Presentation done at Dialysis workshop at Indus Hospital Derabassi

1. Dr Narinder Sharma
Indus International Hospital, Derabassi

5. Urine Formation
 Glomerular filtration
 Glomerular filtration rate
 Tubular reabsorption
 Include water, electrolytes—Na, glucose,HCO3
 Tubular secretion--Acid
 Urine concentration—reabsorb water

6. Endocrine Function
 Renin–angiotensin–aldosterone system
 Role in blood pressure and sodium reabsorption
 Erythropoietin
 Role in RBC production
 Vitamin D and calcium regulation
 Acid–base balance

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 “spot” urine sample
• 24-hour urine collections are NOT needed.

10. Renal Failure
 Acute ---Acute kidney injury or AKI
 Chronic –CKD stages 1-5
 Acute on CKD

11. Acute Renal Failure
 Sudden interruption of kidney function resulting from
obstruction, reduced circulation, or disease of the
renal tissue
 Results in retention of toxins, fluids, and end
products of metabolism
 Usually reversible with medical treatment
 May progress to end stage renal disease, uremic
syndrome, and death without treatment

14. Acute Renal Failure--AKI
 Persons at Risks
 Sepsis
 Major surgery
 Major trauma
 Receiving nephrotoxic medications
 Elderly
 contrast

15. Chronic Renal Failure--CKD
 Results from gradual, progressive loss of renal
function
 Occasionally results from rapid progression of acute
renal failure
 Symptoms occur when 75% of function is lost
 Dialysis is necessary to remove uremic toxins

16. Kidney Disease: Improving Global Outcomes
(KDIGO) CKD Work Group. Kidney Int Suppls.
2013;3:1-150.

17. Causes of CKD
 Diabetes
 Hypertension
 Glomerulonephritis
 Polycystic kidney disease
 Obstructive uropathy
 Chronic interstitial disease
 unknown

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

20. Glomerulonephritis /
Glomerulosclerosis
 Glomerulonephritis - An inflammatory condition that
affects predominantly the glomeruli.
 Causes
 IgA nephropathy
 FSGS
 MN
 Autoimmune
 Glomerulosclerosis - scarring of the glomeruli

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

22. Stages in the Initiation and Progression
of CKD

23. When to start dialysis in CKD
 High potassium—hyperkalemia
 Fluid overload
 Severe metabolic acidosis
 Encephalopathic patient
 Uremic pericarditis

24. When to start dialysis in CKD-contd
 Appetite loss
 Vomiting
 Weight loss
 Rising creatinine or declining GFR

26. Hemodialysis