Chronic Kidney Disease - What You Need to Know


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  • Majority of Stage 3-4 patients are dying from CV deaths
  • Chronic Kidney Disease - What You Need to Know

    1. 1. Chronic Kidney Disease What You Need to Know Phil Ramos, MD, MSCI Denver Nephrologists, P.C.
    2. 2. Objectives <ul><li>What are the kidneys and how do they work? </li></ul><ul><li>What is Chronic Kidney Disease? </li></ul><ul><li>What are the causes? </li></ul><ul><li>How do I know if I have chronic kidney disease? </li></ul><ul><li>How do I prevent this from happening to me? </li></ul>
    3. 3. The Kidney <ul><li>2 bean-shaped organs </li></ul><ul><li>the human body’s internal filters </li></ul><ul><li>Main Job: Helps Make Urine! </li></ul><ul><li>Other important functions </li></ul>
    4. 4. The Nephron <ul><li>1 million nephrons per kidney </li></ul><ul><li>Filters the blood keeping the good (proteins) and excreting the waste (toxins, drugs) </li></ul><ul><li>Regulation of electrolytes (sodium, potassium, calcium and phosphorus) </li></ul><ul><li>Regulation of Water </li></ul>
    5. 5. Other Important Functions <ul><li>Produces Hormones </li></ul><ul><ul><li>Helps Red Blood Cells Develop ( Erythropoietin ) </li></ul></ul><ul><ul><li>Regulates Bone Health (calcium and phosphorus) by producing a special Vitamin D </li></ul></ul><ul><ul><li>Produces enzyme ( Renin ) which helps regulate salt balance and blood pressure </li></ul></ul>
    6. 6. Estimating Kidney Function <ul><li>Measure blood (serum) creatinine </li></ul><ul><li>Estimated Glomerular Filtration Rate </li></ul><ul><ul><li>eGFR </li></ul></ul><ul><ul><li>Sum of all the filtration rate of the “working” nephrons </li></ul></ul><ul><ul><li>The kidneys filter about 180 liters of blood per day (125 milliliters per minute) </li></ul></ul><ul><ul><li>Normal eGFR is 130 and 120 mL/min for men and women, respectively </li></ul></ul><ul><ul><li>used clinically to assess the degree of kidney impairment and to follow the course of the disease </li></ul></ul>
    7. 7. What is Chronic Kidney Disease <ul><li>Kidney damage for  3 months </li></ul><ul><ul><li>Defined by structural or functional abnormalities of the kidney, with or without decreased eGFR (protein and/or blood in the urine, multiple kidney cysts, small kidneys) </li></ul></ul><ul><li>Reduced eGFR <60 mL/min for  3 months, with or without other evidence of kidney damage </li></ul><ul><li>Staging for chronic kidney disease (CKD) is primarily based on kidney function but also evidence of damage to the filtering units (glomeruli) </li></ul>National Kidney Foundation (NKF). Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.
    8. 8. CKD Progresses in Stages (Defined by eGFR) NKF. Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266. CKD Stage Description GFR (mL/min/1.73 m 2 ) 1 Kidney damage with normal or  GFR  90 2 Kidney damage with mild  GFR 60-89 3 Moderate  GFR 30-59 4 Severe  GFR 15-29 5 Kidney failure <15 or dialysis
    9. 9. The Epidemic of CKD <ul><li>Approximately 26 million Americans suffer from chronic kidney disease, many of whom are undiagnosed since symptoms of kidney disease are not obvious until the kidneys totally fail </li></ul><ul><li>Many more at risk… </li></ul><ul><li>Over 500,000 Americans suffer from end stage renal disease (ESRD) and this number continues to increase yearly. </li></ul>
    10. 10. CKD Is a Growing Epidemic CKD Stage Number of Individuals* 1  90 3.6 million 2 60-89 6.5 million 3 30-59 15.5 million 4 15-29 700,000 5 <15 or dialysis 500,000 GFR (mL/min/1.73 m 2 ) *Coresh et al. JAMA; 298 (17): 2038 (2007) United States Renal Data System, 2008
    11. 11. Risk Factors for CKD <ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Vascular disease </li></ul><ul><li>Kidney stones </li></ul><ul><li>Chronic urinary tract infections </li></ul><ul><li>Exposure to certain drugs and Chinese herbs </li></ul><ul><li>High cholesterol </li></ul><ul><li>Obesity </li></ul><ul><li>Smoking </li></ul>
    12. 12. Diabetic Kidney Disease
    13. 13. Hypertension Kidney Disease
    14. 14. Medication Risk Factors: NSAID’s <ul><li>Non-Steroidal Anti-inflammatory Drugs (NSAID’s) </li></ul><ul><ul><li>Almost 60% of community-dwelling adults use NSAID’s </li></ul></ul><ul><ul><li>Higher doses and longer exposure to NSAID’s are associated with an increased risk of kidney disease progression </li></ul></ul><ul><ul><li>For those with CKD due to another cause, NSAIDs can worsen kidney function quickly. Consult your doctor about this. </li></ul></ul>Gooch, K. et. al. Am J Med 2007;120.
