, increasing fatigue
Itching
Muscle cramps (especially in your legs)
Anemia (a low blood count)
May need less insulin

13. How to get checked for Kidney disease?
Ask your physician to perform a simple blood and urine test
Free screening through NKF KidneyMobile®
Tests:
Creatinine
Blood urea nitrogen (BUN)
Estimated glomerular filtration rate (eGFR)

14. Evaluation of Kidney Disease
Blood tests
BUN
Creatinine – higher is worse kidney function
eGFR – monitors severity
Urine tests
Albumin or protein in urine
May need a 24hour urine collection

15. Evaluation of Kidney Disease
Imaging: Ultrasound
Normal Kidney
Polycystic Kidney

16. Kidney Imaging: CT scan

17. Evaluation: Kidney biopsy

18. Stages of Kidney Disease

20. Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1-150

21. Prevention and Protection
Control diabetes
Control high blood pressure
Change diet if needed
Maintain healthy weight
Quit smoking / illicit drugs
Avoid any medicines that may cause kidney damage (like over-the-counter pain medications like ibuprofen)
Avoid intravenous contrast

22. More Prevention and Protection
Get treatment for urinary tract infections
Correct any problems in your urinary system
Work at improving proteinuria (protein in urine)
Certain medications like angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB)
E.g. Lisinopril, enalapril, valsartan
Monitor Blood pressure, sugars, tests
Follow up with your doctor

23. Options for patients with advanced kidney disease
Scott Wheaton, BSN, RN
Living Donor and Transplant Coordinator

24. Options With or without pancreas transplantation Hemodialysis
Kidney Transplantation
With or without pancreas transplantation
Dialysis
Hemodialysis
Peritoneal dialysis ….

25. Hemodialysis
UTD

27. Fistula for dialysis

29. Peritoneal dialysis UTD
Reproduced from: Treatment Methods for Kidney Failure: Peritoneal Dialysis. National Institute of Diabetes and Digestive and Kidney Diseases. Available at:

30. Kidney transplantation

31. Transplant versus dialysis
If the patient is a good candidate for kidney transplantation:
Kidney transplant patients tend to live longer
AND
Healthier
Better quality of life

32. Concerns with transplant
Involves surgery
Difficulty finding a donor
Need to be educated about risks
Need to be evaluated
Need to take medicines every day for the rest of your life to prevent “rejection”
Risks of medications
Infection
Some cancers
More

33. The Transplant Wait List
Is a wait list for deceased donor organs
Maintained by UNOS (United Network for Organ Sharing)
Unfortunately, there are more people who need a transplant than there are donors

34. Some Numbers Waiting list candidates – 116,484
As of September 13, 2017:
Waiting list candidates – 116,484
Waiting for kidney alone – 96,602
In 2016
Number of Kidney Transplants – 19,060
Deceased Donors – ,431
Living Donors – ,629
OPTN Data as of September 13, 2017
Source: OPTN, The Organ Procurement and Transplantation Network

35. Register to be an organ donor

36. Summary PREVENTION! Look after yourself Educate yourself and others
Be involved in your health care
Close follow up with your physicians
Laboratory tests as recommended
Be proactive

37. Useful Links National Kidney Foundation of Illinois
Gift of Hope Organ and Tissue Donor Network