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chronic kidney disease.ppt

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SOMETHING ABOUT CHRONICC KIDNEY DISEASE

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chronic kidney disease.ppt

  1. 1. Involves progressive, irreversible loss of kidney function Defined as either presence of • Kidney damage  Pathological abnormalities • Glomerular filtration rate (GFR)  <60 ml/min for 3 months or longer
  2. 2. CKD death Complications Screening for CKD risk factors CKD risk reduction; Screening for CKD Diagnosis & treatment; Treat comorbid conditions; Slow progression Estimate progression; Treat complications; Prepare for replacement Replacement by dialysis & transplant Normal Increased risk Kidney failure Damage  GFR
  3. 3. Stage Description GFR (ml/min/1.73 m2) Prevalence* N (1000s) % 1 Kidney Damage with Normal or  GFR  90 5,900 3.3 2 Kidney Damage with Mild  GFR 60-89 5,300 3.0 3 Moderate  GFR 30-59 7,600 4.3 4 Severe  GFR 15-29 400 0.2 5 Kidney Failure < 15 or Dialysis 300 0.1 *Stages 1-4 from NHANES III (1988-1994). Population of 177 million with age 20. Stage 5 from USRDS (1998), includes approximately 230,000 patients treated by dialysis, and assuming 70,000 additional patients not on dialysis. GFR estimated from serum creatinine using MDRD Study equation based on age, gender, race and calibration for serum creatinine. For Stage 1 and 2, kidney damage estimated by spot albumin-to-creatinine ratio 17 mg/g in men or 25 mg/g in women in two measurements.
  4. 4.  Leading causes of ESRD • Diabetes • Hypertension • Last stage of kidney failure  End-stage renal disease (ESRD) occurs when GFR <15 ml/min
  5. 5.  Diabetes Mellitus  Hypertension  Cardiovascular Disease  Obesity  Metabolic Syndrome  Age and Race  Acute Kidney Injury  Malignancy  Family history of CKD  Kidney Stones  Infections like Hep C and HIV  Autoimmune diseases  Nephrotoxics like NSAIDS
  6. 6. Uremia • Syndrome that incorporates all signs and symptoms seen in various systems throughout the body
  7. 7. Fig. 47-5
  8. 8. Urinary system Polyuria • Results from inability of kidneys to concentrate urine • Occurs most often at night • Specific gravity fixed around 1.010 Oliguria • Occurs as CKD worsens Anuria • Urine output <40 ml per 24 hours
  9. 9. Metabolic disturbances Waste product accumulation • As GFR ↓, BUN ↑ and serum creatinine levels ↑  BUN ↑  Not only by kidney failure but by protein intake, fever, corticosteroids, and catabolism  N/V, lethargy, fatigue, impaired thought processes, and headaches occur
  10. 10. Electrolyte/acid–base imbalances Sodium • May be normal or low • Because of impaired excretion, sodium is retained  Water is retained  Edema  Hypertension  CHF  Potassium • Hyperkalemia  Most serious electrolyte disorder in kidney disease  Fatal dysrhythmias
  11. 11. Electrolyte/acid–base imbalances Calcium and phosphate alterations Magnesium alterations Metabolic acidosis • Results from  Inability of kidneys to excrete acid load (primary ammonia)
  12. 12. Hematologic system Anemia • Due to ↓ production of erythropoietin  From ↓ of functioning renal tubular cells Bleeding tendencies • Defect in platelet function Infection • Changes in leukocyte function • Altered immune response and function • Diminished inflammatory response
  13. 13. Cardiovascular system Hypertension Heart failure Left ventricular hypertrophy Peripheral edema Dysrhythmias Uremic pericarditis
  14. 14. Respiratory system Kussmaul respiration Dyspnea Pulmonary edema Uremic pleuritis Pleural effusion Predisposition to respiratory infections Depressed cough reflex “Uremic lung”
  15. 15. Gastrointestinal system  Every part of GI is affected • Due to excessive urea  Mucosal ulcerations  Stomatitis  Uremic fetor (urinous odor of the breath)  GI bleeding  Anorexia  N/V
