1. Chronic Kidney disease
Blake Briggs, Class of 2017

2. 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.

3. 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.

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

5. 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.

6. 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

7. Stages

8. 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

9. Thanks for listening
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