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Chronic Kidney Disease

Chronic Kidney Disease. What is CKD?. Definition: GFR < 60mL/min/1.73m 2 for > 3 months +/- evidence of kidney damage OR Evidence of kidney damage for > 3 months +/- decreased GFR Microalbuminaemia Proteinuria Glomerular haematuria Pathological abnormalities Anatomical abnormalities.

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Chronic Kidney Disease

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  1. Chronic Kidney Disease

  2. What is CKD? • Definition: • GFR < 60mL/min/1.73m2 for > 3 months +/- evidence of kidney damage • OR • Evidence of kidney damage for > 3 months +/- decreased GFR • Microalbuminaemia • Proteinuria • Glomerular haematuria • Pathological abnormalities • Anatomical abnormalities

  3. What causes Ckd? • Diabetic Nephropathy • Glomerulonephritis • Hypertension • Reflux nephropathy

  4. What are the 2 mechanisms of damage in ckd • Initiating mechanism of damage specific to underlying etiology- eg immune complexes and inflammatory mediators in glomerulonephritis- eg toxin exposure • Progressive damage non-specific to underlying etiology- due to hyperfiltration and hypertrophy of viable nephrons- increased pressure and flow predisposes to sclerosis

  5. Risk factors Modifiable Non modifiable Age Ethinicity Family hx of renal disease Previous episode of ARF • Hypertension • Diabetes • Smoking • Obesity • Autoimmune disease

  6. Screening tests for CKD • Blood pressure • Urine dipstick (microalbuminuriaif diabetes present) • eGFR • How often does this need to be performed? • Every 12 months

  7. Creatinine Mdrd - eGFR Cockcroft gault – creatinine clearance Serum creatinine Gender Weight Age • Serum creatinine • Gender • Age • African ethnicity

  8. When is using egfr unreliable? • Acute kidney failure • Dialysis patients • Unusual dietary intakes • Extremes of body size • Skeletal muscle diseases, amputees, paraplegia • High muscle mass • Children under 18 years old • Chronic liver disease

  9. If GFR is <60, what do you do next? • BP • Dipstick for haematuria and proteinuria • IF positive for protein –urine protein/creatinine ratio • U&Es and creatinine • Fasting lipids • Fasting glucose • FBC • +/- iron studies, serum calcium, phosphate and parathyroid hormone

  10. STAGES OF CKD

  11. Management of ckd • STAGE 1 & 2: • CKD risk reduction – BP, blood glucose, lipids, lifestyle modifications, • STAGE 3: • Quarterly eGFR checks • Prescribe antiproteinuric drugs – ACE inhibitors • Medications review • STAGE 4 & 5: • Refer to nephrologist – dialysis or transplant

  12. What are the consequences of CKD? • Accumulation of nitrogenous wastes • Electrolyte imbalance • Salt and water overload or depletion  HTN, oedema, CHF • Anaemia- due to decrease erythropoietin • Bone Disease – inc phosphate, decr calcium and vit D • Acidosis

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