    15. 15. NSAID’s <ul><li>Motrin </li></ul><ul><li>Naprosyn </li></ul><ul><li>Ibuprofen </li></ul><ul><li>Aleve </li></ul><ul><li>BC Powder </li></ul><ul><li>Daypro, Celebrex, Feldene, Lodine, Anaprox, Dolobid, Voltaren </li></ul>
    16. 16. Signs/Symptoms of CKD <ul><li>You cannot “feel” CKD at the early stages </li></ul><ul><li>The amount of urination can be “normal”, decreased, or even increased with CKD </li></ul><ul><ul><li>Worsening high blood pressure </li></ul></ul><ul><ul><li>increased swelling in the legs, hands or face </li></ul></ul><ul><ul><li>foamy or bloody urine </li></ul></ul>
    17. 17. Signs/Symptoms of End Stage Renal Disease (ESRD) <ul><li>decreased appetite and malnutrition </li></ul><ul><li>metallic taste to food </li></ul><ul><li>nausea, vomiting, stomach pain </li></ul><ul><li>chest pain and shortness of breath </li></ul><ul><li>generalized itching </li></ul><ul><li>decreased concentration and memory </li></ul><ul><li>sleep disturbances </li></ul><ul><li>numbness in the hands and feet </li></ul><ul><li>worsening anemia </li></ul><ul><li>bone fractures </li></ul>
    18. 18. Signs/Symptoms of End Stage Renal Disease (ESRD) <ul><li>Most Common Cause of Sickness and Death in CKD and ESRD </li></ul><ul><li> Cardiovascular Disease (heart attack, heart failure, stroke) </li></ul><ul><ul><li>CKD/ESRD highly associated with cardiovascular disease compared to the non-kidney disease population </li></ul></ul>
    19. 19. Blood and Urine Results in CKD/ESRD <ul><li>High blood urea nitrogen (BUN) and creatinine </li></ul><ul><li>Worsening anemia (decreased red blood cells) </li></ul><ul><li>High blood phosphorus and low calcium. High parathyroid hormone </li></ul><ul><li>High acid build up in blood and high blood potassium </li></ul><ul><li>Urine with microalbuminuria, proteinuria or hematuria </li></ul>
    20. 20. Urinary Tract Obstruction <ul><li>Blockade of the urinary tract from kidneys to urethra </li></ul><ul><ul><li>Kidney stones </li></ul></ul><ul><ul><li>Enlarged prostate </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Abnormal Anatomy </li></ul></ul><ul><ul><li>Renal Ultrasound to diagnose </li></ul></ul>
    21. 21. Kidney Cysts <ul><li>Simple cysts not bad </li></ul><ul><li>Genetic diseases associated with multiple kidney cysts can cause ESRD </li></ul>
    22. 22. Which Patients Should Be Screened for CKD? Levey et al. Ann Intern Med . 2003;139:137-147. USRDS. 1999 Annual Data Report. Available at: Susceptibility Risk Factors Progression Factors <ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Older age </li></ul><ul><li>Family history of nephropathy </li></ul><ul><li>Racial or ethnic minority </li></ul><ul><li>Other: kidney-mass reduction, known kidney disease </li></ul><ul><li>Higher level of proteinuria </li></ul><ul><li>Higher BP </li></ul><ul><li>Poor glycemic control </li></ul><ul><li>Smoking </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Drug use </li></ul>
    23. 23. Primary Goals of Management in CKD <ul><ul><li>Diabetes Control </li></ul></ul><ul><ul><li>Hypertension control </li></ul></ul><ul><ul><ul><li>Simplified BP goals: <130/80 </li></ul></ul></ul><ul><ul><li>Reduction of proteinuria with ACE-Inhibitors or ARBs </li></ul></ul><ul><ul><ul><li>High proteinuria through time scars the kidneys </li></ul></ul></ul><ul><ul><li>Anemia control </li></ul></ul><ul><ul><li>Maintaining Bone Health (Secondary hyperparathyroidism) </li></ul></ul><ul><ul><ul><li>Prevent progression with decreased phosphorous in the diet and vitamin D </li></ul></ul></ul>
    24. 24. Primary Goals of Management in CKD <ul><li>Quit Smoking </li></ul><ul><li>Control High Cholesterol </li></ul><ul><li>Avoid NSAIDs and adjust other medications for decreased renal function </li></ul><ul><li>Low-potassium diet for blood potassium high </li></ul><ul><li>Avoid iodine contrast injection in veins for certain procedures unless absolutely necessary </li></ul><ul><li>Avoid dehydration </li></ul>
    25. 25. ESRD and Hemodialysis <ul><li>When eGFR < 15 ml/min and feeling sick for kidney failure (UREMIA) </li></ul><ul><li>Three times a week for 3-4 hours at a time </li></ul><ul><li>Can be done at home and at night </li></ul><ul><li>Need arm “fistula” placed </li></ul>
    26. 26. ESRD and Peritoneal Dialysis <ul><li>Putting dialysis fluid into the abdominal space </li></ul><ul><li>Peritoneal catheter </li></ul><ul><li>Advantage of dialyzing continuously, at work and home. </li></ul><ul><li>Can perform at night </li></ul>
    27. 27. Renal Transplantation <ul><li>A great option </li></ul><ul><li>Can be put on waiting list for a cadaveric kidney </li></ul><ul><li>Can have a living related or unrelated person donate if they are healthy enough </li></ul>
    28. 28. Prevention of CKD Most Important <ul><li>Adhering to a low-fat, low-salt diet </li></ul><ul><li>Controlling blood pressure </li></ul><ul><li>Regular exercise </li></ul><ul><li>Avoid the on-set of diabetes </li></ul><ul><li>Avoid smoking </li></ul><ul><li>Regular annual check-ups with your Primary Care Provider to screen for kidney disease with urine and blood work </li></ul>