The document provides guidelines for the evaluation and management of chronic kidney disease (CKD) according to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline. It defines CKD based on abnormalities in kidney structure/function persisting over 3 months and classified by cause, GFR, and albuminuria categories. It recommends evaluating GFR, albuminuria, and CKD chronicity and cause. It provides guidance on managing CKD progression and complications like anemia, bone disease, acidosis, cardiovascular risk, infections, and drug toxicity. It also covers referral to specialists and multidisciplinary care for advanced CKD patients.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/AtiaKPIdzAQ
Arabic Language version of this lecture is available at:
https://youtu.be/2cwyPcRDGEY
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Renal Replacement therapy (Dialytic Management) in AKI - Dr.GawadNephroTube - Dr.Gawad
ย
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/NN9vyWjIPbE
Arabic Language version of this lecture is available at:
https://youtu.be/i-Qlf31Vd-Y
- Visit our website for more lectures: www.NephroTube.com
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Chronic kidney disease-mineral bone disorder (CKD-MBD) is a common complication in chronic kidney disease caused by reduced kidney function and mineral metabolism abnormalities. This leads to high phosphate, activation of parathyroid hormone, and bone abnormalities from renal osteodystrophy to vascular calcification. Treatment focuses on controlling phosphate levels through binders like sevelamer and cinacalcet to reduce parathyroid hormone in order to prevent bone disease and fractures while minimizing cardiovascular risks.
This document discusses the prescription of peritoneal dialysis, including the choice of modality (CAPD vs APD), clearance targets, and measurement of clearance through Kt/V and creatinine clearance. It also covers factors that determine clearance like residual renal function, body size, and transport characteristics. For CAPD and APD, prescription factors include exchange frequency and volume, and dwell times. Nutritional monitoring for PD patients includes nPNA, serum albumin, subjective global assessment, and lean body mass. Treatment of malnutrition may include dietitian support, supplements, promotility agents, steroids, and amino acids.
This document discusses renal replacement therapy (RRT) including the stages of kidney disease, types of dialysis, and access methods. It covers the primary functions of the kidney and consequences of kidney failure. The two main types of RRT are peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the peritoneal membrane as a filter through a catheter, while hemodialysis uses an artificial kidney external to the body with vascular access.
Intra dialytic hypotension ,,, prof Alaa SabryFarragBahbah
ย
This document describes a case of intradialytic hypotension in a 65-year-old man on hemodialysis. During one of his dialysis treatments, he developed hypotension with symptoms of feeling poorly and diaphoresis. His dry weight was increased in response, but he experienced another episode of hypotension several days later. The document then discusses intradialytic hypotension in general, including definitions, mechanisms, complications, and approaches to assessing volume status in hemodialysis patients.
This document discusses the management of anemia in chronic kidney disease (CKD). It begins by defining anemia and its causes in CKD, which include reduced erythropoietin production and decreased red blood cell survival due to kidney failure. Left untreated, anemia in CKD can lead to deterioration in cardiac function, impaired cognition, and increased fatigue and mortality risk. The main therapeutic options for treating anemia in CKD are red blood cell transfusions, androgens, and erythropoiesis-stimulating agents (ESAs). ESAs such as epoetin alfa and darbepoetin alfa are now the standard treatment as they reduce transfusion needs and risks while helping to mobilize
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/AtiaKPIdzAQ
Arabic Language version of this lecture is available at:
https://youtu.be/2cwyPcRDGEY
- Visit our website for more lectures: www.NephroTube.com
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Renal Replacement therapy (Dialytic Management) in AKI - Dr.GawadNephroTube - Dr.Gawad
ย
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/NN9vyWjIPbE
Arabic Language version of this lecture is available at:
https://youtu.be/i-Qlf31Vd-Y
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
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Chronic kidney disease-mineral bone disorder (CKD-MBD) is a common complication in chronic kidney disease caused by reduced kidney function and mineral metabolism abnormalities. This leads to high phosphate, activation of parathyroid hormone, and bone abnormalities from renal osteodystrophy to vascular calcification. Treatment focuses on controlling phosphate levels through binders like sevelamer and cinacalcet to reduce parathyroid hormone in order to prevent bone disease and fractures while minimizing cardiovascular risks.
This document discusses the prescription of peritoneal dialysis, including the choice of modality (CAPD vs APD), clearance targets, and measurement of clearance through Kt/V and creatinine clearance. It also covers factors that determine clearance like residual renal function, body size, and transport characteristics. For CAPD and APD, prescription factors include exchange frequency and volume, and dwell times. Nutritional monitoring for PD patients includes nPNA, serum albumin, subjective global assessment, and lean body mass. Treatment of malnutrition may include dietitian support, supplements, promotility agents, steroids, and amino acids.
This document discusses renal replacement therapy (RRT) including the stages of kidney disease, types of dialysis, and access methods. It covers the primary functions of the kidney and consequences of kidney failure. The two main types of RRT are peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the peritoneal membrane as a filter through a catheter, while hemodialysis uses an artificial kidney external to the body with vascular access.
Intra dialytic hypotension ,,, prof Alaa SabryFarragBahbah
ย
This document describes a case of intradialytic hypotension in a 65-year-old man on hemodialysis. During one of his dialysis treatments, he developed hypotension with symptoms of feeling poorly and diaphoresis. His dry weight was increased in response, but he experienced another episode of hypotension several days later. The document then discusses intradialytic hypotension in general, including definitions, mechanisms, complications, and approaches to assessing volume status in hemodialysis patients.
This document discusses the management of anemia in chronic kidney disease (CKD). It begins by defining anemia and its causes in CKD, which include reduced erythropoietin production and decreased red blood cell survival due to kidney failure. Left untreated, anemia in CKD can lead to deterioration in cardiac function, impaired cognition, and increased fatigue and mortality risk. The main therapeutic options for treating anemia in CKD are red blood cell transfusions, androgens, and erythropoiesis-stimulating agents (ESAs). ESAs such as epoetin alfa and darbepoetin alfa are now the standard treatment as they reduce transfusion needs and risks while helping to mobilize
The document summarizes potential complications of peritoneal dialysis catheters including malfunctioning catheters, early and late non-functioning, and causes such as constipation, intra-abdominal adhesions from previous surgery or peritonitis, catheter migration, blood or fibrin blocking the catheter, and hernias. It describes methods for investigating malfunctioning catheters including abdominal x-rays, x-rays with contrast dye, and CT scans. It provides guidance on managing different causes through measures like laxatives, re-siting the catheter, adding heparin to dialysate, or removing the catheter.
Dialysis dose prescription (the basics) dr ujjawalUjjawal Roy
ย
The document discusses key aspects of dialysis dose prescription, including:
1) Components of the dialysis prescription include dialyzer choice, time, blood and dialysate flow rates, ultrafiltration rate, dialysate composition, temperature, and anticoagulation.
2) Prescription goals are to restore the body's fluid and electrolyte balance and remove waste and excess water from patients with end-stage renal disease.
3) Important considerations for dialysis prescription include a patient's dry weight and risk of intradialytic hypotension.
Mineral and Bone Disorder in Chronic Kidney Diseasedrsampadasinha
ย
This document summarizes chronic kidney disease-mineral and bone disorder (CKD-MBD), including its definition, pathogenesis, diagnosis, and management recommendations. Specifically:
- CKD-MBD is defined as a systemic disorder involving abnormalities in calcium, phosphorus, vitamin D, PTH, and bone. It can cause skeletal and extraskeletal complications.
