This document discusses chronic kidney disease (CKD) in children, including definitions, stages, etiology, pathogenesis, clinical manifestations, complications, treatment, and strategies to slow progression. Key points include:
- CKD is defined as kidney damage or glomerular filtration rate <60 mL/min/1.73m2 for over 3 months.
- Etiology depends on age, and includes congenital abnormalities, glomerulonephritis, cystic kidney diseases.
- Pathogenesis involves hyperfiltration injury to surviving nephrons from loss of other nephrons.
- Treatment aims to replace renal function and slow progression, including fluid/electrolyte management, nutrition, growth supplements
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
chronic kidney disease, diagnosis, management, prognosis, complications, renal replacement therapy, when to initiate hemodialysis, complication of hemodialysis, mortality and morbility.
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. Acute kidney failure is also called acute kidney injury or acute renal failure. It's common in people who are already in the hospital. It may develop rapidly over a few hours.
Abstract: Uremia is a clinical manifestation of chronic kidney failure (CKD) and is defined as the elevation of urea levels in plasma associated to fluid, electrolytes and hormonal imbalances and metabolic abnormalities. Uremia even though arises from CKD, it can also occur with Acute Kidney injury (AKI). The terms uremia was first coined by Piorry which translates to urine in blood. Also, Uremia and uremic syndrome have been used interchangeably for a long time. Comparatively, Azotemia is also uremia but the only difference is that the urea elevation in azotemia is not high enough to have manifesting signs or symptoms. Thus, Uremia is pathological and symptomatic manifestations of severe azotemia.
Urea itself has direct and indirect toxic effects on our body; parathyroid hormone (PTH), beta2 microglobulin, polyamines, advanced glycosylation end products, and other middle molecules, are thought to contribute to the clinical syndrome. Patient’s symptoms range from mild bleeds to severe congestive heart failure. If left untreated complications include seizure, coma, cardiac arrest, and death. He most severe is cardiac arrest secondary to electrolyte abnormalities such as hyperkalemia, metabolic acidosis, or hypocalcemia. The patients, who are diabetic, tend to develop severe hypoglycemic reactions if the medications are not adjusted for creatinine clearance. Renal failure and renal osteodystrophy may cause early onset osteoporosis or formation of adynamic bone which predisposes the patient to fractures on mild trauma. Also medications the patient was previously on can lead to unwanted side effects due to impaired clearance e.g. Digoxin toxicity secondary to renal failure, increased sensitivity to narcotics.
Key Words: Uremia, Uremic syndrome, Chronic kidney failure, azotemia, beta 2 microglobulins, congestive heart failure, electrolyte abnormalities, hyperkalemia, hyocalcemia, metabolic acidosis, creatinine, osteodystrophy
chronic kidney disease, diagnosis, management, prognosis, complications, renal replacement therapy, when to initiate hemodialysis, complication of hemodialysis, mortality and morbility.
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. Acute kidney failure is also called acute kidney injury or acute renal failure. It's common in people who are already in the hospital. It may develop rapidly over a few hours.
Abstract: Uremia is a clinical manifestation of chronic kidney failure (CKD) and is defined as the elevation of urea levels in plasma associated to fluid, electrolytes and hormonal imbalances and metabolic abnormalities. Uremia even though arises from CKD, it can also occur with Acute Kidney injury (AKI). The terms uremia was first coined by Piorry which translates to urine in blood. Also, Uremia and uremic syndrome have been used interchangeably for a long time. Comparatively, Azotemia is also uremia but the only difference is that the urea elevation in azotemia is not high enough to have manifesting signs or symptoms. Thus, Uremia is pathological and symptomatic manifestations of severe azotemia.
Urea itself has direct and indirect toxic effects on our body; parathyroid hormone (PTH), beta2 microglobulin, polyamines, advanced glycosylation end products, and other middle molecules, are thought to contribute to the clinical syndrome. Patient’s symptoms range from mild bleeds to severe congestive heart failure. If left untreated complications include seizure, coma, cardiac arrest, and death. He most severe is cardiac arrest secondary to electrolyte abnormalities such as hyperkalemia, metabolic acidosis, or hypocalcemia. The patients, who are diabetic, tend to develop severe hypoglycemic reactions if the medications are not adjusted for creatinine clearance. Renal failure and renal osteodystrophy may cause early onset osteoporosis or formation of adynamic bone which predisposes the patient to fractures on mild trauma. Also medications the patient was previously on can lead to unwanted side effects due to impaired clearance e.g. Digoxin toxicity secondary to renal failure, increased sensitivity to narcotics.
