Chronic kidney disease is defined as kidney damage or reduced glomerular filtration rate <60 mL/min for ≥3 months. It is a progressive condition caused by conditions like diabetes and hypertension. Symptoms are nonspecific until late stages when complications like fluid overload, electrolyte abnormalities, and uremia occur. Treatment focuses on controlling risk factors, restricting diet, treating complications, and renal replacement therapy like dialysis or transplantation for end-stage disease. Prognosis depends on stage and treatment, with long-term dialysis patients living 3-4 years on average.
1. Acute renal failure (ARF) is an acute, potentially reversible condition where the kidneys fail to maintain homeostasis. Causes include prerenal factors like shock, congestive heart failure, or intrarenal injury from toxins. Symptoms range from nonspecific like fever to specific kidney issues like electrolyte imbalances. Treatment focuses on fluid management, electrolyte replacement, and potentially dialysis.
2. Chronic renal failure is a permanent loss of kidney function that progresses to end stage renal disease. It is usually caused by congenital anomalies or acquired glomerular diseases. Symptoms emerge late and include fatigue, nausea, and cardiac/bone issues. Treatment manages complications and slows progression with a low protein
The document discusses chronic kidney disease (CKD), including its definition, stages, diagnosis, prevalence, costs, and treatment options such as renal replacement therapy. CKD is common and often occurs alongside other conditions like cardiovascular disease or diabetes. While usually asymptomatic, CKD can be detected through simple tests and treating it can prevent progression and complications. However, it often goes unrecognized until later stages.
This document provides an overview of renal failure for nursing students. It begins with general and specific objectives of understanding renal failure and providing nursing care using the nursing process. It then reviews anatomy and physiology of the kidneys, defines renal failure, and discusses the incidence, etiology, pathophysiology, phases, signs and symptoms, diagnostic measures, management, complications and prevention of acute renal failure. The document concludes by outlining a nursing care plan using the nursing process to address issues such as fluid imbalance, nutritional deficits, activity intolerance, and knowledge deficits regarding the condition and its treatment.
This document discusses chronic kidney disease and end stage renal disease. It defines chronic kidney disease as kidney damage or decreased glomerular filtration rate for more than 3 months. It describes the 5 stages of chronic kidney disease based on GFR level. Common causes include infections, diseases like glomerulonephritis, obstructive issues, developmental anomalies, and genetic factors. End stage renal disease requires renal replacement therapy like hemodialysis, peritoneal dialysis, or kidney transplantation. The document outlines considerations for each treatment approach and notes nursing diagnoses and management strategies for patients with chronic kidney failure.
This PowerPoint presentation will introduce you to a basic understanding of what is a chronic kidney disease and how significant it impacts millions of Australians.
The document discusses chronic kidney disease (CKD) in children. It defines CKD, describes the stages and progression of disease. Common causes in children include congenital abnormalities and inherited disorders. Clinical features range from asymptomatic to growth retardation, hypertension, anemia and bone disease. Investigations include blood and urine tests to assess kidney function and damage. Management involves fluid, electrolyte, nutritional, anemic and bone disease management tailored to the stage of CKD.
This document discusses renal failure, including anatomy and function of the kidneys, classifications of acute and chronic renal failure, causes and symptoms of acute and chronic renal failure, diagnosis, management of acute renal failure including life-threatening conditions like hyperkalemia, dialysis options including hemodialysis and peritoneal dialysis, and potential problems related to end stage renal disease and dialysis.
Management of Chronic Kidney Disorder (CKD)Sharanya Rajan
This document provides an overview of the management of chronic kidney disease (CKD). It defines CKD and describes its most common causes as diabetes mellitus and hypertension. It explains the pathophysiology of CKD as progressive loss of nephrons leading to activation of the renin-angiotensin-aldosterone system and hypertension. The clinical presentation ranges from asymptomatic early on to later symptoms of kidney failure like fluid overload and hyperuremia. Diagnosis involves assessing glomerular filtration rate and looking for signs of kidney damage through blood and urine tests. Treatment aims to control blood pressure and glucose, treat underlying causes, and prevent complications through diet, medications, and renal replacement therapy like dialysis if indicated. Complications discussed
1. Acute renal failure (ARF) is an acute, potentially reversible condition where the kidneys fail to maintain homeostasis. Causes include prerenal factors like shock, congestive heart failure, or intrarenal injury from toxins. Symptoms range from nonspecific like fever to specific kidney issues like electrolyte imbalances. Treatment focuses on fluid management, electrolyte replacement, and potentially dialysis.
2. Chronic renal failure is a permanent loss of kidney function that progresses to end stage renal disease. It is usually caused by congenital anomalies or acquired glomerular diseases. Symptoms emerge late and include fatigue, nausea, and cardiac/bone issues. Treatment manages complications and slows progression with a low protein
The document discusses chronic kidney disease (CKD), including its definition, stages, diagnosis, prevalence, costs, and treatment options such as renal replacement therapy. CKD is common and often occurs alongside other conditions like cardiovascular disease or diabetes. While usually asymptomatic, CKD can be detected through simple tests and treating it can prevent progression and complications. However, it often goes unrecognized until later stages.
This document provides an overview of renal failure for nursing students. It begins with general and specific objectives of understanding renal failure and providing nursing care using the nursing process. It then reviews anatomy and physiology of the kidneys, defines renal failure, and discusses the incidence, etiology, pathophysiology, phases, signs and symptoms, diagnostic measures, management, complications and prevention of acute renal failure. The document concludes by outlining a nursing care plan using the nursing process to address issues such as fluid imbalance, nutritional deficits, activity intolerance, and knowledge deficits regarding the condition and its treatment.
This document discusses chronic kidney disease and end stage renal disease. It defines chronic kidney disease as kidney damage or decreased glomerular filtration rate for more than 3 months. It describes the 5 stages of chronic kidney disease based on GFR level. Common causes include infections, diseases like glomerulonephritis, obstructive issues, developmental anomalies, and genetic factors. End stage renal disease requires renal replacement therapy like hemodialysis, peritoneal dialysis, or kidney transplantation. The document outlines considerations for each treatment approach and notes nursing diagnoses and management strategies for patients with chronic kidney failure.
This PowerPoint presentation will introduce you to a basic understanding of what is a chronic kidney disease and how significant it impacts millions of Australians.
The document discusses chronic kidney disease (CKD) in children. It defines CKD, describes the stages and progression of disease. Common causes in children include congenital abnormalities and inherited disorders. Clinical features range from asymptomatic to growth retardation, hypertension, anemia and bone disease. Investigations include blood and urine tests to assess kidney function and damage. Management involves fluid, electrolyte, nutritional, anemic and bone disease management tailored to the stage of CKD.
This document discusses renal failure, including anatomy and function of the kidneys, classifications of acute and chronic renal failure, causes and symptoms of acute and chronic renal failure, diagnosis, management of acute renal failure including life-threatening conditions like hyperkalemia, dialysis options including hemodialysis and peritoneal dialysis, and potential problems related to end stage renal disease and dialysis.