- As kidney function declines, abnormalities in mineral metabolism develop, leading to high or low bone turnover diseases. Phosphate retention, low calcitriol, and parathyroid gland changes drive secondary hyperparathyroidism.
- Diagnosis involves monitoring mineral levels and PTH. Bone biopsy determines the type of renal osteodystrophy
This document discusses the clinical manifestations of renal disease that can help detect underlying kidney disorders. Symptoms include disturbances in urination like frequency, pain, retention, incontinence, and nocturia. Changes in urine such as amount, appearance, and presence of blood, protein, or casts are also discussed. Pain symptoms can include flank pain, ureteric colic, or suprapubic discomfort. General symptoms include fever, swelling, fatigue, itching, and pallor. Detecting these clinical signs is important for identifying renal abnormalities.
The document discusses vaccination in patients with chronic kidney disease (CKD). It outlines the rationale and recommendations for vaccination in CKD patients, including those undergoing dialysis or renal transplantation. Specific recommendations are provided for pneumococcal vaccination in CKD patients based on guidelines. The summary discusses how CKD and end-stage renal disease can impair immune function, making vaccinations less effective, and the importance of vaccinating CKD patients to prevent infectious diseases.
This document discusses peritonitis and exit site infections related to peritoneal dialysis. It provides statistics on the rates of these infections and their impact. Prevention is key and involves things like proper training, exit site care, antibiotic prophylaxis and monitoring infection rates. Symptoms, diagnosis, empirical antibiotic treatment and culture-specific treatment are outlined. Factors affecting exit site infections and appropriate pre-operative, operative and post-operative care are also covered.
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.
The patient is a 49-year-old woman with end-stage renal disease and diabetes who presented with altered mental status. She receives hemodialysis three times per week for a few years. Recently, she has been increasingly tired, weak, and unable to perform daily activities with poor appetite and nausea. On examination, she was pale and swollen with low hemoglobin. Tests found elevated creatinine, BUN, and electrolyte abnormalities. The most probable diagnosis is inadequate hemodialysis, as her symptoms and labs are consistent with worsening uremia due to insufficient solute clearance from her dialysis sessions. Kt/V is a measure of dialysis adequacy that accounts for urea clearance and patient
This document discusses the screening, management, and treatment of chronic kidney disease. It notes that chronic kidney disease affects over 10% of US adults and risk increases with age. Diabetes and hypertension are the most common causes of end-stage renal disease. It recommends referring patients with decreased eGFR and increased albuminuria to a nephrologist. The management of complications such as hypertension, dyslipidemia, anemia, acidosis, and bone mineral disorders is also covered.
CKD-MBD is a systemic disorder seen in progressive kidney disease characterized by abnormalities in calcium, phosphorus, PTH, and vitamin D levels as well as bone abnormalities and soft tissue calcification. Key aspects of CKD-MBD include impaired regulation of phosphorus and calcium leading to elevated levels that stimulate PTH production and reduced vitamin D activation. This disrupts bone and mineral homeostasis and increases cardiovascular risks. Treatment involves controlling levels through diet, phosphate binders, vitamin D, and PTH therapies according to KDIGO guidelines.
This document outlines an electrolytes and acid-base disturbance workshop presented by Dr. Mohammed Abdel Gawad. It includes 8 cases covering disorders of sodium, potassium, calcium, magnesium, phosphorus, and acid-base balance. For each case, it provides background information on the patient's history, physical exam findings, and lab results. It then asks a multiple choice question testing the diagnosis or management of the electrolyte disturbance. The cases are intended to help participants learn about evaluating and treating common electrolyte and acid-base disorders.
This document discusses evaluating the adequacy of hemodialysis treatment. It states that numerous studies have shown a correlation between the delivered dose of hemodialysis and patient mortality and morbidity. The urea reduction ratio (URR), which measures the percentage reduction of urea levels pre- and post-dialysis, is one way to evaluate adequacy, with a URR over 60% generally associated with better outcomes. Equilibrated Kt/V is also discussed as a standard measure of dialysis dose, with a minimum of 1.4 recommended. The document outlines factors that influence adequacy, including treatment time and frequency, dialyzer characteristics, blood and dialysate flow rates, and dialysis solution composition
Diagnosis, Evaluation, Prevention and Treatment of CKD-MBDAbdullah Ansari
ย
Introduction and definition of CKDโMBD
Diagnosis of CKDโMBD: biochemical abnormalities
Diagnosis of CKDโMBD: bone
Diagnosis of CKDโMBD: vascular calcification
Treatment of CKDโMBD targeted at serum phosphorus and serum calcium
Treatment of abnormal PTH levels in CKDโMBD
Treatment of bone with bisphosphonates, other osteoporosis medications and growth hormone
Evaluation and treatment of kidney transplant bone disease
Challenges in Diagnosis and Management of Diabetic Kidney Disease - Dr. GawadNephroTube - Dr.Gawad
ย
This document discusses challenges in diagnosing and managing diabetic kidney disease. It emphasizes that renal problems in diabetic patients are not always due to diabetic nephropathy and may be caused by other conditions. A thorough evaluation is needed to determine the underlying cause, including considering patient history, type of diabetes, presence of retinopathy, characteristics of proteinuria and hematuria, rate of renal impairment, hypertension, and potential contributing factors. A renal biopsy may be warranted if the presentation is atypical or suggests an alternative diagnosis.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/NQMiLXb0AXk
Arabic Language version of this lecture is available at:
https://youtu.be/o_I9bzxcJoQ
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
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Presentation of CKD Corporation in pneumatic division.
You can find those products in Brazil by Italpneumatica Automaรงรฃo. www.italpneumatica.com (11) 4177-1010
1) Shock represents life-threatening conditions caused by inadequate cellular oxygenation due to decreased cardiac output, maldistribution of blood flow, or reduced blood oxygen content.
2) The main stages of shock are compensatory, progressive, and irreversible. Compensatory mechanisms initially maintain tissue perfusion but eventually fail in progressive shock.
3) Types of shock include cardiogenic, obstructive, hypovolemic, distributive (e.g. septic, anaphylactic, neurogenic), each with distinct causes and management approaches focused on improving oxygen delivery.
The document summarizes potential complications of peritoneal dialysis catheters including malfunctioning catheters, early and late non-functioning, and causes such as constipation, intra-abdominal adhesions from previous surgery or peritonitis, catheter migration, blood or fibrin blocking the catheter, and hernias. It describes methods for investigating malfunctioning catheters including abdominal x-rays, x-rays with contrast dye, and CT scans. It provides guidance on managing different causes through measures like laxatives, re-siting the catheter, adding heparin to dialysate, or removing the catheter.
Dialysis dose prescription (the basics) dr ujjawalUjjawal Roy
ย
The document discusses key aspects of dialysis dose prescription, including:
1) Components of the dialysis prescription include dialyzer choice, time, blood and dialysate flow rates, ultrafiltration rate, dialysate composition, temperature, and anticoagulation.
2) Prescription goals are to restore the body's fluid and electrolyte balance and remove waste and excess water from patients with end-stage renal disease.
3) Important considerations for dialysis prescription include a patient's dry weight and risk of intradialytic hypotension.
Mineral and Bone Disorder in Chronic Kidney Diseasedrsampadasinha
ย
This document summarizes chronic kidney disease-mineral and bone disorder (CKD-MBD), including its definition, pathogenesis, diagnosis, and management recommendations. Specifically:
- CKD-MBD is defined as a systemic disorder involving abnormalities in calcium, phosphorus, vitamin D, PTH, and bone. It can cause skeletal and extraskeletal complications.
