CKD Flashcards
a spectrum of different pathophysiologic
processes associated with abnormal kidney
function and a progressive decline in GFR
Chronic Kidney Disease
ESRD results to
UREMIC SYNDROME
(dialysis or transplantation)
pathophysiology of CKD
- initiating mechanisms specific to the
underlying etiology
abnormalities in kidney development, immune complex deposition,
inflammation, toxin exposure - set of progressive mechanisms
(hyperfiltration and hypertrophy) with long term reduction in renal mass
increase pressure and flow—- distortion of glomerular architecture,
abnormal podocyte function, disruption of filtration barrier— sclerosis and drop
out of the remaining nephrons
maladaptive
Decrease nephron numbers
- vasoactive hormones,
- cytokines,
- growth factors
Risk Factors for CKD
- small for gestational birth weight
- childhood obesity
- hypertension
- diabetes
- autoimmune disease
- advanced age
- African ancestry
- family hx of kidney disease
- AKI
- Proteinuria/sediment
- structural abnormalities
- Mendelian: ADPKD
Leading Categories of Etiologies of CKD
- Diabetic nephropathy
- Glomerulonephritis
- Hypertension
- Autosomal dominant polycystic kidney disease
- Other cystic and tubulointerstitial nephropathy
KDIGO Classification of CKD
- <30 mg/g
- <3 mg/mmol
A1
KDIGO Classification of CKD
- 30-300 mg/g
- 3-30 mg/mmol
A2
KDIGO Classification of CKD
- > 300 mg/g
- > 30 mg/mmol
A3
KDIGO Classification of CKD
- > /=290
G1: Normal or high
KDIGO Classification of CKD
- 60-89
G2: Mildly decreased
KDIGO Classification of CKD
- 45-59
G3a: Mildly to moderately decreased
KDIGO Classification of CKD
- 30-44
G3b: Moderately to severely decreased
KDIGO Classification of CKD
- 15-29
G4: Severely decreased
KDIGO Classification of CKD
- <15
G5: Kidney failure
Cockcroft- Gault Formula
(72) (creatinine)
Signs and Symptoms of CKD and Uremia:
HYPERNATREMIA
- Intake > urinary excretion
- extracellular fluid volume expansion
- hypertension
Treatment for ECVF Expansion:
Stage 3-5 CKD
- Thiazide
- Loop furosemide
- Unresponsive: higher dose/ metolazone
decrease vitamin K dependent
regeneration of matrix GLA protein
warfarin
Tx:
- Livedo reticularis
- Patches of ischemic necrosis
Legs, thighs, abdomen, breast
- hyperbaric O2
- IV thiosulfate
- discontinue drugs
progressive dose reduction as renal function
deteriorates
Insulin