Management of Chronic Kidney Disorder (CKD)Sharanya Rajan
This document provides an overview of the management of chronic kidney disease (CKD). It defines CKD and describes its most common causes as diabetes mellitus and hypertension. It explains the pathophysiology of CKD as progressive loss of nephrons leading to activation of the renin-angiotensin-aldosterone system and hypertension. The clinical presentation ranges from asymptomatic early on to later symptoms of kidney failure like fluid overload and hyperuremia. Diagnosis involves assessing glomerular filtration rate and looking for signs of kidney damage through blood and urine tests. Treatment aims to control blood pressure and glucose, treat underlying causes, and prevent complications through diet, medications, and renal replacement therapy like dialysis if indicated. Complications discussed
Chronic kidney failure is the progressive loss of kidney function over months or years. It is characterized by a buildup of waste products due to decreased filtration by the kidneys. The National Kidney Foundation stages chronic kidney disease based on glomerular filtration rate. Stage 1 involves normal kidney function while stage 5 is end-stage renal disease requiring dialysis or transplantation. Treatment options depend on the stage and may include lifestyle changes, medication, dialysis, and transplantation.
Renal failure occurs when the kidneys can no longer remove waste and regulate fluids and electrolytes in the body. Chronic kidney disease develops gradually over months to years and initially presents no symptoms. As kidney function declines, waste builds up in the blood and the kidneys lose their ability to concentrate urine and regulate fluids, electrolytes, and acid-base balance. Treatment focuses on managing complications through medications, diet, dialysis, and potentially a kidney transplant. The goals are to maintain kidney function and homeostasis for as long as possible.
Chronic kidney disease is defined as kidney damage or reduced kidney function (glomerular filtration rate below 60 mL/min/1.73m2) lasting at least 3 months. It is a progressive condition that leads to complete kidney failure if left untreated. Common causes include diabetes, hypertension, and cardiovascular disease. Symptoms are often nonspecific until late stages and include fatigue, pruritis, and neurological problems. Treatment focuses on slowing progression through blood pressure control and managing complications like anemia, bone disease, and fluid and electrolyte imbalances. Dialysis or kidney transplantation are required once kidney function has declined sufficiently.
Chronic renal failure is a progressive loss of kidney function over months to years characterized by the replacement of normal kidney tissue with fibrosis. It is classified into 5 stages based on glomerular filtration rate and urine production. Common causes include diabetes, hypertension, glomerulonephritis, and polycystic kidney disease. The pathophysiology involves loss of nephrons, glomerular hypertension from increased angiotensin II, proteinuria, and subsequent inflammation and scarring that leads to further nephron loss and declining GFR. Treatment focuses on controlling risk factors, restricting protein intake, and managing complications like anemia and hyperlipidemia.
Renal failure
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body
pathophysiology
Initial :Renal damage is occurring, the child may be Asymptomatic
Oliguric: <1ml/kg/hr of urineImpaired glomerular filtration-Waste cannot be remove-Uremia develops-Neurotoxicity-CCF, HTN, anemia
Diuretic :lasts 2 weekscellular regeneration and healinggradual return to normaldehydration and electrolyte imbalance due to excess urination
Recovery: it takes monthsf left untreated it result in fluid overload, electrolyteimbalance
CAUSES OF ARF
Prerenal Most common cause of ARF Caused by impaired renal blood flow GFR declines because of the decrease in filtration pressure
• Intrarenal Acute tubular necrosis (ATN) is the most common cause of intrarenal failure Post-ischemic or nephrotoxic• Postrenal Occurs with urinary tract obstructions distal to the kidneys
diagnosis:
H&P (History & Physical test)
BUN, creatinine, sodium, potassium. pH, bicarbontae, Hgb (haemoglobin) and Hct (hematocrit).
Urine studies
US of kidneys
KUB (Kidney, Ureters, Bladders radiography).
Renal CT/MRI
Retrograde pyelogram- Retrograde Pyelogram is a urologic procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast (up from the bladder to the kidney) is opposite the usual flow of urine, hence the retrograde name.
Medical treatment
Fluid and dietary restrictions
Maintain Electrolytes
May need dialysis to jump start renal function
May need to stimulate production of urine with IV fluids, Dopomine, diuretics, etc.
Hemodialysis
Peritoneal dialysis
Continuous renal replacement therapy (CRRT
chronic kidney disease causes;
Diabetic kidney disease.
Hypertension.
Vascular disease (Angina & MI).
Glomerular disease (primary or secondary).
Urinary tract obstruction or dysfunction
Recurrent kidney stone disease
Congenital (birth) defects of the kidney or bladder
Unrecovered acute kidney injury
The document discusses renal failure, including acute kidney injury (AKI) and chronic kidney disease (CKD). It covers the epidemiology and burden of kidney disease globally and in India. It describes the anatomy and physiology of the kidney and nephron. It defines AKI and its stages, causes including prerenal, intrarenal and postrenal factors. Signs, symptoms, diagnosis and management of AKI are summarized. CKD is defined and its stages, signs and symptoms, and diagnosis are outlined. Risk factors for CKD are also mentioned.
This document discusses chronic kidney disease in children. It defines chronic kidney disease as either kidney damage or a glomerular filtration rate below 60 ml/min/1.73m2 for over 3 months. Causes in children include congenital abnormalities, glomerulonephritis, cystic kidney diseases, and inherited disorders. Chronic kidney disease progresses through 5 stages and can cause complications affecting multiple organ systems. Treatment aims to replace kidney function, slow progression, and manage complications through measures like fluid/electrolyte control, nutrition, anemia treatment, bone disease management, and slowing kidney damage progression.
Renal failure and its homeopathy treatment in Chembur, Mumbai, India Shewta shetty
"Treatment & remedies for renal failure and its homeopathy treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."/>
Chronic renal failure (CRF) or end stage renal disease (ESRD) is an irreversible deterioration of renal function that results in uremia or azotemia. It is caused by a progressive reduction in kidney function such that the kidneys can no longer maintain homeostasis. This leads to decreased glomerular filtration rate, hypertrophy of remaining nephrons, inability to concentrate urine, further nephron loss, and loss of excretory and non-excretory renal functions. Management of CRF focuses on preserving renal function, alleviating extra-renal manifestations through medications and dialysis, and improving body chemistry through diet and medication.
This document defines acute renal failure (ARF) as the sudden reduction in renal function causing the kidneys to be unable to excrete waste products and regulate water and electrolyte balance. It classifies ARF as either acute or chronic and pre-renal, renal, or post-renal. The causes and pathogenesis of ARF are described including pre-renal from hypovolemia, renal from acute tubular necrosis or glomerulonephritis, and post-renal from urinary tract obstruction. Clinical features include oliguria, edema, hypertension and uremia. Investigations include blood and urine tests. Management involves fluid resuscitation, vasopressors, and dialysis depending on the cause
Chronic renal failure is a gradual loss of kidney function over time that cannot be reversed. It affects approximately 290,000 people in the United States. The kidneys gradually lose their ability to filter waste and excess fluid from the blood. Chronic renal failure is caused by conditions like hypertension, diabetes, kidney infections, and can lead to complications that affect many organ systems if not managed properly through treatments like dialysis and kidney transplantation. Proper management includes monitoring fluid and electrolytes, reducing metabolic rate, preventing infections, and providing nutritional therapy and skin care.
pathophysiology of acute and chronic renal failure - Bestha Chakrapani associate professor Deparrtment of Balaji college of pharmacy , ananthapuramu-515004
Chronic renal failure (CRF) is the progressive loss of kidney function over time. It can be caused by conditions that damage the nephrons like diabetes and hypertension. As kidney function declines, waste products build up in the bloodstream. CRF is classified by the location of damage as pre-renal, post-renal, or renal. The most common causes of renal CRF are diabetes and high blood pressure. Multiple myeloma can also lead to CRF through protein deposits and related complications that strain the kidneys.
