Chronic Kidney Disease, a.k.a Chronic Kidney Failure, is a vast but serious topic that requires thorough study. This presentation entails the essentials - its stages, pathogenesis, risk factors, etiology, symptoms, diagnosis, treatment and prognosis.

1. CHRONIC
KIDNEY DISEASE (CKD)
By Dr. Sarah D’souza
BDS
©

2. INTRODUCTION:
Chronic kidney disease (CKD) is a general term covering heterogene

3. INCIDENCE:
Chronic kidney disease arises when one or both of the following
conditions are present:
• When there is evidence of kidney damage lasting for at least 3
months with or without a decreased glomerular filtration rate
(GFR), as demonstrated either by pathologic abnormalities or by
markers of kidney damage, including urine or blood abnormalities
or abnormalities noted on imaging.
• When the GFR is less than 60 ml/min/1.73 m2 for at least 3
months with or without kidney damage.

4. •Stage 1: Normal GFR (≥ 90 mL/min/1.73 m2) plus either persistent
albuminuria or known structural or hereditary renal disease
•Stage 2: GFR 60 to 89 mL/min/1.73 m2
•Stage 3a: 45 to 59 mL/min/1.73 m2
•Stage 3b: 30 to 44 mL/min/1.73 m2
•Stage 4: GFR 15 to 29 mL/min/1.73 m2
•Stage 5: GFR < 15 mL/min/1.73 m2
STAGES

5. PATHOGENESIS

6. ETIOLOGY:
• Diabetic glomerulosclerosis
• Hypertensive nephrosclerosis
• Glomerular disease
• Glomerulonephritis
• Amyloidosis
• Systemic lupus erythematosus
• Tubulointerstitial disease
• Obstructive nephropathy
• Myeloma kidney
• Vascular disease
• Scleroderma
• Vasculitis
• Cystic disease
• Autosomal dominant
polycystic kidney disease
• Systemic disease
involving the kidney.

7. RISK
FACTORS:
• Diabetic
• Advancing age
• Proteinuria
• Smoking
• Cardiovascular disease (CVD)
• Certain ethnicities (e.g., African-American, Native-American, and
Asian-American)
• Abnormal cholesterol, previous episode(s) of acute kidney injury
• Exposure to nephrotoxins
• Family history of kidney disease

8. SYMPTOMS:

9. SYMPTOMS:

10. DIAGNOSIS:
•Electrolytes, blood urea nitrogen (BUN), creatinine, phosphate, calcium,
complete blood count (CBC)
•Urinalysis (including urinary sediment examination)
•Quantitative urine protein (24-hour urine protein collection or spot urine protein to
creatinine ratio)
•Ultrasonography
•Sometimes renal biopsy
Chronic kidney disease (CKD) is usually first suspected when serum creatinine
rises.

11. COMPLICATIONS:
•Hypertension
•Cardiovascular complications
•Anemia
•CKD-related mineral bone disorder
•Salt and water retention
•Metabolic acidosis and electrolyte
disorders
•Uremic symptoms

12. TREATMENT:

13. TREATMENT:
• Lifestyle modifications (dietary management, weight management,
physical activity)
• Blockade of the renin angiotensin aldosterone system with either an
angiotensin converting enzyme inhibitor (ACEI) or an angiotensin
receptor blocker (ARB)
• Blood pressure control reduces renal disease progression and
cardiovascular morbidity/mortality.
- Target BP <130/80mm Hg if without hypotension risk (eg,without:
orthostatic hypotension, heart failure, older age).
- Consider a target BP of <140/90 mm Hg if risk for hypotension.

14. TREATMENT
•Optimally manage comorbid diabetes and
address cardiovascular risk factors.
Statin or statin/ezetimibe therapy is
recommended in all CKD patients age ≥ 50
years to decrease the risk of cardiovascular or
atherosclerotic events.
• Monitor for other common complications of
CKD including: anemia, electrolyte
abnormalities, abnormal fluid balance, mineral
bone disease, and malnutrition.
• Avoid nephrotoxic medications to prevent
worsening renal function.

15. PROGNOSIS:
• Chronic kidney disease results in worse all-cause mortality (the
overall death rate) which increases as kidney function decreases.
• The leading cause of death in chronic kidney disease is
cardiovascular disease, regardless of whether there is progression
to stage 5.
• While kidney replacement therapies can maintain people
indefinitely and prolong life, the quality of life is negatively affected.
• Kidney transplantation increases the survival of people with stage 5
CKD when compared to other options