Scribd
Upload
128 views67 pages

Alternative Names

This document discusses chronic kidney disease (CKD), providing information on alternative names, definition, causes, risk factors, clinical presentation, investigations including blood and urine tests, management of complications, and indications for renal replacement therapy such as dialysis. It covers the etiology, pathophysiology, clinical features, diagnostic evaluation and management of CKD.

Uploaded by

pasha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
128 views67 pages

Alternative Names

This document discusses chronic kidney disease (CKD), providing information on alternative names, definition, causes, risk factors, clinical presentation, investigations including blood and urine tests, management of complications, and indications for renal replacement therapy such as dialysis. It covers the etiology, pathophysiology, clinical features, diagnostic evaluation and management of CKD.

Uploaded by

pasha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 67

 Alternative Names:

 Chronic Renal Failure


 Chronic Renal Insufficiency
 Chronic Renal Disease
 Chronic Kidney Insufficiency
 Chronic Kidney Failure
 CKD implies longstanding (>3 Months),
and usually progressive impairment in renal
function.
 GGFR <60 mL/min per 1.73 m2 or
 Diabetes Mellitus  Family history of CKD
 Hypertension  Kidney Stones
 Cardiovascular  Infections like Hep B,
Disease C and HIV
 Age and Race  Autoimmune diseases
 Acute Kidney Injury  Nephrotoxic drugs like
NSAIDS
 Diabetes
 Non Diabetic
 Glomerular

 Tubulointerstitial: Analgesic, Reflux, Ch. Obs

 Vascular: Vasculitis, HTN, RAS

 Cystic: ADPKD

 CKD in transplantation
100%
90% Other
80%
70% Interstit N
60% Cystic KD
% 50% GN
40%
30% BP
20% Diabetes
10%
0%
l te n
Al hi ac
k is a ian
W Bl A Ind
e r
Am
USRDS Annual Data Report
 History
 Duration of symptoms
 Drug ingestion
 Previous Medical & Surgical History
 Previous Occasions of Investigations
 Family History of Renal Disease
amlaise, loss of energy, loss of appetite,
insomnia,
Nocturia & polyuria due to impaired concentrating ability,
Itching,
Nausea, vomiting and diarrhoea,
Paraesthesiae due to polyneuropathy
 ‘Restless legs’ syndrome (overwhelming need
to frequently alter position of lower limbs)
 Bone pain due to metabolic bone disease
 Paraesthesiae and tetany due to hypocalcaemia
 Symptoms due to salt and water retention –
peripheral or pulmonary oedema
 Symptoms due to anaemia
Mental slowing, clouding of consciousness and Seizures

Myoclonic twitching.
 SPallor (due to anemia)
 Increased photosensitive pigmentation Brown
discoloration of the nails
 Scratch marks due to uraemic pruritus
 Ccutaneous vasculitic lesions in systemic
vasculitides
 Retinopathy in diabetes and hypertensive
retinopathy in hypertension
 Evidence of peripheral vascular disease and
associated renal artery stenosis
 Hematuria:
 Proteinuria:
 Urine Culture:
 White Cells: UTI, GN, Papillary Necrosis or TB

Eosinophilia: Allergic Tubulointerstitial Nephritis or


Cholesterol Embolization
Casts

Granular cast: Active renal tubular disease

RBC Cast: GN

 Red Cells
 Urinary Electrolytes
 Urine Osmolality
 Urine Electrophoresis & Immunofixation
 Urea & Creatinine
 Calculation of eGFR
 Electrophoresis & Immunofixation for
myeloma
 Elevation of creatinine kinase:
Rhabdomyolysis
 Eosinophilia: vasculitis, allergic Tubulointerstitial
nephritis or cholesterol embolism
 Markedly raised viscosity or ESR: Myeloma or
Vasculitis
 Fragmented RBC &/or Thrombocytopenia:
Accelerated HTN, HUS or TTP
 Complement Components
 Autoantibody Screening
 Cryoglobulins
 Antibodies to Streptococcal Antigens
 Antibodies to Hep B & C
 Antibodies to HIV
 Ultrasound
 CT Scan
 MR Angiography in Renovascular
Disease
 Should be performed in every patient
with unexplained CKD & normal-sized
kidneys
 Erythropoietin Deficiency
 Bone marrow toxins
 Bone marrow Fibrosis
 Hematinic Deficiency
 Increased RBC destruction
 Abnormal RBC membranes
 Increased Blood Loss
 ACE inhibitors
 Hypeparathyroid Bone Disease
 Osteomalacia
 Osteoporosis
 Osteosclerosis
 Adynamic Bone Disease
 Pruritis
 Eczematous
 Porphyria Cutanea Tarda
 Pseudoporphyria
 Decreased gastric Emptying
 Reflux Esophagitis
 Peptic Ulceration
 Acute Pancreatitis
 Constipation
 Gout
 Insulin
 Lipid Metabolism Abnormalities
 Hyperprolactinemia
 Increased LH
 Decreased Testosterone
 Oligomenorrhea or Amenorrhea
 GH Abnormalities (Low)
 Thyroid Hormone Abnormalities
(Hypothyroid)
 Uremia cause Muscle dysfunction
 Decreased Physical Fitness
 Central Nervous System
 Depressed Cerebral Function

 Dialysis Dementia

 Psychiatric Problems; psychosis, depression,

Phobias
 Peripheral Nervous System
 Restless leg Syndrome

 Median nerve Compression

 Polyneuropathy

 Autonomic Nervous System


 Lymphomas
 Primary Liver cancer
 Thyroid cancer
DDiet:
low protein diet 0.6 – 0.8 gm/kg
Low K diet, Low phosphate diet, Salt restriction
Fluid chart
GIT
Hiccup and vomiting; domperidone
Gastritis; H2 blockers, proton pump inhibitors
CCVS
Hypertension control (CCB, BB, (ACEI and ARBs
with careful monitoring of kidney function and
potassium)
Volume overload: Loop diuretics
pericarditis is an indication of dialysis
Bone
Ca carbonate 1500 – 2000 mg/day (hold if there is
hypercalcemia)
Vit D analog (Calcitriol)
PO4 chelators Oral Ca carbonate, Sevelamer
AAnemia:
Iron therapy better IV
Erythropoetoin
Target Hb 11 – 12 gm/dl
Avoid blood transfusion as possible as it may
cause sensitization to HLA which may affect
renal transplantation
PPruritis:
C o n t r o l C a / P O 4 p r o d u c t a n d
hyperparathyroidism
Antihistaminics
Oral charcoal
Ultraviolet photo therapy (narrow band)
Hyperkalemia:
(dietary restriction, cation exchange resins
t o r e m ove K i n G I T, G l u c o s e i n s u l i n
infusion, if no response dialysis is
indicated

Acidosis:
oral sodium/calcium bicarbonate
If no response dialysis
RRenal replacement therapy

Dialysis (H D , P D)
Transplantation
Indication of dialysis
 Uremic symptoms (encephalopathy, coma ,
pericarditis)
 Volume overload not responding to diuretics
 Hyperkalemia > 6.5 mmol/L not responding
to medical treatment or if there is ECG
changes
 Acidosis not responding to medical treatment
 High urea. 200 mg/dl (BUN>100), Cr >10

You might also like