Renal failure, also known as kidney failure, can be acute (AKI) or chronic (CKD). AKI is a rapid loss of kidney function that can be caused by decreased blood flow, kidney damage, or urinary tract obstruction. CKD is a progressive loss of kidney function over months or years that is commonly caused by diabetes, hypertension, or glomerulonephritis. Diagnosis involves measuring glomerular filtration rate and urine/blood tests. Treatment depends on the stage and type of kidney failure, and may include medications, dialysis, or transplant.
This document discusses renal failure and acute kidney injury (AKI). It defines AKI and outlines its causes, which include prerenal, intrinsic renal, and postrenal factors. The main types of intrinsic renal injury are acute tubular necrosis, glomerulonephritis, and interstitial nephritis. Signs and symptoms of AKI include oliguria, edema, and flank pain. The document also describes methods of diagnosing and classifying the severity of AKI.
This document provides information on chronic kidney disease (CKD) including its stages, causes, risk factors, clinical manifestations, diagnostic evaluation, medical management including dialysis and renal transplantation, and nursing management. Some key points are: CKD is progressive and irreversible, leading to end-stage renal disease if kidney function becomes too poor. It disproportionately affects African Americans and incidence increases with age. Common causes include diabetes, hypertension, glomerulonephritis. Later stages result in buildup of waste and complications impacting multiple organ systems. Treatment focuses on managing complications, slowing progression, and renal replacement therapies like hemodialysis or transplantation.
Chronic kidney disease is defined as abnormal kidney function or structure lasting over 3 months. It is a progressive condition caused by conditions like diabetes, hypertension, or glomerulonephritis. Symptoms develop slowly and include fatigue, pruritis, nausea, and neurological issues. Treatment focuses on controlling blood pressure and diabetes, dietary modifications, and dialysis or transplantation for end-stage renal disease. Complications include anemia, bone disease, heart disease, and fluid and electrolyte imbalances.
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
This document summarizes chronic kidney disease (CKD), defining it as abnormalities of kidney structure or function lasting over 3 months that impact health. CKD is classified based on cause, glomerular filtration rate (GFR) category, and albuminuria levels. Key aspects of CKD addressed include pathophysiology, GFR estimation and staging, risk factors, clinical abnormalities associated with decreased kidney function like fluid/electrolyte issues and anemia, leading causes, and management including treating complications and renal replacement therapy for late stages.
Chronic kidney failure is the progressive loss of kidney function over months or years. It is characterized by a buildup of waste products due to decreased filtration by the kidneys. The National Kidney Foundation stages chronic kidney disease based on glomerular filtration rate. Stage 1 involves normal kidney function while stage 5 is end-stage renal disease requiring dialysis or transplantation. Treatment options depend on the stage and may include lifestyle changes, medication, dialysis, and transplantation.
Renal failure occurs when the kidneys can no longer remove waste and regulate fluids and electrolytes in the body. Chronic kidney disease develops gradually over months to years and initially presents no symptoms. As kidney function declines, waste builds up in the blood and the kidneys lose their ability to concentrate urine and regulate fluids, electrolytes, and acid-base balance. Treatment focuses on managing complications through medications, diet, dialysis, and potentially a kidney transplant. The goals are to maintain kidney function and homeostasis for as long as possible.
Chronic kidney disease is defined as kidney damage or reduced kidney function (glomerular filtration rate below 60 mL/min/1.73m2) lasting at least 3 months. It is a progressive condition that leads to complete kidney failure if left untreated. Common causes include diabetes, hypertension, and cardiovascular disease. Symptoms are often nonspecific until late stages and include fatigue, pruritis, and neurological problems. Treatment focuses on slowing progression through blood pressure control and managing complications like anemia, bone disease, and fluid and electrolyte imbalances. Dialysis or kidney transplantation are required once kidney function has declined sufficiently.
Chronic renal failure is a progressive loss of kidney function over months to years characterized by the replacement of normal kidney tissue with fibrosis. It is classified into 5 stages based on glomerular filtration rate and urine production. Common causes include diabetes, hypertension, glomerulonephritis, and polycystic kidney disease. The pathophysiology involves loss of nephrons, glomerular hypertension from increased angiotensin II, proteinuria, and subsequent inflammation and scarring that leads to further nephron loss and declining GFR. Treatment focuses on controlling risk factors, restricting protein intake, and managing complications like anemia and hyperlipidemia.
Renal failure
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body
pathophysiology
Initial :Renal damage is occurring, the child may be Asymptomatic
Oliguric: <1ml/kg/hr of urineImpaired glomerular filtration-Waste cannot be remove-Uremia develops-Neurotoxicity-CCF, HTN, anemia
Diuretic :lasts 2 weekscellular regeneration and healinggradual return to normaldehydration and electrolyte imbalance due to excess urination
Recovery: it takes monthsf left untreated it result in fluid overload, electrolyteimbalance
CAUSES OF ARF
Prerenal Most common cause of ARF Caused by impaired renal blood flow GFR declines because of the decrease in filtration pressure
• Intrarenal Acute tubular necrosis (ATN) is the most common cause of intrarenal failure Post-ischemic or nephrotoxic• Postrenal Occurs with urinary tract obstructions distal to the kidneys
diagnosis:
H&P (History & Physical test)
BUN, creatinine, sodium, potassium. pH, bicarbontae, Hgb (haemoglobin) and Hct (hematocrit).
Urine studies
US of kidneys
KUB (Kidney, Ureters, Bladders radiography).
Renal CT/MRI
Retrograde pyelogram- Retrograde Pyelogram is a urologic procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast (up from the bladder to the kidney) is opposite the usual flow of urine, hence the retrograde name.
Medical treatment
Fluid and dietary restrictions
Maintain Electrolytes
May need dialysis to jump start renal function
May need to stimulate production of urine with IV fluids, Dopomine, diuretics, etc.
Hemodialysis
Peritoneal dialysis
Continuous renal replacement therapy (CRRT
chronic kidney disease causes;
Diabetic kidney disease.
Hypertension.
Vascular disease (Angina & MI).
Glomerular disease (primary or secondary).
Urinary tract obstruction or dysfunction
Recurrent kidney stone disease
Congenital (birth) defects of the kidney or bladder
Unrecovered acute kidney injury
The document discusses renal failure, including acute kidney injury (AKI) and chronic kidney disease (CKD). It covers the epidemiology and burden of kidney disease globally and in India. It describes the anatomy and physiology of the kidney and nephron. It defines AKI and its stages, causes including prerenal, intrarenal and postrenal factors. Signs, symptoms, diagnosis and management of AKI are summarized. CKD is defined and its stages, signs and symptoms, and diagnosis are outlined. Risk factors for CKD are also mentioned.