- As kidney function declines, abnormalities in mineral metabolism develop, leading to high or low bone turnover diseases. Phosphate retention, low calcitriol, and parathyroid gland changes drive secondary hyperparathyroidism.
- Diagnosis involves monitoring mineral levels and PTH. Bone biopsy determines the type of renal osteodystrophy
This document discusses the clinical manifestations of renal disease that can help detect underlying kidney disorders. Symptoms include disturbances in urination like frequency, pain, retention, incontinence, and nocturia. Changes in urine such as amount, appearance, and presence of blood, protein, or casts are also discussed. Pain symptoms can include flank pain, ureteric colic, or suprapubic discomfort. General symptoms include fever, swelling, fatigue, itching, and pallor. Detecting these clinical signs is important for identifying renal abnormalities.
The document discusses vaccination in patients with chronic kidney disease (CKD). It outlines the rationale and recommendations for vaccination in CKD patients, including those undergoing dialysis or renal transplantation. Specific recommendations are provided for pneumococcal vaccination in CKD patients based on guidelines. The summary discusses how CKD and end-stage renal disease can impair immune function, making vaccinations less effective, and the importance of vaccinating CKD patients to prevent infectious diseases.
This document discusses peritonitis and exit site infections related to peritoneal dialysis. It provides statistics on the rates of these infections and their impact. Prevention is key and involves things like proper training, exit site care, antibiotic prophylaxis and monitoring infection rates. Symptoms, diagnosis, empirical antibiotic treatment and culture-specific treatment are outlined. Factors affecting exit site infections and appropriate pre-operative, operative and post-operative care are also covered.
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.
The patient is a 49-year-old woman with end-stage renal disease and diabetes who presented with altered mental status. She receives hemodialysis three times per week for a few years. Recently, she has been increasingly tired, weak, and unable to perform daily activities with poor appetite and nausea. On examination, she was pale and swollen with low hemoglobin. Tests found elevated creatinine, BUN, and electrolyte abnormalities. The most probable diagnosis is inadequate hemodialysis, as her symptoms and labs are consistent with worsening uremia due to insufficient solute clearance from her dialysis sessions. Kt/V is a measure of dialysis adequacy that accounts for urea clearance and patient
This document discusses the screening, management, and treatment of chronic kidney disease. It notes that chronic kidney disease affects over 10% of US adults and risk increases with age. Diabetes and hypertension are the most common causes of end-stage renal disease. It recommends referring patients with decreased eGFR and increased albuminuria to a nephrologist. The management of complications such as hypertension, dyslipidemia, anemia, acidosis, and bone mineral disorders is also covered.
CKD-MBD is a systemic disorder seen in progressive kidney disease characterized by abnormalities in calcium, phosphorus, PTH, and vitamin D levels as well as bone abnormalities and soft tissue calcification. Key aspects of CKD-MBD include impaired regulation of phosphorus and calcium leading to elevated levels that stimulate PTH production and reduced vitamin D activation. This disrupts bone and mineral homeostasis and increases cardiovascular risks. Treatment involves controlling levels through diet, phosphate binders, vitamin D, and PTH therapies according to KDIGO guidelines.
This document outlines an electrolytes and acid-base disturbance workshop presented by Dr. Mohammed Abdel Gawad. It includes 8 cases covering disorders of sodium, potassium, calcium, magnesium, phosphorus, and acid-base balance. For each case, it provides background information on the patient's history, physical exam findings, and lab results. It then asks a multiple choice question testing the diagnosis or management of the electrolyte disturbance. The cases are intended to help participants learn about evaluating and treating common electrolyte and acid-base disorders.
This document discusses evaluating the adequacy of hemodialysis treatment. It states that numerous studies have shown a correlation between the delivered dose of hemodialysis and patient mortality and morbidity. The urea reduction ratio (URR), which measures the percentage reduction of urea levels pre- and post-dialysis, is one way to evaluate adequacy, with a URR over 60% generally associated with better outcomes. Equilibrated Kt/V is also discussed as a standard measure of dialysis dose, with a minimum of 1.4 recommended. The document outlines factors that influence adequacy, including treatment time and frequency, dialyzer characteristics, blood and dialysate flow rates, and dialysis solution composition
Diagnosis, Evaluation, Prevention and Treatment of CKD-MBDAbdullah Ansari
ย
Introduction and definition of CKDโMBD
Diagnosis of CKDโMBD: biochemical abnormalities
Diagnosis of CKDโMBD: bone
Diagnosis of CKDโMBD: vascular calcification
Treatment of CKDโMBD targeted at serum phosphorus and serum calcium
Treatment of abnormal PTH levels in CKDโMBD
Treatment of bone with bisphosphonates, other osteoporosis medications and growth hormone
Evaluation and treatment of kidney transplant bone disease
Challenges in Diagnosis and Management of Diabetic Kidney Disease - Dr. GawadNephroTube - Dr.Gawad
ย
This document discusses challenges in diagnosing and managing diabetic kidney disease. It emphasizes that renal problems in diabetic patients are not always due to diabetic nephropathy and may be caused by other conditions. A thorough evaluation is needed to determine the underlying cause, including considering patient history, type of diabetes, presence of retinopathy, characteristics of proteinuria and hematuria, rate of renal impairment, hypertension, and potential contributing factors. A renal biopsy may be warranted if the presentation is atypical or suggests an alternative diagnosis.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/NQMiLXb0AXk
Arabic Language version of this lecture is available at:
https://youtu.be/o_I9bzxcJoQ
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Presentation of CKD Corporation in pneumatic division.
You can find those products in Brazil by Italpneumatica Automaรงรฃo. www.italpneumatica.com (11) 4177-1010
1) Shock represents life-threatening conditions caused by inadequate cellular oxygenation due to decreased cardiac output, maldistribution of blood flow, or reduced blood oxygen content.
2) The main stages of shock are compensatory, progressive, and irreversible. Compensatory mechanisms initially maintain tissue perfusion but eventually fail in progressive shock.
3) Types of shock include cardiogenic, obstructive, hypovolemic, distributive (e.g. septic, anaphylactic, neurogenic), each with distinct causes and management approaches focused on improving oxygen delivery.
best Ckd presentation1 by Dr. sachin kr ranaSachin Rana
ย
Chronic Kidney Disease is defined as a slow loss of renal function over time leading to decreased ability to remove waste from the body. It affects about 26 million people in the US and is increasing due to diabetes and hypertension. Pathophysiology involves a decrease in nephrons leading to adaptive changes that eventually cause glomerular sclerosis and further kidney function decline. Stages are based on Glomerular Filtration Rate from normal to end stage renal disease requiring dialysis. Treatment focuses on controlling hypertension, acidosis, electrolyte abnormalities, secondary effects like anemia and bone disease through diet, medication and potentially dialysis. Dialysis options include peritoneal dialysis with advantages of immediate initiation but risks of peritonitis
This document discusses acute renal failure and chronic kidney disease. It defines acute renal failure as a sudden reduction in renal function, and identifies three types: prerenal, postrenal, and intrarenal. Chronic kidney disease is defined as decreased kidney function or damage lasting over 3 months. Risk factors include diabetes, hypertension, and glomerulonephritis. Late-stage chronic kidney disease complications include cardiovascular disease, electrolyte imbalances, and anemia. Therapeutic interventions focus on slowing chronic kidney disease progression through managing comorbidities, nutrition, and medications.
