Chronic Kidney Disease

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!