This document discusses chronic kidney disease in children. It defines chronic kidney disease as either kidney damage or a glomerular filtration rate below 60 ml/min/1.73m2 for over 3 months. Causes in children include congenital abnormalities, glomerulonephritis, cystic kidney diseases, and inherited disorders. Chronic kidney disease progresses through 5 stages and can cause complications affecting multiple organ systems. Treatment aims to replace kidney function, slow progression, and manage complications through measures like fluid/electrolyte control, nutrition, anemia treatment, bone disease management, and slowing kidney damage progression.
Renal failure and its homeopathy treatment in Chembur, Mumbai, India Shewta shetty
"Treatment & remedies for renal failure and its homeopathy treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."/>
Chronic renal failure (CRF) or end stage renal disease (ESRD) is an irreversible deterioration of renal function that results in uremia or azotemia. It is caused by a progressive reduction in kidney function such that the kidneys can no longer maintain homeostasis. This leads to decreased glomerular filtration rate, hypertrophy of remaining nephrons, inability to concentrate urine, further nephron loss, and loss of excretory and non-excretory renal functions. Management of CRF focuses on preserving renal function, alleviating extra-renal manifestations through medications and dialysis, and improving body chemistry through diet and medication.
This document defines acute renal failure (ARF) as the sudden reduction in renal function causing the kidneys to be unable to excrete waste products and regulate water and electrolyte balance. It classifies ARF as either acute or chronic and pre-renal, renal, or post-renal. The causes and pathogenesis of ARF are described including pre-renal from hypovolemia, renal from acute tubular necrosis or glomerulonephritis, and post-renal from urinary tract obstruction. Clinical features include oliguria, edema, hypertension and uremia. Investigations include blood and urine tests. Management involves fluid resuscitation, vasopressors, and dialysis depending on the cause
Chronic renal failure is a gradual loss of kidney function over time that cannot be reversed. It affects approximately 290,000 people in the United States. The kidneys gradually lose their ability to filter waste and excess fluid from the blood. Chronic renal failure is caused by conditions like hypertension, diabetes, kidney infections, and can lead to complications that affect many organ systems if not managed properly through treatments like dialysis and kidney transplantation. Proper management includes monitoring fluid and electrolytes, reducing metabolic rate, preventing infections, and providing nutritional therapy and skin care.
pathophysiology of acute and chronic renal failure - Bestha Chakrapani associate professor Deparrtment of Balaji college of pharmacy , ananthapuramu-515004
Chronic renal failure (CRF) is the progressive loss of kidney function over time. It can be caused by conditions that damage the nephrons like diabetes and hypertension. As kidney function declines, waste products build up in the bloodstream. CRF is classified by the location of damage as pre-renal, post-renal, or renal. The most common causes of renal CRF are diabetes and high blood pressure. Multiple myeloma can also lead to CRF through protein deposits and related complications that strain the kidneys.
Renal failure, also known as kidney failure, can be acute (AKI) or chronic (CKD). AKI is a rapid loss of kidney function that can be caused by decreased blood flow, kidney damage, or urinary tract obstruction. CKD is a progressive loss of kidney function over months or years that is commonly caused by diabetes, hypertension, or glomerulonephritis. Diagnosis involves measuring glomerular filtration rate and urine/blood tests. Treatment depends on the stage and type of kidney failure, and may include medications, dialysis, or transplant.
This document discusses renal failure and acute kidney injury (AKI). It defines AKI and outlines its causes, which include prerenal, intrinsic renal, and postrenal factors. The main types of intrinsic renal injury are acute tubular necrosis, glomerulonephritis, and interstitial nephritis. Signs and symptoms of AKI include oliguria, edema, and flank pain. The document also describes methods of diagnosing and classifying the severity of AKI.
This document provides information on chronic kidney disease (CKD) including its stages, causes, risk factors, clinical manifestations, diagnostic evaluation, medical management including dialysis and renal transplantation, and nursing management. Some key points are: CKD is progressive and irreversible, leading to end-stage renal disease if kidney function becomes too poor. It disproportionately affects African Americans and incidence increases with age. Common causes include diabetes, hypertension, glomerulonephritis. Later stages result in buildup of waste and complications impacting multiple organ systems. Treatment focuses on managing complications, slowing progression, and renal replacement therapies like hemodialysis or transplantation.
Chronic kidney disease is defined as abnormal kidney function or structure lasting over 3 months. It is a progressive condition caused by conditions like diabetes, hypertension, or glomerulonephritis. Symptoms develop slowly and include fatigue, pruritis, nausea, and neurological issues. Treatment focuses on controlling blood pressure and diabetes, dietary modifications, and dialysis or transplantation for end-stage renal disease. Complications include anemia, bone disease, heart disease, and fluid and electrolyte imbalances.
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
This document summarizes chronic kidney disease (CKD), defining it as abnormalities of kidney structure or function lasting over 3 months that impact health. CKD is classified based on cause, glomerular filtration rate (GFR) category, and albuminuria levels. Key aspects of CKD addressed include pathophysiology, GFR estimation and staging, risk factors, clinical abnormalities associated with decreased kidney function like fluid/electrolyte issues and anemia, leading causes, and management including treating complications and renal replacement therapy for late stages.
Acute kidney injury (AKI), also known as acute renal failure (ARF), is a sudden episode of kidney failure or kidney damage that happens within a few hours
CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.
Brief Information regarding the disorders of the genitourinary system. This presentation involves the disorders of the urinary system including Chronic Kidney Disease, Congenital problems related to the urinary system, and renal cancers.
The kidneys are located retroperitoneally and filter waste from the blood to form urine. Kidney failure occurs when the kidneys cannot adequately remove waste or regulate fluids and electrolytes. Acute kidney injury is a sudden decrease in function while chronic kidney disease is long-term damage. Causes include decreased blood flow, direct damage, and obstruction. Treatment focuses on treating reversible causes and managing complications like anemia and bone disease. Dialysis or transplantation may be needed for late-stage disease.
This document provides information on chronic kidney disease (CKD) and dialysis. It discusses:
1. The functions of the kidneys and how CKD develops due to gradual loss of kidney function over time.
2. The stages of CKD progression and treatment strategies at each stage, including managing risk factors, complications, and preparing for renal replacement therapy.
3. The two main types of renal replacement therapy - hemodialysis which uses an artificial kidney to filter waste from the blood, and peritoneal dialysis which uses the peritoneal membrane in the abdomen.
The document provides information about kidney structure and function, as well as kidney diseases. It discusses that the kidneys contain nephrons and filter blood to remove waste and regulate fluid levels. It describes acute kidney injury (AKI) as a sudden decline in kidney function, and chronic kidney disease (CKD) as long-term decreased function. For kidney failure, dialysis or transplantation is needed to replace lost kidney function.
