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Renal 24 CKD

Thomas: Clinical Manifestations of Chronic Kidney Disease

Chronic Kidney Disease (CKD) Definitions GFR <60 for >3months or Structural/functional abnormalities of the kidney
What percent of the US population is affected? >10% (>20 million)
What increases incidence? Age Diabetes Increased longevity
End-stage renal disease (ESRD) defined as... GFR <15% Usually required dialysis
How many people have ESRD, and what is the 5 year survival rate? >500,000 people in 2008 5 year survival rateL 34.5%
CKD Risk factors Diabetes Mellitus HTN Obesity/metabolic syndrome CV disease Smoking Glomerular diseases
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
CKD Clinical Manifestations CV disease Anemia Bone disease Increased infxn rate
Pts with CKD are more likely to die from ___ before they progress to ESRD CV disease
A 10mL/min decrease in GFR Mortality increases by 7%
As GFR decreases, so does... Vascular compliance
CKD and CV disease Treatment Lifestyle Modification -Exercise, low salt fat diet Aggressive BP control (<130/80) -ACEI/ARBs LDL<100 Glycemic Control
CKD and Anemia Seen in stage 4-5 ↓ erythropoietin production
What can anemia cause in pts with CKD? Chronic hypoxemia -↑ free radicals -MI/angina due to supply/demand mismatch -Activation of RAAS → LVH
Signs and symptoms of anemia Tired SoB Palor Cyanosis Fatigue
CKD and anemia Treatment Erythropoietin stimulation agents -use when Hb <10 g/dL Target level 11-12 g/dL
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
CKD and Bone Disease ↓ phosphorus clearance ↓ conversion of Vit D2 to D3 ↑ PTH release and parathyroid hyperplasia ↑ Bone Destruction
What conditions usually stimulate PTH release? ↑ serum phosphorua ↓ serum Ca
CKD and Bone Disease Manifestations Suberiostial bone resorption (fingers and clavicles) "Brown" tumors→erosive osteolytic lesions -taking away bone, leaving holes
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
Created by: bcriss