8. Who is at risk of kidney
disease?
National Kidney Foundation, 2002
⢠Diabetes mellitus
⢠Hypertension
⢠Age >65yrs
⢠Family members of patients with CKD
⢠Patients taking pain killers
9. Three simple tests will identify
kidney disease in adults
⢠BUN and S creatinine- measurement
⢠eGFR - Estimated GFR from serum creatinine using the CKD--EPI
equation
⢠UACR - Urine albumin to creatinine ratio on a âspotâ urine sample
⢠24-hour urine collections are NOT needed.
10. Renal Failure
ď Acute ---Acute kidney injury or AKI
ď Chronic âCKD stages 1-5
ď Acute on CKD
11. Acute Renal Failure
ď Sudden interruption of kidney function resulting from
obstruction, reduced circulation, or disease of the
renal tissue
ď Results in retention of toxins, fluids, and end
products of metabolism
ď Usually reversible with medical treatment
ď May progress to end stage renal disease, uremic
syndrome, and death without treatment
12.
13.
14. Acute Renal Failure--AKI
ď Persons at Risks
ď Sepsis
ď Major surgery
ď Major trauma
ď Receiving nephrotoxic medications
ď Elderly
ď contrast
15. Chronic Renal Failure--CKD
ď Results from gradual, progressive loss of renal
function
ď Occasionally results from rapid progression of acute
renal failure
ď Symptoms occur when 75% of function is lost
ď Dialysis is necessary to remove uremic toxins
18. Diabetic Kidney Disease
⢠Common in long standing and poorly
controlled diabetics
⢠Diabetes damages blood vessels in the kidneys
⢠Occurs in both types of diabetes
⢠Occurrence of high blood pressure in diabetics
is a strong predictor for diabetic nephropathy
⢠Most common cause of ESRD in many
developed countries
19. Hypertensive Nephrosclerosis
⢠Poorly controlled high blood pressure (hypertension) can lead to
kidney failure
Signs and Symptoms
⢠Headache
⢠Giddiness (sometimes related to posture)
⢠Protein in urine
⢠Easily tired-- uremia
⢠Nauseous and/or vomiting -uremia
21. ⢠Genetically acquired
⢠2 forms - dominant and recessive
⢠In the dominant PKD form, one parent has the
disease and passes it to the child. The chance
of passing the gene to the offspring is 50%.
⢠Cysts are abnormal pouches containing fluid.
Eventually the cysts replace normal kidney
tissue -> suffers ESRD
Polycystic Kidney Disease
23. When to start dialysis in CKD
ď High potassiumâhyperkalemia
ď Fluid overload
ď Severe metabolic acidosis
ď Encephalopathic patient
ď Uremic pericarditis
24. When to start dialysis in CKD-contd
ď Appetite loss
ď Vomiting
ď Weight loss
ď Rising creatinine or declining GFR