The Medical Assessment and Management of OliguriaLuis Daniel Lugo
The document discusses the medical assessment and management of oliguria. It defines oliguria as urine output less than 400 mL per day in adults. Oliguria can result from prerenal, intrinsic renal, or postrenal causes. The assessment of oliguria involves urine analysis and blood tests to evaluate electrolytes, BUN, creatinine, and acid-base balance. Medical management focuses on treating the underlying cause, managing fluid balance and hyperkalemia, and considering dialysis for complications like volume overload or refractory acidosis. Identifying and treating reversible causes is important for prognosis, which depends on etiology and comorbidities.
This document provides an overview of acute kidney injury (AKI). It defines AKI and notes its worldwide epidemiology. The main causes of AKI are discussed as pre-renal, renal, and post-renal. The pathophysiology of each type is explained. Clinical presentation depends on the cause but may include elevated creatinine and reduced urine output. Staging of AKI is outlined using KDIGO criteria. Investigations and management aim to identify and treat the underlying cause while maintaining fluid and electrolyte balance. Complications include fluid overload and metabolic disturbances. Prognosis depends on severity and comorbidities.
CKD is defined as abnormal kidney structure or function lasting over 3 months. Common causes include diabetes, hypertension, cardiovascular disease, and chronic glomerulonephritis. Symptoms develop slowly and include fatigue, pruritis, and neurological problems. Complications arise from the retention of waste products and include heart and bone disease. Treatment options include managing risk factors, dietary modifications, dialysis, and transplantation.
Acute kidney injury (AKI) is a deterioration of renal function over hours to days resulting in failure to excrete waste and maintain homeostasis. [1] There are over 35 AKI definitions showing its complexity. [2] It can be classified as oliguric/non-oliguric or prerenal, renal, postrenal. [3] Prerenal and acute tubular necrosis account for most hospital AKI cases. [4] Management involves diagnosis through tests and imaging, and treatment focusing on fluid balance, electrolytes, and potentially renal replacement therapy. [5] The prognosis remains poor especially in critically ill patients, as currently the condition can only be supported but not cured. [6
The summary of the document is:
1. The Renin-Angiotensin-Aldosterone System (RAAS) is activated in response to hypotension, decreased sodium concentration, and decreased blood volume to increase blood pressure through vasoconstriction and sodium retention.
2. Nephrotic syndrome requires proteinuria over 3g per day, hypobulinemia, and edema. The most common causes are membranous glomerulonephritis, minimal-change GN, and focal segmental glomerulosclerosis.
3. Nephritic syndrome presents with hematuria, proteinuria, hypertension, edema, and oliguria. It is often seen in IgA nep
Acute renal failure (ARF), also known as acute kidney injury (AKI), can have various causes including pre-renal, renal, and post-renal factors. The definition includes an abrupt decline in kidney function over 48 hours seen through rises in creatinine or decreases in urine output. Evaluation involves assessing volume status, obtaining urine and blood tests, and ultrasound. Treatment focuses on identifying and treating the underlying cause, providing supportive care like fluid management, and potentially initiating renal replacement therapy for complications such as fluid overload or electrolyte imbalances. Prognosis depends on the severity and underlying etiology of the AKI.
1) Acute renal failure is a sudden reduction in kidney function that results in waste accumulating in the blood and is categorized as pre-renal, renal, or post-renal based on the underlying cause.
2) Pre-renal acute renal failure is caused by problems affecting blood flow to the kidneys such as dehydration, blood loss, or heart issues. Renal acute renal failure involves direct damage to the kidney itself from issues like acute tubular necrosis. Post-renal acute renal failure is caused by problems blocking urine flow out of the kidneys.
3) Symptoms can include weakness, fatigue, edema, and electrolyte imbalances. Treatment involves addressing the underlying cause, maintaining
This document provides an overview of the management of chronic kidney disease (CKD). It defines CKD and outlines criteria for diagnosis based on markers of kidney damage and glomerular filtration rate (GFR). It describes tools for screening and staging CKD, including estimated GFR (eGFR) calculators and urine albumin-to-creatinine ratio. Common clinical manifestations of CKD like fluid and electrolyte disorders, anemia, bone disease, and cardiovascular complications are summarized. Treatment strategies are covered for managing complications involving hypertension, acid-base abnormalities, mineral and bone disorders, anemia, and diabetes in CKD patients.
This includes a comprehensive study of Renal Failure - both AKI & CKD (ESRD). It is very helpful for those who are managing the clients with renal failure.
1. The patient is experiencing acute kidney injury (AKI) as evidenced by his elevated urea and creatinine levels, which were previously normal.
2. The underlying mechanism is likely pre-renal AKI caused by the nephrotoxic effects of the ACE inhibitor (Lisinopril) medication prescribed for his hypertension. ACE inhibitors can cause afferent arteriole vasoconstriction leading to reduced kidney perfusion and function.
3. Management includes discontinuing the ACE inhibitor, optimizing his blood pressure with another class of antihypertensive medication, and monitoring his kidney function and fluid status.
AKI and CKD are both conditions affecting kidney function. AKI refers to acute kidney injury and can be caused by factors like sepsis that lead to a rapid decline in kidney function over a period of days. CKD refers to chronic kidney disease, which develops over a period of months or years due to conditions like diabetes or hypertension. The prevalence of CKD stages 3-5 is around 5-7% globally. Mortality from AKI depends on the underlying cause, ranging from low to over 70% when associated with multi-organ failure from sepsis. Management of CKD focuses on slowing progression of disease and treating complications through diet, medication and preparing for renal replacement therapies like dialysis if needed.
Similar to Chronic kidney-disease-1216842299045729-8 (1) (20)
Acute tubular necrosis is a common cause of acute kidney injury where the renal tubular epithelial cells become damaged. It typically occurs in hospitalized patients following ischemia, exposure to toxins, or sepsis. Acute tubular necrosis progresses through clinical phases of initiation, extension, maintenance, and recovery. Treatment focuses on identifying at-risk patients and preventing hypotension and nephrotoxic exposures to avoid injury in the first place. An interprofessional team approach is important for managing the complex patients who develop this condition.
Acute tubular necrosis is the most common cause of acute kidney injury. It occurs when there is damage to the renal tubules, usually due to ischemia, toxins, or sepsis. The histopathology shows necrosis of tubular epithelial cells and regeneration. Patients may present with decreased kidney function and fluid/electrolyte abnormalities. Evaluation includes urinalysis to detect tubular cell casts and fractional excretion of sodium to differentiate from prerenal causes. Treatment focuses on supportive care and management of the underlying condition with interprofessional collaboration.
Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The most common cause is minimal change disease. Treatment involves corticosteroids as initial therapy, with cyclophosphamide or other immunosuppressants used for frequent relapses or steroid resistance. Supportive care focuses on managing edema, diet, and preventing infections, which are a major complication. Kidney biopsy may be needed to identify underlying renal pathology or guide treatment decisions.
This slide deck summarizes the key points from the American Diabetes Association's Standards of Medical Care in Diabetes - 2017. It was created by the ADA and covers their evidence-based guidelines for classifying, diagnosing, and screening for diabetes and prediabetes. The slides may be used for presentations without alteration as long as the ADA is properly attributed. Permission is required for commercial use or print reproduction.