This document provides an overview of chronic kidney disease (CKD) basics for primary care providers. It discusses the burden of CKD, risk factors such as diabetes and hypertension, methods for assessing kidney function including estimated glomerular filtration rate and urine albumin-to-creatinine ratio, and guidelines for treatment from the American College of Physicians. The document emphasizes the importance of slowing CKD progression through control of conditions like diabetes and hypertension using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins.
Fahim, a 5 1/2 year old boy, presented with fever for 5 days and acute retention of urine for 10 hours. He had a history of urinary problems like dribbling, straining and lower abdominal pain with occasional fever over the past 6 months. On examination, he appeared ill and toxic with a fever. His urinary bladder was palpably full. Based on his history and examination, he was given a provisional diagnosis of obstructive uropathy likely due to posterior urethral valves, complicated urinary tract infection, and failure to thrive. Laboratory investigations showed elevated creatinine, anemia, and hydronephrosis on ultrasound. He was treated with antibiotics and catheter
Chronic Kidney Disease - What You Need to KnowEvan Dechtman
ย
Chronic Kidney Disease (CKD) is a condition where the kidneys are damaged and cannot properly filter waste from the blood. The kidneys help regulate blood pressure, make red blood cells, and remove waste. CKD is defined as kidney damage for 3 or more months as shown by blood and urine tests or imaging tests. Risk factors include diabetes, high blood pressure, heart disease, family history, smoking, obesity, and use of certain medications. Early CKD often has no symptoms but can eventually cause fatigue, swollen limbs, and other issues. Treatment focuses on controlling blood pressure and diabetes, exercise, diet, and medication. End-stage renal disease requires dialysis or transplant. Screening those at high risk can
Chronic Kidney Disease (CKD) is defined as a progressive loss of kidney function over months or years. Patients with early stage CKD are generally asymptomatic, while later stages can cause nausea, vomiting, fatigue, and other symptoms. CKD is staged based on glomerular filtration rate, with stage 5 being severe kidney failure requiring dialysis or transplant. Risk factors include diabetes, high blood pressure, smoking, and family history. Screening helps detect CKD in at-risk groups. Treatment focuses on lifestyle changes, medications, and dialysis or transplant for kidney failure.
Chronic renal failure is the progressive loss of kidney function over time that can lead to end-stage renal disease. It is caused by conditions like diabetes, hypertension, and glomerulonephritis. As kidney function declines, patients experience complications from fluid and electrolyte imbalances, metabolic acidosis, anemia, renal osteodystrophy, and uremia. Treatment aims to prevent further deterioration of kidney function through controlling blood pressure, blood glucose, proteinuria, and other risk factors. Medications like ACE inhibitors, ARBs, diuretics, and statins are used and dosages may need adjustment based on level of kidney function.
This document presents guidelines from Kidney Disease: Improving Global Outcomes (KDIGO) for the diagnosis, evaluation, prevention and treatment of chronic kidney disease - mineral and bone disorder (CKD-MBD). KDIGO is an independent nonprofit foundation that develops clinical practice guidelines to improve care for kidney disease patients worldwide. The guidelines were developed by an international work group and evidence review team using the GRADE framework. The guidelines cover diagnosis of CKD-MBD through biochemical abnormalities, bone changes, and vascular calcification, as well as treatment targeting phosphorus, PTH levels, bone, and kidney transplant bone disease.
Approach and management of chronic kidney disease sandeepMohit Aggarwal
ย
Chronic kidney disease is a spectrum of conditions associated with progressive kidney function decline and damage. It is increasingly prevalent due to rising rates of diabetes and hypertension. Management involves identifying the underlying cause, calculating GFR to stage severity, investigating for complications, and slowing progression. Treatment focuses on managing complications through diet, medication, and preparing patients for renal replacement therapies like dialysis and transplantation if kidney failure occurs. The goal is optimizing quality of life and outcomes through a coordinated multidisciplinary approach.
Chronic Kidney Disease: An Update (Part II) provides information on:
1. The pathophysiology, signs and symptoms, disease progression, and treatment interventions for chronic kidney disease.
2. Treatment strategies for chronic kidney disease including screening for risk factors, slowing disease progression through treatment of comorbid conditions, and preparing for renal replacement therapies like dialysis and transplant as kidney function declines.
3. The role of controlling cardiovascular risk factors like blood pressure, cholesterol, and blood sugar in treating chronic kidney disease and preventing associated complications like cardiovascular disease. Intensive treatment can help slow kidney disease progression.
The Pathophysiology Of Acute Renal FailureBayu_F_Wibowo
ย
The document discusses acute renal failure and describes its three distinct phases:
1) Prerenal failure occurs when decreased blood flow to the kidneys leads to hypoperfusion and excess nitrogenous waste in the blood. Common causes include dehydration, heart failure, and hemorrhage.
2) Intrarenal failure involves direct damage to the kidney structure from toxins, inflammation, or ischemia. Necrosis can result from nephrotoxins or lack of blood flow and oxygen.
3) Postrenal failure is due to bilateral obstruction of urine outflow from the bladder, ureters, or urethra. Common causes of obstruction include enlarged prostate, tumors, blood
Chronic Kidney Disease, CKD, Nephrology, Dee Evardone
ย
This document provides an overview of chronic kidney disease (CKD). It defines CKD as the presence of kidney damage or decreased kidney function for three or more months. Key points include:
- CKD is defined based on evidence of kidney damage through structural abnormalities found on biopsy, imaging, or urine tests, or decreased glomerular filtration rate (GFR) below 60 mL/min/1.73m2.
- Common causes of CKD include diabetes, hypertension, glomerulonephritis, cystic kidney diseases, and vascular diseases.
- The document outlines clinical and laboratory manifestations of CKD and approaches to evaluating and managing patients with CKD.
The document summarizes renal physiology and kidney function. It discusses:
1) The structure of the kidney including nephrons, collecting ducts, and microvasculature. Nephron number is established prenatally and cannot be replaced if lost.
2) Urine formation through selective retention and elimination of solutes and water by different nephron segments including the glomerulus, proximal tubule, loop of Henle, and collecting ducts.
3) Causes, types (prerenal, intrarenal, postrenal), phases, prevention and management of acute renal failure and end-stage renal disease where dialysis or transplantation is needed for survival.
This document discusses chronic kidney disease (CKD). It defines CKD and notes that risk factors include diabetes, hypertension, glomerulonephritis, smoking, dyslipidemia, and obesity. These conditions can both initiate and promote progression of CKD by damaging kidney structures over time. The document outlines epidemiological data on CKD and provides details on how specific conditions like diabetes and hypertension increase CKD risk and progression. It also examines the role of proteinuria and other factors in contributing to declining kidney function in CKD patients.
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.
The document summarizes chronic kidney disease (CKD) and its management. It defines CKD and outlines the new classification system. It discusses evaluating kidney function through estimated GFR and albuminuria. It covers managing CKD progression through blood pressure control, RAAS interruption, glycemic control, and treating complications like anemia. It recommends lowering protein intake in later stages and salt intake. Overall, the document provides clinical practice guidelines for defining, evaluating, and managing CKD and its progression and complications.
The document defines chronic kidney disease (CKD) and provides guidelines for evaluating and managing CKD according to the KDIGO 2012 Clinical Practice Guideline. It defines CKD based on glomerular filtration rate (GFR) and albuminuria categories. It recommends evaluating CKD severity annually and monitoring for progression. It provides guidance on managing complications of CKD like anemia, bone disease, and cardiovascular risk. It also addresses medication management, specialist referral indications, and timing the initiation of renal replacement therapy.
1. The document provides information on chronic kidney disease (CKD) management in primary care, including screening, evaluation, goals of care, and complications.
