one in every ______ americans has CKD
9
*Renal Insufficiency
measurable reduction in renal function
*Renal Failure
further reduction of renal function to the point that biochemical homeostatis cannot be maintained
Azotemia
increased BUN
Uremia
symptomatic renal failure (lab + symptoms)
Oliguria
<400 ml urine output/day
Anuria
< 50 ml urine output/day
Chronic Kidney Disease definition:
1. Kidney damage for > 3 months, as defined by strucurla or functional abnormalities +/- decreased GFR, manifested by either
(a) pathologic abnormalities
(b) markers of kidney damage (BUN, imaging etc)
2. GFR <60 ml/min/1.73 for >= 3 months c/s kidney dam
Stage 1 CKD:
Kidney damage w/ normal/increased GFR
GFR > 90
Stage 2 CKD
Mild decrease in GFR
GFR 60-89
Stage 3 CKD
Moderate decrease GFR
GFR 30-59
Stage 4 CKD
Severe decrease in GFR
GFR 15-29
Stage 5 CKD
Renal Failure
GFR <15 or on dialysis
What is the main killer of patients w/ CKD?
cardiac diseases
What is the most common stage of CKD?
Stage III
Are patients w/ serum creatinine 2,3,4 symptomatic usually?
Not usually
What are the two major causes of CKD?
HTN
Type II DM
Risk Factors for a rapid decline in CKD?
african american
age
proteinuria
biopsy findings
obesity
male gender
family history
Why can albumin be used for classification of CKD?
because it will raise slightly before creatinine
Microalbuminuria
30-300 mg/day
Albuminuria
>300 mg/day
Nephrotic Range proteinuria
> 3 gram/day
Cardio manifestations of CKD
HTN
hyperlipidemia
cardiomyopathy
LVH
pericardial diseases
Hematologic manifestations of CKD
Anemia (decreased EPO production, blood loss)
Platelet Dysfunction (bleeding tendencies)
Fluid Overload
- decline of sodium and intravascular volume balance at GFR 10-15
- hyperkalemia
- hyperphosphatemia
Acidosis
- inability to clear sulfates, phosphates
- bone will try to buffer hydrogen ions at the expense of Ca and Phosph
- decreased albumin synthesis, loss of mean body mass
Neuro issues associated w/ CKD
decreased consciousness
sleep reversal
memory
cognitive tasking
asterixis
coma
Tx in CKD starts at what stage/
III
Tx Goals of pt's w/ CKD
- tx of reversible causes of renal dysfunction
- slowing or halting the progression of renal disease
- tx of the complications of renal dysfunction
- identification and adequate preparation of the pt in whom renal replacement therapy will be required
Htn Goals in tx of patients w/ CKD:
goal < 130/80
- ACE In, ARB
- Diuretics
- Aldosterone
- other agents
Glycemic control in diabetics goal:
HgBA1c < 7%
Proteinuria Goal....
300-500 mg/day
At what stage to we start preparing for RRT?
Stage 4
What are the three options for RRT?
Hemo
PD
Transplant
Normal hemodialysis access uses what vessels?
Radio-Cephalic Fistula
When to start RRT:
- pericarditis or pleuritis; pericardial rub
- progressive uremic encephalopathy or neuropathy, with signs such as confusion, asterixis, myoclonus, writs or foot drop
- clinically significant bleeding diathesis atttributable to uremia
- fluid overload ref
AEIOU" for when to start RRT
Acidosis
Electrolyte Abnormality
Ingestion of Toxins
Overload (volume)
Uremia
What gives CKD patients the best method?
Transplant!