Pathophysiology and Management of Chronic Kidney Disease Flashcards
What is the cause of the CKD epidemic?
The ageing population
Increasing prevalence of diabetes, obesity and hypertension
Better detection
People living longer with CKD
What is ESKD?
End-Stage Kidney Disease
Kidneys have lost almost all of their function
Kidneys are unable to effectively filter waste products and excess fluid from the blood, leading to a buildup of toxins and fluids in the body
What is risk of progression to ESKD determined by?
Nature of original disease
Proteinuria
Hypertension
What is Tubulointerstitial fibrosis?
Tubulointerstitial fibrosis is a pathological condition characterized by the excessive deposition of scar tissue (fibrosis) in the tubules and interstitial spaces of the kidneys
What are the Mechanisms of renal fibrosis?
Chronic inflammation is a common trigger.
Fibroblasts are primary for synthesising ECM proteins in the kidney.
TGF-beta stimulates ECM production and limits degradation.
Epithelial-Mesenchymal Transition is a process in which epithelial cells lose their characteristic features and acquire a mesenchymal phenotype.
Increased production of reactive oxygen species (ROS) and impaired antioxidant defences in the kidney can lead to oxidative stress, which promotes renal fibrosis by activating fibroblasts.
Dysregulation of ECM turnover, characterized by excessive ECM deposition and impaired degradation, contributes to the persistence of fibrosis.
How to prevent the progression of CKD?
- Treat underlying cause
- Blood pressure control
- Reduce proteinuria
- Improved glycaemic control
- SGLT2 inhibitors
Why prevent the progression of CKD?
- Reduce the morbidity and mortality associated
- Prevent progression
- Avoid the need for dialysis
- Treatment planning
- Cardiovascular risk management
Lowering blood pressure reduces the risk of renal failure how?
Lowering blood pressure reduces the risk of renal failure by alleviating glomerular hypertension, slowing kidney disease progression, reducing proteinuria, improving renal blood flow, protecting renal vasculature, and preventing hypertensive nephropathy.
Reducing proteinuria slows progression of CKD, how?
Reducing proteinuria slows CKD progression by minimizing renal damage, preserving glomerular integrity, decreasing inflammation, alleviating hemodynamic stress, limiting tubulointerstitial injury, and delaying the progression to ESKD.
Improving glycaemic control slows
progression of CKD, how?
Improving glycaemic control slows CKD progression by reducing kidney damage caused by high blood sugar levels, minimizing inflammation and oxidative stress.
Preserving renal blood flow and glomerular function, preventing the development of diabetic nephropathy.
What is dialysis?
Dialysis is a medical treatment used to perform the functions of the kidneys.
It involves the removal of waste products, excess fluids, and electrolytes from the blood.
What is hemodialysis?
Blood is circulated outside the body through a dialysis machine that contains a special filter called a dialyzer.
The dialyzer acts as an artificial kidney, removing waste products and excess fluids from the blood.
The cleaned blood is then returned to the body.
What is Peritoneal dialysis?
Peritoneal dialysis involves using the lining of the abdomen (peritoneum) as a natural filter to remove waste products and excess fluids from the blood.
A special dialysis solution is infused into the abdomen through a catheter, and the solution absorbs waste products and fluids from the blood across the peritoneal membrane.
The used dialysis solution is then drained out of the abdomen and replaced with fresh solution.
Why is dialysis a difficult treatment for patients?
- Time consuming
- Restrictions on diet and fluid intake
- Significant symptom burden
- High mortality