2. It emphasizes the primary care provider's important role in early CKD detection through testing at-risk patients, managing blood pressure and diabetes, and referring to nephrology as appropriate.
3. A collaborative care model between primary care and nephrology can improve outcomes through coordinated management and addressing patient safety issues in CKD.
1. The document provides information on chronic kidney disease (CKD) management in primary care, including screening, evaluation, goals of care, and complications.
2. It emphasizes the primary care provider's important role in early CKD detection through testing at-risk patients, managing blood pressure and diabetes, and referring to nephrology as appropriate.
3. A collaborative care model between primary care and nephrology can improve outcomes through coordinated management and addressing patient safety issues in CKD.
- Diabetic kidney disease is a major cause of mortality and morbidity in patients with diabetes. It can progress from microalbuminuria to macroalbuminuria and decreased kidney function over many years.
- Risk factors include uncontrolled hypertension and hyperglycemia, genetics, obesity, and smoking. The pathogenesis involves hemodynamic changes, activation of metabolic pathways, growth factors, the renin-angiotensin system, and oxidative stress.
- Management involves tight glycemic and blood pressure control, lifestyle modifications like diet and exercise, and medications targeting glucose, blood pressure, lipids, and proteinuria. Dialysis and kidney transplantation are treatment options for end-stage kidney disease.
This document discusses diabetic nephropathy and chronic kidney disease in patients with diabetes. It notes that diabetic nephropathy is a leading cause of end-stage renal disease in the United States. It recommends annual screening for albuminuria and measuring creatinine to monitor kidney function. Intensive glucose control can help reduce risk of kidney complications. Medications like ACE inhibitors and ARBs may preserve kidney function for patients with modestly elevated albumin levels. Lifestyle changes like reducing protein intake and controlling blood pressure and cholesterol are also important aspects of management.
This document provides information on diabetic nephropathy and diabetic kidney disease (DKD) for healthcare professionals. It covers the causes and risk factors of DKD, how to screen for and diagnose it, treatment options, and guidelines for when to refer patients to specialists. It emphasizes the importance of controlling blood glucose and blood pressure to prevent and slow the progression of DKD. Lifestyle modifications and medication adjustments may be needed for patients with reduced kidney function.
Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function lasting over 3 months. The document summarizes guidelines for staging CKD based on cause and glomerular filtration rate, evaluating CKD, managing progression through controlling blood pressure and protein intake, and addressing complications like anemia and cardiovascular disease. The timing of renal replacement therapy like dialysis depends on symptoms and declining kidney function.
Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function lasting over 3 months. CKD is evaluated based on glomerular filtration rate (GFR) and markers of kidney damage. Progression is defined as a sustained decline in GFR or a 25% drop from baseline. Management focuses on preventing progression through blood pressure control, ACE inhibitors/ARBs, glycemic control, salt restriction, and lifestyle changes like exercise and smoking cessation. Complications include anemia, bone disease, vitamin D deficiency, acidosis, cardiovascular disease, and increased risk of infection. Dialysis is initiated when symptoms develop or control of volume, pressure, or nutrition cannot be maintained.
Approach To CKD Patient....................pptx.pptximrulsujon1
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This document provides guidance for primary care providers on managing patients with chronic kidney disease (CKD). It discusses screening patients for CKD risk factors like diabetes and hypertension. Key tests for diagnosis include estimated GFR (eGFR) and urinary albumin-to-creatinine ratio (ACR). Goals of care include slowing kidney function decline through blood pressure control and ACE inhibitors/ARBs. Providers should monitor for and manage CKD complications. Co-management with nephrologists is recommended for advanced CKD. Patient safety issues include dosing adjustments for renally cleared drugs and electrolyte monitoring.
1. Chronic kidney disease (CKD) affects 1 in 10 people in the UK and is often unrecognized as it commonly occurs alongside other conditions like cardiovascular disease or diabetes.
2. CKD is defined as abnormalities of the kidneys persisting for over 3 months, determined by markers of kidney damage or a glomerular filtration rate (GFR) of under 60 ml/min/1.73m^2.
3. People with CKD should be monitored for progression and referred to a nephrologist if their GFR declines rapidly or they have advanced CKD with a GFR under 30 ml/min/1.73m^2.
Chronic kidney disease (CKD) is a global public health problem with rising rates worldwide. CKD can be caused by conditions such as diabetes, hypertension, glomerulonephritis, polycystic kidney disease, and others. Progression of CKD can be monitored using glomerular filtration rate and proteinuria levels, with faster progression seen in diabetes. Complications of advanced CKD include uremia, malnutrition, fluid and electrolyte imbalances, and mineral bone disease. Non-dialytic management focuses on controlling hypertension, diabetes, and slowing progression.
This document discusses chronic kidney disease (CKD), including its definition, staging, epidemiology, causes, progression, complications, and non-dialytic management. CKD is defined based on kidney damage or decreased glomerular filtration rate below 60 mL/min/1.73m2 for over 3 months. Common causes include hypertension, diabetes, glomerulonephritis, and HIV. Progression is monitored using GFR and proteinuria levels, with faster progression seen in diabetes. Complications involve fluid/electrolyte disorders, bone disease, cardiovascular issues, and others. Non-dialytic management focuses on treating the underlying cause, controlling blood pressure and other risk factors, and preparing for renal replacement
The document discusses the role of family physicians in controlling chronic kidney disease (CKD) in India. It notes that while infections are decreasing, non-communicable diseases like diabetes and hypertension that can lead to CKD are increasing. CKD prevalence in India is estimated at 11-15% but awareness remains low. Family physicians can play a key role in early detection through regular screening of at-risk groups and monitoring of creatinine levels and protein in urine. Lifestyle modifications like diet, exercise, and controlling diabetes and hypertension are emphasized. Close coordination between family physicians and nephrologists from early stages of CKD is important for optimal care.
No, the combination of an ACE inhibitor and an ARB is not generally recommended for patients with diabetes and CKD. Some key points:
- There is no evidence that combining an ACEi with an ARB provides additional renal protection compared to monotherapy in patients with diabetes and CKD.
- Combining the two classes of drugs increases the risk of hyperkalemia and acute kidney injury without proven additional benefit over monotherapy.
- Current guidelines recommend using either an ACEi or an ARB as first-line therapy for albuminuria, but do not recommend combining the two classes of drugs.
So in summary, while ACEis and ARBs are both reasonable first-line options, combining
This document provides information on chronic kidney disease (CKD), including its definition, causes, stages, clinical assessment, complications, treatment, and management of associated conditions like hypertension and dyslipidemia. CKD is defined as kidney damage or decreased kidney function lasting 3 months or more. The three most common causes are diabetes, hypertension, and glomerular disease. CKD progresses through five stages depending on kidney damage severity and function level. Treatment focuses on slowing disease progression, managing complications, and reducing cardiovascular risk through blood pressure control, cholesterol lowering, and other measures.
Dapagliflozin demonstrated clear treatment benefits for cardiovascular, kidney, and mortality outcomes in patients with chronic kidney disease (CKD), regardless of the presence of diabetes. It provides glomerular protection, limits proteinuria and kidney damage, and slows the decline of glomerular filtration rate in CKD patients. The DAPA-CKD trial found that dapagliflozin reduced the risk of end-stage renal disease or death from renal causes compared to placebo in CKD patients with and without type 2 diabetes. Dapagliflozin is indicated for the treatment of CKD up to stage III and was well tolerated with a low rate of treatment discontinuation.