The slides review the criteria for diagnosing diabetes based on A1C, fasting plasma glucose, and oral glucose tolerance tests. Prediabetes criteria and risk factors are also outlined. Recommendations are provided for screening asymptomatic individuals and those at high risk. Diagnosis and screening protocols for gestational diabetes are summarized
This document discusses hypertension (HTN), including its definition, prevalence, causes, complications, evaluation, treatment goals, and management. Some key points:
- HTN is defined as BP over 140/90 mmHg and affects over 50 million Americans. It increases risk of heart disease, stroke, and kidney disease.
- Causes include primary HTN in 95% of cases and secondary HTN related to other conditions like kidney disease. Target organ damage can occur in the heart, brain, kidneys, and eyes.
- Evaluation includes assessing risk factors, screening for secondary causes, and checking for target organ damage. Treatment goals are BP under 140/90 mmHg or 130/80 for those with
Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It is usually due to problems with the structure or function of the heart. Common causes include coronary artery disease, hypertension, and cardiomyopathy. Symptoms include shortness of breath, fatigue, and fluid retention. Treatment focuses on managing symptoms with diuretics and drugs that target the renin-angiotensin-aldosterone system like ACE inhibitors. Other treatments include beta-blockers, digitalis glycosides, and managing comorbidities and lifestyle factors like diet and exercise. The goals are to improve quality of life, slow disease progression, and reduce mortality risk.
Heart failure is a clinical syndrome that results from any structural or functional impairment of the ventricle that reduces its ability to fill with or eject blood. It impacts over 5 million Americans with high costs of care. The key aspects are reduced cardiac output, ejection fraction, preload and afterload. Compensatory mechanisms initially help but eventually fail, leading to fluid overload and decompensation. Diagnosis involves history, exam, echocardiogram and blood tests. Treatment depends on symptoms and stages from risk factor modification to drug therapy and devices.
1. Ischemic heart disease results from an imbalance between myocardial oxygen supply and demand, usually due to atherosclerotic plaques narrowing coronary arteries.
2. Stable angina is chronic, exertion-induced chest pain relieved by rest, while unstable angina involves more frequent or severe chest pain at lower exertion levels or at rest.
3. Diagnostic tests include electrocardiograms, which may show transient ST segment changes during chest pain, and stress tests, which can provoke chest pain and ECG changes. Coronary angiography can identify blockages.
1. Acute coronary syndrome is defined as myocardial ischemia due to myocardial infarction (NSTEMI or STEMI) or unstable angina.
2. Unstable angina is defined as angina at rest, new onset exertional angina (<2 months), recent acceleration of angina (<2 months), or post revascularization angina.
3. The diagnosis of acute coronary syndrome is based on history, physical exam, ECG, and cardiac enzymes, and patients can then be divided into several groups including stable angina, unstable angina, and myocardial infarction.
Clairenephroticandnephriticsyndrome1 150218105627-conversion-gate01Gordhan Das asani
This document discusses nephrotic and nephritic syndrome. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema. Nephritic syndrome presents with hematuria, hypertension, and oliguria. Both can be caused by primary glomerulonephritis or secondary causes like diabetes or vasculitis. Evaluation involves a urinalysis, blood work including renal function, and possibly a renal biopsy. Treatment depends on the underlying cause but may include diuretics, immunosuppression, and dialysis. Complications can include infection, thromboembolism, and progression to kidney failure if left untreated.
This document outlines the topics to be covered in a discussion of chronic kidney disease (CKD) and uremia. It includes sections on the introduction, clinical and laboratory manifestations, evaluation and management of CKD patients, and treatment approaches. Specific subtopics are listed under each main section, such as the pathophysiology and risk factors of CKD, fluid and electrolyte abnormalities seen in uremia, and methods for slowing CKD progression and managing complications. Common etiologies, epidemiology, and definitions of CKD and uremia are also outlined.
Acute renal failure (ARF) is a sudden reduction in kidney function that results in waste accumulating in the blood. It occurs in 5% of hospitalized patients and 35% of intensive care unit patients. ARF can be prerenal from decreased blood flow, renal from direct kidney damage, or postrenal from urinary tract obstruction. Causes include dehydration, heart issues, infections, kidney diseases, and nephrotoxic drugs. Symptoms include reduced urine output and waste buildup in the blood. Treatment focuses on fluid management, electrolyte control, and potentially dialysis. Prevention involves proper hydration and treating infections promptly.
This document discusses various types of drug and chemical poisonings. It covers the classification, incidence, drugs commonly involved, clinical presentations, investigations, management principles, and specific treatments for paracetamol, salicylates, and NSAIDs. The key points are: accidental poisoning is most common in children under 5, deliberate self-poisoning is common in adults over 15, and management involves supportive care, preventing further absorption, enhancing elimination, and specific antidotes/treatments depending on the toxin. N-acetylcysteine is the antidote for paracetamol overdose, sodium bicarbonate and hemodialysis are used to treat salicylate poisoning, and activated charcoal and
Organophosphorus (OP) poisoning is a major cause of morbidity and mortality in Nepal. OP compounds inhibit acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of nicotinic and muscarinic receptors. Common presentations include excessive sweating, salivation, vomiting, diarrhea, bronchospasm, bradycardia, hypotension. Treatment involves atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on severity of cholinergic crisis, and intermediate syndrome occurring 1-4 days later can cause respiratory failure if not properly managed.
The document discusses diabetes mellitus (DM), which is characterized by high blood glucose levels due to defects in insulin production or action. There are two main types of DM: Type 1 is an autoimmune disease where the body destroys insulin-producing cells, while Type 2 is associated with obesity and aging and results from insulin resistance and relative insulin deficiency. Gestational diabetes occurs during pregnancy and increases risk of future Type 2 DM. Other types include genetic disorders. The prevalence of DM, especially Type 2, is increasing worldwide due to rising obesity and physical inactivity.
Cushingsyndromeandaddisondisease 130618105538-phpapp01Gordhan Das asani
The adrenal gland produces three classes of steroid hormones: glucocorticoids, mineralocorticoids, and androgens. These hormones play important roles in metabolism, immune function, blood pressure, and secondary sexual characteristics. Adrenal disorders include Cushing's syndrome (hyperfunction) and adrenal insufficiency (hypofunction). Cushing's syndrome is caused by excessive cortisol levels and can be due to pituitary or adrenal tumors, or ectopic ACTH secretion. Adrenal insufficiency, also called Addison's disease, results from insufficient cortisol and aldosterone and can be caused by autoimmune destruction, infections, or tumors. Both conditions are diagnosed through clinical features and laboratory
The document outlines a 6 step approach to diagnosing and treating vasculitis:
1. Recognize features of vasculitis like purpura or organ ischemia.
2. Rule out secondary causes through tests for infections and malignancies.
3. Determine the size of blood vessels involved - large, medium, or small.
4. Consider characteristic presentations of primary vasculitides like temporal arteritis or Wegener's.
5. Make diagnoses through tests like ANCA, biopsy of affected tissues, and angiography.
6. Treat based on severity, using immunosuppression, addressing underlying causes, and monitoring for side effects.
This document discusses crystal-induced arthritides such as gout, which is an inflammatory arthritis associated with hyperuricaemia. Acute gout often affects the first metatarsophalangeal joint, causing sudden and severe pain. Chronic gout can lead to tophaceous deposits of urate crystals in tissues. Hyperuricaemia is generally caused by either impaired uric acid excretion or increased production, and treatment involves medications like allopurinol to reduce uric acid levels as well as lifestyle changes. Pseudogout is another type of crystal arthropathy seen in elderly women that involves calcium pyrophosphate crystal deposition.