  16. 16. Neurologic system Expected as renal failure progresses • Attributed to  Increased nitrogenous waste products  Electrolyte imbalances  Metabolic acidosis  Demyelination of nerve fibers Altered mental ability Seizures and Coma Dialysis encephalopathy Peripheral neuropathy
  17. 17. Neurologic system  Restless leg syndrome  Muscle twitching  Irritability  Decreased ability to concentrate Reproductive system  Infertility • Experienced by both sexes  Decreased libido  Low sperm counts  Sexual dysfunction
  18. 18. Musculoskeletal system Renal osteodystrophy • Syndrome of skeletal changes • Result of alterations in calcium and phosphate metabolism  Weaken bones, increase fracture risk • Two types associated with ESRD:  Osteomalacia  Osteitis fibrosa
  19. 19. Integumentary system  Most noticeable change • Yellow-gray discoloration of the skin  Due to absorption/retention of urinary pigments  Pruritus  Uremic frost  Dry, pale skin  Dry, brittle hair  Thin nails  Petechiae  Ecchymoses
  20. 20. Laboratory tests (cont’d) • Urinalysis • Urine culture • Hematocrit • Hemoglobin • Urea • Creatinine Renal ultrasound Renal scan
  21. 21. Drug therapy • Hyperkalemia  IV insulin and glucose • IV 10% calcium gluconate  Raises threshold for excitation  Sodium bicarbonate  Shift potassium into cells  Correct acidosis  Sodium polystyrene sulfonate (Kayexalate)  Cation-exchange resin  Resin in bowel exchanges potassium for sodium  Evacuates potassium-rich stool from body  Educate patient that diarrhea may occur due to laxative in preparation
  22. 22. Drug therapy  Hypertension (cont’d) • Antihypertensive drugs  Diuretics  β-Adrenergic blockers  Calcium channel blockers  Angiotensin-converting enzyme (ACE) inhibitors  Angiotensin receptor blocker agents
  23. 23. Drug therapy Renal osteodystrophy • Phosphate intake restricted to <1000 mg/day • Phosphate binders Calcium carbonate (Tums) Bind phosphate in bowel and excreted Sevelamer hydrochloride (Renagel) Lowers cholesterol and LDLs
  24. 24. Drug therapy  Renal osteodystrophy (cont’d) • Phosphate binders (cont’d)  Should be administered with each meal  Side effect: Constipation • Supplementing vitamin D  Calcitriol (Rocaltrol)  Serum phosphate level must be lowered before administering calcium or vitamin D
  25. 25. Drug therapy  Renal osteodystrophy (cont’d) • Controlling secondary hyperparathyroidism  Calcimimetic agents  Cinacalcet (Sensipar)  ↑ Sensitivity of calcium receptors in parathyroid glands  Subtotal parathyroidectomy
  26. 26. Drug therapy  Anemia • Erythropoietin  Epoetin alfa (Epogen, Procrit)  Administered IV or subcutaneously  Increased hemoglobin and hematocrit in 2 to 3 weeks  Side effect: Hypertension
  27. 27. Drug therapy  Anemia (cont’d) • Iron supplements  If plasma ferritin <100 ng/ml  Side effect: Gastric irritation, constipation  May make stool dark in color • Folic acid supplements  Needed for RBC formation  Removed by dialysis • Avoid blood transfusions
  28. 28. Drug therapy  Complications • Drug toxicity  Digitalis  Antibiotics  Pain medication (Demerol, NSAIDs)
  29. 29. Nutritional therapy Protein restriction • 0.6 to 0.8 g/kg body weight/day Water restriction • Intake depends on daily urine output
  30. 30. Nutritional therapy Sodium restriction • Diets vary from 2 to 4 g depending on degree of edema and hypertension • Sodium and salt should not be equated • Patient should be instructed to avoid high-sodium foods • Salt substitutes should not be used because they contain potassium chloride
  31. 31. Nutritional therapy Potassium restriction • 2 to 4 g • High-potassium foods should be avoided  Oranges  Bananas  Tomatoes  Green vegetables
  32. 32. Phosphate restriction • 1000 mg/day • Foods high in phosphate  Dairy products • Most foods high in phosphate are also high in calcium
  33. 33. Thank you

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