How to retard the progression of ckd dr Tareq tantawyFarragBahbah
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The document discusses ways to retard the progression of chronic kidney disease (CKD). It outlines several risk factors that can accelerate CKD progression, including proteinuria, obesity, metabolic syndrome, hypertension, cardiovascular abnormalities, and high uric acid levels. The document recommends general measures to address these risks, such as lifestyle changes to improve cardiovascular health, strict blood pressure control, and interrupting the renin-angiotensin-aldosterone system through medications.
Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function lasting more than 3 months. Management of CKD involves controlling comorbidities like hypertension and diabetes, and nutritional management including restricting protein and salt intake. Treatment of complications includes managing anemia with iron or ESAs, controlling mineral and bone disorder with phosphate binders, vitamin D analogs, and calcimimetics, and treating secondary hyperparathyroidism.
This document provides an overview of chronic kidney disease (CKD). It defines CKD as kidney damage or decreased kidney function lasting at least 3 months. The global prevalence of CKD is estimated to be 13.4% with higher rates in certain regions like eastern Uganda. Common causes include diabetes, hypertension, and glomerulonephritis. Later stages of CKD can cause complications like fluid overload, hyperkalemia, and metabolic acidosis which require management approaches like dietary modifications and medications. The document discusses evaluating and managing CKD and its associated risks and complications.
The document discusses the oculomotor nerve (cranial nerve 3), which is entirely motor and supplies several extraocular muscles and the levator palpebrae superioris muscle. It has nuclei located in the midbrain and courses from the midbrain to the orbit. Common causes of cranial nerve 3 palsy include vascular issues like diabetes and hypertension, neoplastic lesions, and trauma. Signs of a total cranial nerve 3 palsy include ptosis, limitation of eye movements, and a dilated pupil. Treatment depends on the underlying cause but may involve surgery, patching, or prism correction of double vision.
This document provides information on non-proliferative diabetic retinopathy (NPDR), including:
1. It discusses the pathogenesis, risk factors, signs and symptoms, classifications, and treatment of NPDR. The main causes of NPDR are changes to the retinal capillaries due to effects of hyperglycemia.
2. Signs of NPDR include microaneurysms, hemorrhages, exudates, cotton wool spots, venous changes, and macular edema. Treatment focuses on glycemic control and may include laser therapy or anti-VEGF injections.
3. Regular eye exams are recommended for diabetic patients to monitor for retinopathy, as early treatment can help prevent
This document defines and classifies different types of nystagmus. It describes the key characteristics of different nystagmus including congenital motor nystagmus, periodic alternating nystagmus, spasmus nutans, vestibular nystagmus, upbeat nystagmus, downbeat nystagmus, and nystagmus associated with strabismus. It also discusses the mechanisms, localization, and treatment options for nystagmus including optical devices, pharmacology, botulinum toxin injections, and surgery.
Central Serous Chorioretinopathy Dr Md Ferdous IslamFerdous101531
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This document provides an overview of central serous chorioretinopathy (CSC), a retinal disease characterized by serous detachment of the neurosensory retina and retinal pigment epithelium in the macula. CSC most often affects men ages 20-50 and is associated with stress, hypertension, sleep disorders, and corticosteroid use. Patients experience blurred vision, scotoma, and metamorphopsia. Diagnosis involves imaging like funduscopy, fluorescein angiography, indocyanine green angiography, and optical coherence tomography. While often self-limiting, CSC can recur and cause vision impairment. Treatment includes managing risk factors, photocoagulation, anti-VEGF
This document discusses peripheral ulcerative keratitis (PUK), a group of inflammatory diseases that cause thinning and ulceration of the peripheral cornea. It describes several types of PUK including Mooren's ulcer, marginal keratitis, Terrien's marginal degeneration, and PUK associated with autoimmune diseases. Mooren's ulcer is a rare autoimmune disease characterized by progressive, peripheral, circumferential ulceration. Marginal keratitis is caused by a hypersensitivity reaction to Staphylococcus exotoxins. Terrien's marginal degeneration causes thinning of the peripheral cornea. PUK associated with autoimmune diseases like rheumatoid arthritis is linked to immune complex deposition in the peripheral cornea. Management involves topical
This document discusses key concepts related to light refraction and the eye's refractive system. It defines refraction as the bending of light when passing from one medium to another, with the refractive index quantifying the ratio of light speeds in different media. Myopia, hyperopia, astigmatism and presbyopia are described as refractive errors caused by mismatches between the eye's axial length and refractive power. Objective and subjective refraction methods are outlined for determining a patient's refractive error and providing appropriate correction through lenses or surgery.
This document provides information about contact lenses, including their specifications, types, uses, and complications. It defines a contact lens as an artificial device that substitutes for the front surface of the cornea to correct refractive errors and corneal irregularities. The main types discussed are hard, rigid gas permeable, and soft lenses. Uses include optical correction as well as therapeutic, preventative, diagnostic, operative, cosmetic, and occupational indications. Complications that can occur involve the eyelids, conjunctiva, and cornea. Contraindications for contact lens use include certain eye diseases and conditions.
1. The tear film consists of three layers - an outer lipid layer, intermediate aqueous layer, and inner mucin layer. The lipid layer prevents evaporation while the aqueous layer nourishes the cornea and washes away debris.
2. Tears are produced both through basal secretion by accessory glands and reflex secretion by the main lacrimal gland in response to irritation. The tear film forms on the cornea through spreading of layers.
3. Diagnosis of dry eye involves tests like tear film break-up time (BUT), Schirmer's test, and Jones tests to evaluate tear production and drainage. Multiple factors can contribute to dry eye and tear film instability.
This document discusses primary angle-closure glaucoma (PACG), including its stages, risk factors, mechanisms, signs and symptoms, investigations, and treatment approaches. PACG is caused by occlusion of the trabecular meshwork by the peripheral iris, obstructing aqueous outflow. It has three stages: primary angle-closure suspect, primary angle-closure, and primary angle-closure glaucoma. Risk factors include age, female sex, hypermetropia, and Asian ethnicity. Treatment involves lowering intraocular pressure through medications, laser peripheral iridotomy or iridectomy to reopen the drainage angle, and surgery if needed.
This document discusses primary angle closure glaucoma (PACG). It begins by describing the stages of PACG from primary angle closure suspect to primary angle closure glaucoma. It then covers risk factors, mechanisms (including pupillary block and non-pupillary block), signs and symptoms, investigations, and treatment approaches including laser iridotomy, medications, and surgery. The treatment goal is to eliminate iris blockage and lower elevated intraocular pressure to prevent optic nerve damage.
This document discusses the anatomy and variations of the optic chiasm. It describes the chiasm as a flattened structure located above the pituitary gland where the optic nerves from each eye partially cross. The temporal fibers remain uncrossed while the nasal fibers cross over. Variations in the position of the chiasm can impact which structures are involved in pituitary tumors. Lesions in the center of the chiasm cause bitemporal hemianopia while lateral lesions cause binasal hemianopia. The blood supply and relations to surrounding structures are also outlined.
Anesthesia in ophthalmic surgery dr ferdous Ferdous101531
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This document discusses anesthesia considerations for ophthalmic surgery. It covers various techniques including general anesthesia, local anesthesia, and different regional block techniques. It discusses preoperative evaluation and management of comorbidities. Complications related to different techniques are outlined such as increases in intraocular pressure, retrobulbar hemorrhage, oculocardiac reflex, brainstem anesthesia, and postoperative nausea and vomiting. Agents, adjuvants, and proper techniques are emphasized to minimize risks and complications during ophthalmic anesthesia.