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease caused by antibody and complement deposition that results in tissue damage. It is characterized by periods of disease exacerbation and remission. SLE can affect many organs and cause a variety of symptoms. Diagnosis involves evaluating a patient's medical history, symptoms, physical exam findings, and lab tests. Treatment is tailored to each individual and aims to control disease activity and symptoms using medications like NSAIDs, antimalarials, corticosteroids, and immunosuppressants.
This document provides information on the diagnosis and management of rheumatoid arthritis (RA). It discusses the typical onset in the third to sixth decades, with a female to male ratio of 3:1. The initial joint involvement can be polyarticular, oligoarticular, or monoarticular. Clinical manifestations include articular features like pain, stiffness, and joint swelling, as well as extra-articular features in 30-40% of patients. Laboratory tests can show elevated acute phase reactants, rheumatoid factor, and anti-CCP antibodies. Radiographs may demonstrate periarticular osteopenia, joint space narrowing, and erosions. The document reviews diagnostic criteria according to the 1987 ACR and 2010 ACR
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
4. Chronic Kidney DiseaseChronic Kidney Disease
• Essentials of diagnosis
– Progressive azotemia over months to years
– Symptoms and signs of uremia when nearing
end-stage disease.
– HTN in majority
– Isosthenuria and broad casts in urinary
sediment are common
– Bilateral small kidneys on US
5. Chronic Kidney DiseaseChronic Kidney Disease
• National Kidney Foundation (NKF) defines
CKD as evidence of renal damage (based
on abnormal UA [proteinuria, hematuria]
or structural abnormalities found with US)
or GFR < 60 mL/min for 3 or more months
7. Chronic Kidney DiseaseChronic Kidney Disease
• Over 28 million affected…number increasing
daily
• Over 400,000 Americans currently treated with
renal replacement therapy
• Most common RF for CKD include DM, HTN,
CVD, FHx of CKD, and age > 60 yrs
• Major outcomes of CKD include CVD,
progression to renal failure, and development of
complications of impaired renal function, such as
anemia, d/o of mineral metabolism, and
secondary hyperparathyroidism
8. Chronic Kidney DiseaseChronic Kidney Disease
• In CKD, reduced clearance of certain
solutes principally excreted by the kidney
results in their retention in the body fluids.
The solutes are end products of the
metabolism of substances of exogenous
origin (eg, food) or endogenous origin (eg,
catabolism of tissue)
9. Chronic Kidney DiseaseChronic Kidney Disease
• CKD is rarely reversible and leads to
progressive decline in renal function. Reduction
in renal mass leads to hypertrophy of the
remaining nephrons with hyperfiltration, and the
glomerular filtration rate in these nephrons is
transiently at supranormal levels. These
adaptations place a burden on remaining
nephrons, leading to progressive glomerular
sclerosis and interstitial fibrosis, suggesting that
hyperfiltration may worsen renal function
10. Chronic Kidney DiseaseChronic Kidney Disease
• Symptoms develop slowly and are
nonspecific
• Pts may remain asymptomatic until renal
failure is far-advanced (GFR < 10-15
ml/min)
• Manifestations can include fatigue,
malaise, weakness, pruritis
• GI anorexia, nausea,vomiting, metallic
taste and hiccups are common
11. Chronic Kidney DiseaseChronic Kidney Disease
• Neurologic problems include irritability,
difficulty concentrating, insomnia, and
forgetfulness
• Menstrual irregularities, infertility,
and loss of libido are also
common as condition
progresses
12. Chronic Kidney DiseaseChronic Kidney Disease
• PE reveals a chronically ill-appearing pt
• Look for possible underlying cause (DM, lupus)
• HTN is common
• Skin may be yellow, with evidence of easy
bruising
• Uremic fetor (fishy breath) may be present
• Cardiopulmonary and mental status changes are
frequently noted .
13. Chronic Kidney DiseaseChronic Kidney Disease
• Labs
– Dx made by documenting elevations of BUN
and serum creatinine concentrations
– GFR…once < 60, refer to Nephrologist
– Persistent proteinuria is suggestive of CKD,
regardless of GFR level
– UA: broad, waxy casts (evidence of loss of
tubular concentrating ability)
14. Chronic Kidney DiseaseChronic Kidney Disease
• Labs (cont)
– May see anemia, metabolic acidosis,
hyperphosphatemia, hypocalcemia, and
hyperkalemia…with both acute and chronic
renal failure
– Further eval needed to differentiate between
acute and chronic renal failure
• Evidence of previously elevated BUN and
creatinine, abnormal prior UA, and stable but
abnormal serum creatinine on successive days is
most consistent with a chronic process
15. • Imaging
– Finding of small echogenic
kidneys b/l (<10 cm) by US
supports dx of CKD/irreversible
disease
– Radiological evidence of renal
osteodystrophy is another helpful
finding
• Check phalanges of hands
17. Chronic Kidney DiseaseChronic Kidney Disease
• Hyperkalemia
– Potassium balance usually remains intact until
GFR < 10-20 mL/min
– Tx of acute hyperkalemia involves cardiac
monitoring, IV calcium chloride or gluconate,
insulin with glucose, bicarbonate, and sodium
polystyrene sulfonate
– Chronic hyperkalemia tx’d with dietary
potassium restriction, and sodium polystyrene
PRN
18. Chronic Kidney DiseaseChronic Kidney Disease
• Acid-base d/o
– Damaged kidneys are unable to excrete the 1
mEq/kg/d of acid generated by metabolism of
dietary proteins. The resultant metabolic
acidosis is primarily due to loss of renal mass
– Tx
• Maintain serum bicarb level at > 21 mEq/L
– Alkali supplements include sodium bicarbonate,
calcium bicarbonate, and sodium citrate
19. Chronic Kidney DiseaseChronic Kidney Disease
• Cardiovascular complications (HTN)
– HTN is most common complication of ESRD
– HTN control with weight loss and tobacco
cessation
– Salt intake reduced to 2g/day
– Initial RX to include ACE inhibitor or
angiotensin II receptor blocker (ARB)
• If serum potassium and GFR permit (recheck 1
wk)
– Goal BP is <130/80 mm Hg; for those with
proteinuria > 1-2 g/d, goal is < 125/75 mm Hg
20. Chronic Kidney DiseaseChronic Kidney Disease
• Cardiovascular complications (pericarditis)
– Pericarditis may develop with uremia
– Cause believed to be retention of metabolic
toxins
– Symptoms include CP and fever. May have
pulsus paradoxus and friction rub on exam
– Pericarditis is an absolute indication for
initiation of hemodialysis
21. Chronic Kidney DiseaseChronic Kidney Disease
• Cardiovascular complications (CHF)
– Pts with ESRD tend toward a high cardiac
output. Often have extracellular fluid overload,
