1. Chronic Kidney Disease

2. Normal Physiology of the Kidney
Hormones – EPO, RAAS, 1-alpha-hydroxylase
Metabolic – excretion of urea/creatinine etc.
Homeostasis – acid base balance, electrolyte levels

3. Chronic Kidney Disease
A progressive decline in renal function
Present for at least 3 months
Marked by increased serum creatinine and a fall in GFR

4. Aetiology
Diabetes is the most important precursor to CKD. Consider the different disease processes: Vascular: increases in pressure, vasculitis Immunological: glomeruonephritis Infection: pylonephritis, UTI Congenital: polycystic disease Obstruction

5. Clinical features Pallor and malaise – due to anaemia
Pruritis – accumulation of urea + other metabolites
Polyuria, nocturia
Bone pain – metabolic bone disease
Sleep reversal, restless legs

6. Staging

7. Management Aggressive BP control Prevent hyperlipideamia
ACEi, ARB, CCB
Aim <140/90
Prevent hyperlipideamia
Statins
Vit D supplements

8. Management of ESRD Renal replacement therapy: *Transplantation HD PD
Haemodialysis: blood taken from patient and put through dialyser
Peritoneal dialysis: tube inserted into peritoneal cavity and dialysate run through
*Transplantation HD PD
Requires hospital visit each time
Requires trained staff
Less frequent (3x week)
Need strict diet and fluid intake
More flexible
Patient is able to be home based
Less dietary restrictions
Body image problems
More prone to infection
Frequent (1x at least per day)
Associated with DM

9. Questions
1. Describe how CKD can lead to metabolic bone disease (5 marks).

11. Reduction in vitamin D means less Ca can be absorbed from gut
This stimulates parathyroid gland
PTH released
Stimulates Ca resorption from bone
Bones become weak, less crystalloid formation

12. Thanks for listening. Any questions just email: K. Tomlinson@warwick
Thanks for listening! Any questions just