This document discusses the history and principles of gonioscopy, a technique used to examine the iridocorneal angle of the eye. It describes the development of direct and indirect goniolens contact lenses used to visualize the angle. Various gonioprism designs are outlined, along with the advantages and disadvantages of direct versus indirect techniques. Normal angle structures are defined, as are manipulative gonioscopy maneuvers like indentation. Clinical applications for diagnosis and treatment of glaucoma are provided. Limitations and contraindications of gonioscopy are also noted.
The document describes the anatomy and physiology of the pupillary light reflex pathway. It discusses the iris, pupil size and shape, functions of the iris such as light control and depth of focus. It then covers clinical uses such as assessing light input and pharmacological response. The document outlines the afferent and efferent pathways in detail from the retina to the Edinger-Westphal nucleus. It discusses various clinical tests and findings including anisocoria and causes.
Bacterial keratitis is a sight-threatening condition that develops when the eye's defenses are compromised. It is caused by bacteria such as Pseudomonas, Staphylococcus, and Streptococcus invading the cornea. Risk factors include trauma, ocular surface diseases, contact lens wear, and immunosuppression. Treatment involves local and systemic antibiotics based on smear and culture results, along with cycloplegics and analgesics. For impending perforation, measures to lower pressure and tissue adhesives may be used. Surgery is needed for large perforations or non-healing ulcers.
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
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(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
Bro. Oh Teik Bin ๐๐ค๐ค๐ฅฐ
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
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The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Information and Communication Technology in EducationMJDuyan
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(๐๐๐ ๐๐๐) (๐๐๐ฌ๐ฌ๐จ๐ง 2)-๐๐ซ๐๐ฅ๐ข๐ฆ๐ฌ
๐๐ฑ๐ฉ๐ฅ๐๐ข๐ง ๐ญ๐ก๐ ๐๐๐ ๐ข๐ง ๐๐๐ฎ๐๐๐ญ๐ข๐จ๐ง:
Students will be able to explain the role and impact of Information and Communication Technology (ICT) in education. They will understand how ICT tools, such as computers, the internet, and educational software, enhance learning and teaching processes. By exploring various ICT applications, students will recognize how these technologies facilitate access to information, improve communication, support collaboration, and enable personalized learning experiences.
๐๐ข๐ฌ๐๐ฎ๐ฌ๐ฌ ๐ญ๐ก๐ ๐ซ๐๐ฅ๐ข๐๐๐ฅ๐ ๐ฌ๐จ๐ฎ๐ซ๐๐๐ฌ ๐จ๐ง ๐ญ๐ก๐ ๐ข๐ง๐ญ๐๐ซ๐ง๐๐ญ:
-Students will be able to discuss what constitutes reliable sources on the internet. They will learn to identify key characteristics of trustworthy information, such as credibility, accuracy, and authority. By examining different types of online sources, students will develop skills to evaluate the reliability of websites and content, ensuring they can distinguish between reputable information and misinformation.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
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(๐๐๐ ๐๐๐) (๐๐๐ฌ๐ฌ๐จ๐ง ๐)-๐๐ซ๐๐ฅ๐ข๐ฆ๐ฌ
๐๐ข๐ฌ๐๐ฎ๐ฌ๐ฌ ๐ญ๐ก๐ ๐๐๐ ๐๐ฎ๐ซ๐ซ๐ข๐๐ฎ๐ฅ๐ฎ๐ฆ ๐ข๐ง ๐ญ๐ก๐ ๐๐ก๐ข๐ฅ๐ข๐ฉ๐ฉ๐ข๐ง๐๐ฌ:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
๐๐ฑ๐ฉ๐ฅ๐๐ข๐ง ๐ญ๐ก๐ ๐๐๐ญ๐ฎ๐ซ๐ ๐๐ง๐ ๐๐๐จ๐ฉ๐ ๐จ๐ ๐๐ง ๐๐ง๐ญ๐ซ๐๐ฉ๐ซ๐๐ง๐๐ฎ๐ซ:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
How to Download & Install Module From the Odoo App Store in Odoo 17Celine George
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Custom modules offer the flexibility to extend Odoo's capabilities, address unique requirements, and optimize workflows to align seamlessly with your organization's processes. By leveraging custom modules, businesses can unlock greater efficiency, productivity, and innovation, empowering them to stay competitive in today's dynamic market landscape. In this tutorial, we'll guide you step by step on how to easily download and install modules from the Odoo App Store.
3. INTRODUCTION
๏ The Kidney Disease Improving Global Outcomes (KDIGO) 2012
Clinical Practice Guideline for the Evaluation and Management of
Chronic Kidney Disease (CKD) serves to update the 2002 KDOQI
Clinical Practice Guideline includes definition, an enhanced
classification frame work.
๏ It also elaborates on the identification and prognosis of CKD;
management of progression and complications and expands on
the continuum of CKD care: timing of specialist referral, timing
of the initiation of dialysis, and finally the implementation of a
treatment program which includes comprehensive conservative
management.
4. Definition Of CKD
๏ CKD is defined as abnormalities of kidney structure or
function, present for>3 months, with implications for
health and CKD is classified based on cause, GFR
category, and albuminuria category (CGA).
5. Criteria For CKD (Either Of The Following
Present For >3 Months)
๏ Markers of kidney damage (one or more)
- Albuminuria (AER <30 mg/24 hours; ACR <30 mg/g [<3
mg/mmol])
-Urine sediment abnormalities
-Electrolyte and other abnormalities due to tubular
disorders
-Abnormalities detected by histology
-Structural abnormalities detected by imaging
-History of kidney transplantation
๏ Decreased GFR
GFR <60 ml/min/1.73 m2
6. GFR Categories In CKD
GFR Category GFR (ml/min/1.73
m2)
Terms
G1 โค90 Normal or high
G2 60โ89 Mildly decreased*
G3a 45โ59 Mildly to moderately
decreased
G3b 30โ44 Moderately to severely
decreased
G4 15โ29 Severely decreased
G5 <15 Kidney failure
9. Evaluation Of CKD
๏ฑEvaluation Of Chronicity:
๏ถ If duration is >3 months, CKD is confirmed.
๏ถIf duration is not >3 months or unclear, not confirmed. Patients
may have CKD or acute kidney diseases or both and tests should
be repeated accordingly.
๏ฑ Evaluation Of Cause:
Evaluate the clinical context, including personal and family
history, social and environmental factor, medications, physical
examination, laboratory measures, imaging, and pathologic
diagnosis to determine the causes of kidney disease.
10. Contd.
๏ฑEvaluation of GFR:
๏ถUsing serum creatinine and a GFR estimating equation for
initial assessment.
๏ถUsing additional tests (such as cystatin C or a clearance
measurement) for confirmatory testing in specific
circumstances when eGFR based on serum creatinine is less
accurate.
๏ถMeasuring cystatin C in adults with eGFRcreat 45โ59
ml/min/1.73 m2 who do not have markers of kidney damage
if confirmation of CKD is required
๏ If eGFRcys/eGFRcreat-cys is also <60 ml/min/1.73 m2, the diagnosis of CKD is
confirmed.
๏ If eGFRcys/eGFRcreat-cys is โฅ60 ml/min/1.73 m2, the diagnosis of CKD is not confirmed.
11. Contd.
๏ฑEvaluation Of Albuminuria:
๏ Using the following measurements for initial testing of
proteinuria ( in all cases an early morning urine sample is
preferred):
1) urine albumin-to-creatinine ratio (ACR);
2) urine protein-to-creatinine ratio (PCR);
3) reagent strip urinalysis for total protein with automated
reading;
4) reagent strip urinalysis for total protein with manual
reading.
