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Published byArron Bryan Modified over 9 years ago
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This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only. 1
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Chronic kidney disease (CKD) by: Rehab.Backer.Albacker 2
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Outline: -Introduction -Pathophysiology and epidemiology -Screening -Stages -Clinical menifestations -Diagnosis and evaluation -Complications -management 3
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Introduction: CKD is characterized by either kidney damage or aglomerular filtration rate(GFR) less than 60 mL/min/1.73m2 that persists for 3 months or more. 4
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:Pathophysiology and epidemiology Approximately 16% of U.S population has CKD.the prevalnce is increasing,possibly because of the increased incidence of major risk factors such as DM,HTN,… 5
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Cont. CKD can arise from progression of acute renal failure or congenital or familial diseases, or as the result of acquired conditions affecting glomerulotubular function that have developed over a period of months or years. 6
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Screening: -Screening high risk patients for CKD allows for early detection of this condition and implementation of effective interventions to slow progression of kidney disease and treat complictions. -Use of patient-centered tool known as Screening for occult Renal disease(SCORED) survey also may help to strartify risk for CKD. 7
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Risk factors for chronic kidney disease: DM Hypertension Hyperlipidemia Cardiovascular disease Age>60years Malignancy Family hx of chronic kidney disease Kidney stones-UTI Exposure to nephrotoxic drugs 8
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Cont. In patients with risk factors for CKD, screening with urinalysis,aurine protein-or albumin- creatinine ratio from a first morning voided specimen,serum creatinine level measurement,and estmation of GFR. 9
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Stages: 10 GFR (ml/min/1.73m 2 ) Description Stage >90 Kidney damage with normal or GFR 1 60-89 Mild GFR 2 30-59 Moderate GFR 3 15-29 Severe GFR 4 <15 ESRD) )Kidney failure 5
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Clinical menifestations: Patient may be present with any of following: -Cardiovascular: HTN,CHF -Gasroenterology: Nusea,vomiting,and loss of appetite. -neurlogical: lathergy,somnolence,confusion,periphral neuropathy,and uremic seizures,pt.may show restless legs,tetany. 11
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Cont. -Hematological: Normocytic normochromic anemia,bleeding -Endocrine/metabolic: Hyperphoshatemia,hypocalcemia,High PTH -Fluid & electrolytes problem: Hypervolemia,hyperkalemia,hypermagnesemia,Met abolic acidosis -and also uremia inhibits cellualr and humoral immunity. 12
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Diagnosis and evaluation: -Evaluation of all patients with CKD should include urinalysis,evaluation of urine sediment,Kidney US,serum electrolytes,and measure random urine protein-creatinine ratio. -Biobsy should be considered in patients with CKD who have evidence of glomerular disease in absence of diabetes. 13
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Complications: -Cardiovascular disease. -Anemia. -chronic kidney disease-mineral and bone disorder. 14
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Management: Our aim to: 1- delay disease progression. 2-treat symptoms. 3-and reduce risk factors for disorders that have an increased prevalence in pt. with disease. 15
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Cont. 1-Diet 2-ACE inhibitors 3-BP control. 4-glycemic control. 5-correction of electrolytes abnormalities. 6-Anemia:erythopoietine. 7-Pulmonary edema: Arrange for dialysis if unresposive to diuretics. 16
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Cont. 8-Dialysis: Indications? 9-kidney transplantation is treatment of choice for most patients with end stage renal disease. 17
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Thanks 18
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