shunting of blood through AV fistula for
dialysis, and anemia. In addition to HTN, this
causes increased myocardial work and
oxygen demand. There is also increased rate
of atherosclerosis. All of this contributes to
LVH and dilation, present in 75% of pts
starting dialysis. Tx with loop diuretics, ACE
inhibitors, and regulation of salt and water
22. Chronic Kidney DiseaseChronic Kidney Disease
• Hematologic complications
– Anemia
• Normochromic, normocytic
• Due to decreased erythropoiesis and RBC survival
• Many pts are also iron deficient
• Recombinant erythropoietin (epoetin alfa) used in
pts whose hematocrits are < 33%
• Iron supplement PRN also
23. Chronic Kidney DiseaseChronic Kidney Disease
• Hematologic complications
– Coagulopathy
• Mainly caused by platelet dysfunction
• Platelet counts only mildly decreased, but bleeding
time is prolonged
• Platelets show abnormal adhesiveness and
aggregation
• Pts may present with petechiae, purpura, and
increased bleeding during surgery
• Dialysis improves bleeding time but doesn’t
normalize it
• Tx goal = Hct increased to 30%
24. Chronic Kidney DiseaseChronic Kidney Disease
• Neurologic complications
– Uremic encephalopathy does not occur until
GFR falls below 10-15 mL/min
– Symptoms begin with diff. concentrating and
can progress to lethargy, confusion, and
coma
– Neuropathy found in 65% of pts on or nearing
dialysis but not until GFR is 10% of normal
– Earlier initiation of dialysis may prevent
peripheral neuropathies
25. Chronic Kidney DiseaseChronic Kidney Disease
• Disorders of mineral metabolism
– D/o of calcium, phosphorus, and bone are
referred to as renal osteodystrophy
– Most common d/o is osteitis fibrosa cystica –
the bony changes of secondary
hyperparathyroidism…affecting 50% of pts
nearing ESRD
– Radiographically, lesions most prominent in
phalanges and lateral ends of clavicles
26. Chronic Kidney DiseaseChronic Kidney Disease
• Disorders of mineral metabolism
– May also have osteomalacia or adynamic
bone dz
– All of the above may cause bony pain,
proximal muscle weakness, and spontaneous
bone fractures
– Tx may consist of dietary phosphorus
restriction, oral phosphorus-binding agents
such as calcium carbonate or Renogel, and
vitamin D
– Hyperparathyroidism tx’d with calcitriol or
Sensipar
27. Chronic Kidney DiseaseChronic Kidney Disease
• Endocrine d/o
– Circulating insulin levels are higher because
of decreased renal insulin clearance
– Glucose intolerance can occur in chronic
renal failure when GFR is < 10-20 mL/min.
This is mainly due to peripheral insulin
resistance
– Decreased libido and impotence are common.
Men have decreased testosterone; women
are often anovulatory
28. Chronic Kidney DiseaseChronic Kidney Disease
• Tx
– ACE/ARB to slow progression of proteinuria and CVD
– Maintain excellent diabetes control…keep HgA1C < 7
• Tx (Consults): early nephrology, vascular, general
surgery
• Tx (Dietary)
– Every pt should be eval by renal nutritionist
– Protein restriction
• In general, protein intake should not exceed 1 g/kg/d
– Salt and water restriction
• For the nondialysis pt approaching ESRD, 2 g/d of sodium is an
initial recommendation
29. Chronic Kidney DiseaseChronic Kidney Disease
– Potassium restriction
• Once GFR has fallen below 10-20 mL/min,
potassium intake should be limited to < 60-70
mEq/d
– Phosphorus restriction
• Phosphorus level should be < 4.6 mg/dL
• Phosphorus binders required if GFR < 20-30
mL/min
– Magnesium restriction
• No magnesium-containing laxatives or antacids
30. Chronic Kidney DiseaseChronic Kidney Disease
• Treatment (Dialysis)
– When conservative management of ESRD is
inadequate, hemodialysis, peritoneal dialysis,
and kidney transplantation are alternatives
– Dialysis should be started when pt has GFR
of 10 mL/min or serum creatinine of 8 mg/dL
– Diabetics should start when GFR reaches 15
mL/min or serum creatinine is 6 mg/dL
31. Chronic Kidney DiseaseChronic Kidney Disease
• Treatment (Dialysis)
– Other absolute indications for dialysis include
• Uremic symptoms such as pericarditis,
encephalopathy, or coagulopathy
• Fluid overload unresponsive to diuresis
• Refractory hyperkalemia…>7
• Severe metabolic acidosis (pH < 7.20)
• Neurologic symptoms such as seizures or
neuropathy
32. Chronic Kidney DiseaseChronic Kidney Disease
• Hemodialysis (choice for 90% of pts)
– Vascular access accomplished by an a/v fistula
(preferred) or prosthetic graft
– Infection, thrombosis, and aneurysm formation are
complications seen more often in grafts than fistulas.
Staphylococcus aureus is most common infecting
agent
– Pts typically require hemodialysis 3x/wk…sessions
last 3-5 hrs each
– Home dialysis also now available
– Ensure pt getting regular labs to include PTH and
ALK PHOS
34. Chronic Kidney DiseaseChronic Kidney Disease
• Peritoneal dialysis
– The peritoneal membrane is the “dialyzer”
– Most common type is continuous ambulatory
peritoneal dialysis (CAPD)
• Pts exchange dialysate 4-6 times/day
– Continuous cyclic peritoneal dialysis (CCPD)
utilizes a cycler machine to automatically
perform exchanges at night
– Most common complication = peritonitis
• Most common pathogen = S aureus
36. Chronic Kidney DiseaseChronic Kidney Disease
• Total costs of both types of dialysis are
about the same ($35,000 - $60,000/yr)
• Pts undergoing dialysis have an average
life expectancy of 3-4 yrs
• Studies are conflicting regarding the
survival advantage assoc. with either
peritoneal dialysis or hemodialysis
37. Chronic Kidney DiseaseChronic Kidney Disease
• Kidney transplantation
– 1st - Dr Hamburger in 1952
– Up to 50% of all pts with ESRD are suitable for
transplant. Age becoming less of a barrier
– In general, not placed on list until GFR <15
– Living donor is best option
– Two-thirds of kidney transplants come from deceased
donors
– Average wait for cadaveric transplant is 2-4 yrs;
becoming longer as more pts go on the list while
donor pool does not expand
– One yr survival rate is approx. 98%
38. Chronic Kidney DiseaseChronic Kidney Disease
• CKD prognosis
– Mortality higher for pts on dialysis than for
age-matched controls
– Expected remaining lifetime for the age group
55-64 is 22 yrs, whereas that of ESRD
population is 5 yrs
– Most common cause of death is cardiac
dysfunction
– For those who require dialysis to sustain life,
but decide against it, death ensues within
days to wks
39. Chronic Kidney DiseaseChronic Kidney Disease
• Overall…medical care of CKD focuses on
delaying or halting progression of CKD
– Tx underlying cause(s)
– Tx HTN and Diabetes
– Avoid nephrotoxins
– Tx complications
• Lastly…watch out for meds that are
renally excreted. You will need to adjust
dose in pts with renal failure