Key Words: Uremia, Uremic syndrome, Chronic kidney failure, azotemia, beta 2 microglobulins, congestive heart failure, electrolyte abnormalities, hyperkalemia, hyocalcemia, metabolic acidosis, creatinine, osteodystrophy
CHRONIC KIDNEY DISEASE CAUSES, PATHOPHYSIOLOGY, CLINICAL PRESENTATION AND TRE...muhammaduzair780907
Chronic Kidney Disease (CKD) is one the major co-morbid condition in human body. what is CKD? what is the basic pathophysiology of the disease? what are the major causes of the disease? what are the sign and symptoms of the disease? and what are the treatment plan of the disease? all are discussed in the slides. hopefully you will find it helpful for your study.
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3. Chronic Renal Failure
Chronic Kidney Disease
Defined as either renal injury (proteinuria)
and / or a glomerular filtration rate <60
ml/min/1.73m2 for >3mo
Prevalence: 18 per 1 million
8. Stages of CKD
Stage
Description
GFR
1
Kidney damage with normal or ↑ GFR
> 90
2
Kidney damage with mild ↓ GFR 60-89
3
Moderate ↓ in GFR
30-59
4
Severe decrease in GFR
5-29
5
Kidney failure
<15
9. Pathophysiology of Chronic Kidney
disease
Accumulation of nitrogenous waste products
Decrease in glomerular filtration rate
Acidosis
Decrease ammonia synthesis.
Impaired bicarbonate reabsorption
Decrease net acid excretion
Sodium Retention
Excessive renin production, oliguria
Sodium Wasting
Solute diuresis, tubular damage
16. GFR
GFR (ml/min /1.73m2) = k x height (cm)
S. Creatinin (mg/dl)
k= 0.33 LBW < 1 yr
0.45 term AGA < 1yr
0.55 children & adolescent female
0.70 adolescent male
20. Nutrition
* Progressive restriction of various dietary components
* Dietary restriction of phosphorus, potassium and sodium
* RDA of caloric intake for age
* Protein intake 2.5g/kg/day
* High biologic value protein (egg, milk, meat, fish, fowl)
* Supplement carbohydrate (polycose), fat (MCT) and
protein (pro-Mod)
* Nasogastric, gastrostomy, or gastrojunal tube feeding
* Continuous overnight infusions
* Water soluble vitamins, routinely supplied
* Zinc and iron only if deficiency
* Supplement with fat soluble vitamins – usually not
required
21. Growth
* Short stature is long term sequela
* Growth hormone resistant state
(GH ↑, IGF ↓)
* Abnormality of IGF binding protein
* Recombinant human GH
(0.05mg/kg/24hrs)
* Continue until 50th percentile for MPH or
achieves a final adult height or undergoes
renal transplantation
22. Renal Osteodystrophy
* Spectrum of bone disorders in CKD
* High turnover bone disease
* Secondary hyperparathyroidism
* Osteitis fibrosa cystica
23. Pathophysiology (Renal Osteodystrophy )
* When GFR decline to 50% of normal
* Decline in 1α hydroxylase
* Decreased production of activated Vit. D
* ↓ intestinal absorption of calcium
* Hypocalcaemia
* Secondary hyperparathyroidism(to correct hypocalcemia)
* Increased bone resorption
* When GFR declines to 25% of normal
* Hyperphosphatemia – further promotes
hypocalcemia and increased PTH
24. Clinical Manifestations of Renal
Osteodydtrophy
* Muscle weakness, Bone pain
Fractures with minor trauma
Rickitic changes, varus or valgus
deformity
* Ca ↓ Ph ↑, alkaline phosphate ↑, PTH normal
* Subperiosteal resorption of bone with
widening of metaphysis
25. Treatment of Renal Osteodystrophy
* Low phosphorus diet
* Phosphate binders
* Calcium carbonate & calcium acetate
* Sevelamer (Renagel) non calcium binder
* Avoid aluminum based binder
* Vitamin D therapy
* Maintain calcium / phosphorus product
(Ca x PO4) at < 55
28. Immunizations
* Immunization according to the schedule
* Avoid live vaccine if on immunosuppressive drugs
* Give live vaccine before renal transplantation
* Yearly influenza vaccine
* Suboptimal response
30. Strategy to slow the progression
* Optimal control of hypertension
* Maintain serum phosphorus (Ca x Ph=<55)
* Prompt treatment of infections and episodes of
dehydration
* Correction of anemia
* Control of hyperlipidemia
* Avoidance of smoking
* Prevention of obesity
* Avoid use of NSAID
* Dietary protein restriction helpful but not
recommended in children