Thomas: Clinical Manifestations of Chronic Kidney Disease
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| Chronic Kidney Disease (CKD) Definitions | GFR <60 for >3months
or
Structural/functional abnormalities of the kidney
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| What percent of the US population is affected? | >10% (>20 million)
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| What increases incidence? | Age
Diabetes
Increased longevity
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| End-stage renal disease (ESRD) defined as... | GFR <15%
Usually required dialysis
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| How many people have ESRD, and what is the 5 year survival rate? | >500,000 people in 2008
5 year survival rateL 34.5%
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| CKD Risk factors | Diabetes Mellitus
HTN
Obesity/metabolic syndrome
CV disease
Smoking
Glomerular diseases
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| If you're looking for CKD, what labs would you order and why? | BMP for creatintine/GFR
UA for protein,hematuria,casts
UA for microabluminuria
Recommended yearly for pts with diabetes or HTN
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| CKD Clinical Manifestations | CV disease
Anemia
Bone disease
Increased infxn rate
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| Pts with CKD are more likely to die from ___ before they progress to ESRD | CV disease
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| A 10mL/min decrease in GFR | Mortality increases by 7%
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| As GFR decreases, so does... | Vascular compliance
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| CKD and CV disease Treatment | Lifestyle Modification
-Exercise, low salt fat diet
Aggressive BP control (<130/80)
-ACEI/ARBs
LDL<100
Glycemic Control
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| CKD and Anemia | Seen in stage 4-5
↓ erythropoietin production
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| What can anemia cause in pts with CKD? | Chronic hypoxemia
-↑ free radicals
-MI/angina due to supply/demand mismatch
-Activation of RAAS → LVH
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| Signs and symptoms of anemia | Tired
SoB
Palor
Cyanosis
Fatigue
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| CKD and anemia Treatment | Erythropoietin stimulation agents
-use when Hb <10 g/dL
Target level 11-12 g/dL
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| Things to do before starting erythropoietin-stimulating agent | 1. Rule out other causes of anemia
-B12 deficiency, GI bleed, hemolysis
2. Check for adequate iron stores
-Ferritin should be >100
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| CKD and Bone Disease | ↓ phosphorus clearance
↓ conversion of Vit D2 to D3
↑ PTH release and parathyroid hyperplasia
↑ Bone Destruction
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| What conditions usually stimulate PTH release? | ↑ serum phosphorua
↓ serum Ca
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| CKD and Bone Disease Manifestations | Suberiostial bone resorption
(fingers and clavicles)
"Brown" tumors→erosive osteolytic lesions
-taking away bone, leaving holes
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| CKD and Infections Mechanism and Treatment | M: decreased B/T cells and macrophage function due to uremic toxins
Tx: Prevention=Vaccinate
Hep B, Influ, Strep pneumo
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