2. DEFINITION
Diminished GFR that is persistently less
than 60ml/min/1.73m2 for at least 3
months from any cause and/or
persistent albuminuria.
. "CKD is defined as abnormalities of kidney structure or
function, present for >3 months, with implications for health,"
and requires one of two criteria documented or inferred for >3
months: either GFR <60 ml/min/1.73 m2 or markers of kidney
damage, including albuminuria.
3. Causes of CKD(better to refer kumar & clerk)
Congenital and inherited disease
Polycystic kidney disease (adult and infantile forms)
Medullary cystic disease
Tuberous sclerosis
Oxalosis
Cystinosis
Congenital obstructive uropathy
Glomerular disease
Primary glomerulonephritides including focal
glomerulosclerosis
Secondary glomerular disease (systemic lupus,
polyangiitis, Wegenerās granulomatosis, amyloidosis,
diabetic glomerulosclerosis, accelerated hypertension,
haemolytic uraemic syndrome, thrombotic
thrombocytopenic purpura, systemic sclerosis, sickle
cell disease)
Vascular disease
Hypertensive nephrosclerosis (common in black Africans)
Renovascular disease
Small and medium-sized vessel vasculitis
Tubulointerstitial disease
Tubulointerstitial nephritis ā idiopathic, due to drugs
(especially nephrotoxic analgesics), immunologically
mediated
Reflux nephropathy
Tuberculosis
Schistosomiasis
Nephrocalcinosis
Multiple myeloma (myeloma kidney)
Balkan nephropathy
Renal papillary necrosis (diabetes, sickle cell disease and
trait, analgesic nephropathy)
Chinese herb nephropathy
Urinary tract obstruction
Calculus disease
Prostatic disease
Pelvic tumours
Retroperitoneal fibrosis
Schistosomiasis
9. Underlying nephropathy
Reduction in nephron number
Many nephrons have failed and scared so burden
of filtration falls to fewer functioning nephrons
Remaining functional nephrons experience
increased flow and pressure per nephron
Pathogenesis of Chronic Kidney Disease
10. Adapt with glomerular hypertrophy and decreased arterioles resistance
Hyperfiltration
Increased glomerular permeability Increased RAAS
Increased filtration of protein
and macromolecules
Proteinurea Nephrotoxic inflammation Hypertension
and remodeling
Tubulointerstitial fibrosis and focal segment glomerular sclerosis
Reduced GFR Reduced urine output Systemic complications
12. What is CKDu?
ā¢ A new form of CKD seen in epidemic proportions which is
NOT attributed to Diabetes Mellitus, Hypertension,
Glomerulonephritis or any other conventional risk factors.
ā¢ Currently CKDu occurs chiefly in Sri Lanka (Mainly North
Central province), El Salvador, Nicaragua, India and parts of
Central America.
ā¢ All affected countries are located close to the equator and
have agriculture-based economies that engage in Chena
and Paddy cultivation.
14. Disease Profile
ā¢ Male preponderance
ā¢ Farmers (Male 85%,
Female 71.1%)
ā¢ Age 30 ā 60 years
ā¢ Asymptomatic in early
stages
ā¢ Slowly progressive
How CKDu differs from common
CKD?
In CKDu,
ā¢ Working age males are mainly
affected
ā¢ No previous history of
glomerulonephritis, DM and
Hypertension or other conventional
risk factors.
ā¢ Proteins in urine- Low
15. Contributive factors
ā¢It is hypothesized from the distribution and epidemiology
that the condition is linked to the environment and is likely
to be related to human activities in particular agriculture.
ā¢Environmental Factors
Excessive Cadmium or Arsenic
High Fluoride in ground water
Cyanobacterial toxins in water
Bio accumulation of pesticides residues
Aluminium utensils + Flouride water
Naturally occurring hard water
