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1. CHRONIC KIDNEY DISEASES
MUSONI VENUSTE
INTERN STUDENT
KIGALI KING FAISAL

2. introduction
• CKD is the type of kidney diseases in which they are gradual loss of
kidney function over period of months or year and is irreversible
• early they are no symptoms
• Later leg swelling feeling tired vomiting loss of appetite or confusion
may develop

3. Etiology and epidemiology
• Congenital renal diseases account 57% of cases in children
• African American black are at high risk 3* to develop focal segmental
glomeluroscrelosis
• Growth retardation is the major complication
• poor growth is the marker of diseases severity in ckd children

4. Classification of CKD
• disorder lasting three or more months with either kidney damage
defined by structural or functional renal abnormalities,
• or an estimated glomerular filtration rate (GFR) of less than 60
mL/min per 1.73 m²,

5. • Stage 1 disease – Normal GFR (≥90 mL/min per 1.73 m²)
• Stage 2 disease – GFR between 60 and 89 mL/min per 1.73 m²
• Stage 3 disease – GFR between 30 and 59 mL/min per 1.73 m²
• Stage 4 disease – GFR between 15 and 29 mL/min per 1.73 m²
• Stage 5 disease – GFR of less than 15 mL/min per 1.73 m² or end-
stage renal disease (ESRD)

6. Causes of ckd
• Diabetes
• Hypertension
• Glomerulonephritis
• Polycystic kidney diseases
• Vascular diseases like birateral renal artery stenosis
• HUS
• Focal segmental glomerulosclerosis
• IgA nephropathy

7. Causes ….
• Diabetes nephropathy
• Family history of kidney disease
• Cardiovascular disease
• Recurrent urinary tract infections
• HIV infection
• Autoimmune diseases

8. Signs and symptoms
• High Bp due to fluid overload and roduction of vasoactive hormones
created by kidney via RAAS
• Azotemia that leads to uremia symptoms range from lethargy to
pericarditis and encephalopathy.
• Hyperkalemia that lead to malaise and cardiac arrhythmia
• Increases in k maybe usually occur after fall of GFR below 25%
• Decreases in erethropoetin that leads to anemia
• Fluid overload that leads o pulmonary edema

9. Signs continue
• Metabolic acidosis
• Hypocalcemia due to 1,25 dihydroxvitamin D3 deficiency
• Hyperphosphatemia
• Iron deficiency anemia
•

10. Diagnosis
• history and physical exam
• Urine distick
• Protein in urine
• Ultrasound

11. • Management to prevent hyperkalemia in children with CKD consists of the
following:
• Low potassium diet.
• Administration of a loop diuretic (eg, furosemide ) to increase urinary
potassium loss.
• If there is metabolic acidosis, oral sodium bicarbonate to correct acidosis.
(See 'Metabolic acidosis' below.)
• In infants under selected circumstances, formula can be mixed with sodium
polystyrene sulfonate and decanted externally to decrease the potassium
content of the formula prior to feeding [ 13 ]. The use of sodium
polystyrene sulfonate in this manner is a common practice in many
pediatric nephrology centers

12. Treatment
• Metabolic acidosis give bicarbonate mentain NaHCO3 >22mEq
• Vitamin D replacement
• Treat dyslipedemia
• erythropoietin therapy
• Recombinant growth hormones
• Limit Na intake to 2 to 3 g/day
• No evidence to stop protein so its can impair growth
• Dialysis
• In stage 5 or ESRD Renal transplant is the good option

13. Commonly prescribed
• Angiotensin-Converting Enzyme Inhibitor (ACEi)
• Angiotensin Receptor Blockers (ARB)
• Whenever an ACEi/ARB/Aldo antagonist/DRI is started check K within
7-10 days (but not sooner than 7 or >14)
• K-sparing diuretics in CKD or diabetes (with normal
eGFR/proteinuria): check K within 3-7 days (but not later)

14. Use cautiously in CKD
• cautiously in CKD
• Aldosterone antagonists
• Renin inhibitors
• Potassium-sparing diuretics
• NSAID

15. Indications for Referral to Specialist Kidney Care
• Acute kidney injury or abrupt sustained fall in GFR
• GFR <30 ml/min/1.73m2 (GFR categories G4-G5)
• Persistent albuminuria (ACR > 300 mg/g)
• Atypical Progression of CKD
• Urinary red cell casts, RBC more than 20 per HPF sustained and not readily
explained
• Hypertension refractory to treatment with 4 or more antihypertensive
agents
• Persistent abnormalities of serum potassium
• Recurrent or extensive nephrolithiasis
• Hereditary kidney disease