Chronic kidney disease

							          Chronic kidney disease
           Alternative Names

Kidney failure - chronic
Renal failure - chronic
Chronic renal insufficiency
Chronic kidney failure
Chronic kidney disease
      KIDNEY FAILURE AND KIDNEY DISEASE

KIDNEY FAILURE

 Kidney failure occurs when the kidneys partly or
  completely lose their ability to carry out normal functions.


 This is dangerous because water, waste, and toxic
  substances build up that normally are removed from the
  body by the kidneys.


 It also causes other problems such as anemia, high blood
  pressure, acidosis (excessive acidity of body fluids),
  disorders of cholesterol and fatty acids, and bone disease in
  the body by impairing hormone production by the kidneys.
           CHRONIC KIDNEY DISEASE
Chronic kidney disease is
when one suffers from gradual
and usually permanent loss of
kidney function over time.
This happens gradually over
time, usually months to years.
Chronic kidney disease is
divided into five stages of
increasing severity . For the
total or near–total loss of
kidney function, the patients
need dialysis or transplantation
to stay alive.
  STAGES OF CHRONIC KIDNEY DISEASE

 Stage 1 with normal or high GFR (GFR > 90
  ml/min)
 Stage 2 Mild CKD (GFR = 60-89 ml/min)
 Stage 3 Moderate CKD (GFR = 30-59 ml/min)
 Stage 4 Severe CKD (GFR = 15-29 ml/min)
 Stage 5 End Stage CKD (GFR <15 ml/min)
      Stages of Chronic Kidney Disease

      Glomerular filtration rate (GFR) is the volume
of fluid filtered from the renal (kidney) glomerular
capillaries into the Bowman's capsule per unit time.
Clinically, this is often measured to determine renal
function. Compare to filtration fraction.
                NORMAL RANGES
    The normal ranges of GFR, adjusted for
body surface area, are:
Males: 70 ± 14 mL/min/m2
Females: 60 ± 10 mL/min/m2

                   (125ml/mt)

     GFR can increase due to hypoproteinemia
because of the reduction in plasma oncotic
pressure. GFR can also increase due to
constriction of the efferent arteriole but
decreases due to constriction of the afferent
            Stage 1 CKD
    Slightly    diminished
function; Kidney damage
with normal or increased
GFR (>90 mL/min/1.73
m2). Kidney damage is
defined     as  pathologic
abnormalities or markers
of     damage,    including
abnormalities in blood or
urine test or imaging
studies.
         Stage 2 CKD
Mild reduction in GFR
(60-89      mL/min/1.73
m2)      with     kidney
damage. Kidney damage
is defined as pathologic
abnormalities or markers
of damage, including
abnormalities in blood
or urine test or imaging
studies
Stage 3 CKD
Moderate reduction in GFR
  (30-59 mL/min/1.73 m2)

Stage 4 CKD
Severe reduction in GFR (15-29
  mL/min/1.73 m2)

Stage 5 CKD
Established kidney failure
  (GFR <15 mL/min/1.73 m2,
  or permanent renal
  replacement therapy (RRT)
                    Causes


Diabetic nephropathy
Hypertension
Glomerulonephritis
Renal artery stenosis
Hemolytic-uremic syndrome
Vasculitis
Focal segmental glomerulosclerosis
         Diabetic nephropathy.
Chronically
elevated blood
sugars damage
blood vessels and
filtering units in the
kidneys, the
condition is known
as diabetic
nephropathy.
Pyelonephritis
          Causes

IgG nephritis
Lupus nephritis
Polycystic kidney disease
Reflux nephropathy
Kidney stones and
Prostate
HIV infection
       Pathophysiology of uremia
 Diminished excretion of electrolytes and
  water,
 Reduced excretion of organic solutes,
 Decreased hormone production
CKD developing atherosclerosis
    Clinical manifestations of kidney
                   failure
            Electrolytes
Edema,
Hyponatremia,
Hyperkalemia,
Metabolic acidosis,
Hyperuricemia,
Hyperphosphatemia,
Hypocalcemia
       Gastrointestinal


 Anorexia,
 nausea,
 vomiting,
 malnutrition
        Cardiovascular
 Accelerated atherosclerosis,
 systemic hypertension,
 pericarditis
Calcification of the left coronary artery in a patient with
chronic kidney disease receiving dialysis as seen on a
computerized tomography (CT) scan. The extensive
deposition of mineral (arrowed) results in a radio-opaque
vessel with a density similar to that of bone
       Hematologic

 Anemia,
 immune dysfunction,
 platelet dysfunction
       Musculoskeletal

 Renal osteodystrophy,
 muscle weakness,
 growth retardation in children,
 amyloid arthropathy caused by beta2-
  microglobulin deposition
Looser zone (arrow) in the distal fibula
of a child with renal osteodystrophy
          Neurologic

 Encephalopathy,
 seizures,
 peripheral neuropathy
         Endocrine

 Hyperlipidemia,
 glucose intolerance caused by insulin
  resistance,
 amenorrhea
 infertility in women,
 impotence
      Skin

Pruritus
                   Decreased hormone
                       production
The kidneys normally
produce several hormones,
including     erythropoietin
and     calcitriol     (1,25-
dihydroxycholecalciferol),
the active form of vitamin
D.      The        decreased
production of these two
hormones        plays      an
important role in the
development of anemia
and      bone        disease,
respectively.
         Exams and Tests

Urinalysis
Creatinine levels progressively increase.
BUN is progressively increased.
Creatinine clearance progressively
 decreases.
Potassium test
Arterial blood gas
blood chemistry
Abdominal CT scan
Abdominal MRI
Systemic complications and their
           treatment
       Uremic syndrome consists of an array of
  complex symptoms and signs that occur when
  advanced kidney failure prompts the malfunction
  of virtually every organ system. However, the
  onset of uremia is slow and insidious, beginning
  with rather nonspecific symptoms such as malaise,
  weakness, insomnia, and a general feeling of
  being unwell. Patients may lose their appetite and
  complain of morning nausea and vomiting.
  Eventually, signs and symptoms of multisystem
  failure are evident.
        MANAGEMENT
 Potassium balance:
 Sodium balance:
 Water balance:
 Metabolic acidosis:
 Gastrointestinal complications
 Cardiovascular complications
 Hematologic complications
 Bone disease
 Hyperphosphatemia
 PTH suppression
 Neurologic complications
HEMODIALYSIS
HOME DIALYSIS
A gene that protects from kidney
             disease
              Scientists from the European
              Molecular Biology Laboratory
              (EMBL) and the University of
              Michigan have discovered a
              gene that protects us against a
              serious kidney disease. In the
              current online issue of Nature
              Genetics they report that
              mutations in the gene cause
              nephronopthisis (NPHP) in
              humans and mice. NPHP is a
              disease marked by kidney
              degeneration during childhood
              that leads to kidney failure
              requiring organ transplantation.
              The insights might help develop
Enzyme For Treatment Of Diabetic
        Kidney Disease

              Northwestern University
              Feinberg School of
              Medicine scientists have
              observed that an enzyme
              called ACE2 may hold the
              potential to treat diabetic
              kidney disease, the most
              common form of kidney
              disease.