12. Predicting Prognosis Of CKD
๏ In predicting risk for outcome of CKD, identify the fol variables:
1) cause of CKD
2) GFR category
3) albuminuria category
4) other risk factors and co morbid conditions such as age,
sex, race/ethnicity, elevated BP, hyperglycemia, dyslipidemia,
smoking, obesity, history of cardiovascular disease, ongoing
exposure to nephrotoxic agents.
๏ In populations with CKD, group GFR and albuminuria categories
with similar relative risk for CKD outcomes into risk categories .
13.
14. Definition And Identification Of Ckd
Progression
๏ CKD Progression based on one of more of the following :
1) Decline in GFR category . A certain drop in eGFR is
defined as a drop in GFR category accompanied by a 25% or
greater drop in eGFR from baseline.
2) Rapid progression is defined as a sustained decline in
eGFR of more than 5 ml/min/1.73 m2/yr.
3) The confidence in assessing progression is increased with
increasing number of serum creatinine measurements and
duration of follow-up.
15. Contd.
๏ Assess GFR and albuminuria at least annually in people with
CKD.
๏ Assess GFR and albuminuria more often for individuals at
higher risk of progression or where measurement will impact
therapeutic decisions
16.
17. Management Of Progression And
Complications Of CKD
Prevention Of CKD Progression:
1)BP Interruption:
Individualize BP targets and agents according to age, coexisting cvs
disease and other co morbidities.
๏ Recommend that in both diabetic and non-diabetic adults with CKD
and urine albumin excretion <30 mg/24 hrs whose office BP is
consistently >140/90mm Hg mm, maintain a BP that is consistently
<140/90mm Hg .
๏ If urine albumin excretion is >30mg/24hrs then target BP is <130/80
mm Hg.
18. Contd.
๏ ARB or ACE-I be used in diabetic adults with CKD and urine
albumin excretion 30โ300 mg/24 hrs.
๏ Recommended that an ARB or ACE-I be used in both
diabetic and non-diabetic adults with CKD and urine
albumin excretion >300 mg/24 hours.
๏ Recommended that in children with CKD, BP-lowering
treatment is started when BP is consistently above the 90th
percentile for age, sex, and height.ARB or ACE-I be used as
BP-lowering drugs , irrespective of the level of proteinuria.
๏ ARB or ACE-I can cause an acute increase in S-Cr &/or K,cont
medication if increase is< 30%.Monitor RFT & K levels with
initiation & with each of dosases change every 1-2 wks until
values return to baseline.
19. Contd.
๏ CKD And Risk Of AKI:
Recommended that all people with CKD are considered to
be at increased risk of AKI.
๏ Protein Intake: lowering protein intake to 0.8 g/kg/day in
adults with or without diabetes.
๏ Glycemic Control:
i. Recommended a target HbA1c approx 7.0% to prevent or
delay progression of the microvascular complications of
diabetes.
ii. Recommended not treating to an HbA1c target of <7.0%
in patients at risk of hypoglycemia. Here target HbA1c
must be extended above 7.0% .
20. Contd.
๏ Lifestyle Modification:
Recommended that people with CKD be encouraged to
undertake physical activity (at least 30minutes 5 times per
week) and stop smoking.
๏ Salt Intake:
Lowering salt intake to <90mmol (o2 g) per day in adults.
๏ Additional Dietary Advice:
Recommend that individuals with CKD receive expert
dietary advice and information in the context of an education
program and the need to intervene on salt, phosphate,
potassium, and protein intake where indicated.
21. Complications Associated With Loss Of
Kidney Function
Anaemia:
Definition and identification of anemia in CKD:
๏ In adults and children >15 years with CKD when the Hb concentration is
<13.0 g/dl in males and <12.0 g/dl in females.
๏ In children with CKD if Hb concentration
o <11.0 g/dl in 0.5โ5 years,
o <11.5 g/dl in children 5โ12 years, and
o <12.0 g/dl in 12-15 years.
๏ To identify anemia in people with CKD measure Hb concentration
1. clinically indicated in G1-G2
2. at least annually in G3a-G3b
3. at least twice per yr in G4-G5
22. Contd.
๏ Metabolic Bone Disease:
Includes renal osteodystrophy and extraskeletal (vascular)
calcification related to abnormalities of bone mineral
metabolism. Renal osteodystrophy is quantified through
bone biopsy histomorphometry and includes osteitis fibrosa,
osteomalacia, and adynamic bone disease.
๏ Recommended measuring serum levels of calcium,
phosphate, PTH, and Alkaline Phosphatase activity at least
once if GFR is <45ml/min/1.73m2 to determine baseline
values.
๏Not to perform bone mineral density testing routinely in
those with eGFR <45 ml/min/1.73m2, as information may be
misleading or unhelpful.
23. Contd.
๏ In people with CKD stage 3b-5 suggest maintaining
serum phosphate concentrations in the normal range.
๏ In people with GFR <45 ml/min/1.73 m2 (GFR categories
G3b-G5) the optimal PTH level is not known.
๏ Suggested that people with levels of intact PTH above the
upper normal limit of the assay are first evaluated for
hyperphosphatemia, hypocalcemia, and vitamin D
deficiency.
24. Contd.
Vitamin D Supplementation And Bisphosphonates:
๏Suggested not to routinely prescribe vitamin D
supplements or vitamin D analogs, in the absence of
suspected or documented deficiency, to suppress
elevated PTH concentrations in people with CKD not on
dialysis.
๏Suggested not to prescribe bisphosphonate treatment in
people with CKD stage 4-5 without a strong clinical
rationale
25. Contd.
Acidosis: declining renal function is assosiated with metabolic
acidosis .
๏ In people with CKD and serum bicarbonate conc. <22 mmol/l
treatment with oral bicarbonate supplementation to be given to
maintain serum bicarbonate within the normal range.
Risk of CVD:
๏ Recommended that all people with CKD should be considered at
increased risk for CVS disease.
๏ Suggested that adults with CKD at risk for atherosclerotic events
should get treatment with antiplatelet agents unless there is an
increased bleeding risk .
.
26. Condt.
๏ CKD And Risk Of Infections:
๏Recommended that all adults with CKD are offered annual
vaccination with influenza vaccine.
๏ Adults with GFR categories G4-G5 and at high risk of
pneumococcal infection receive polyvalent pneumococcal
vaccine and revaccination within 5 yrs.
๏ All adults who are at high risk of progression of CKD should
be immunized against hep B .
๏ Consideration of live vaccine should include an appreciation
of the patientโs immune status and should be in line with
recommendations from official or governmental bodies.
27. Contd.
Risk factors for infection in people with CKD:
1) Advanced age
2)High burden of coexisting illnesses such as DM
3) Hypoalbuminemia
4)Immunosuppressive therapy
5)Nephrotic syndrome
6)Uremia
7)Anemia and malnutrition
8)High prevalence of functional disabilities
28. Contd.
Drug Toxicity: Altered pharmacokinetics of drugs excreted
by the kidney and an increased risk of drug-interactions are
common and require adjustment in the dosage of many
drugs.
29. Medication Management And Patient Safety In
CKD
๏ Recommended that prescribers should take GFR into
account when drug dosing.
๏ Temporary discontinuation of potentially nephrotoxic and
renally excreted drugs in people with CKD stage 3a-5 who
have serious intercurrent illness that increases the risk of
AKI. These agents include ACE-Is, ARBs, aldosterone
inhibitors, direct renin inhibitors, diuretics, NSAIDs,
metformin, lithium, and digoxin.
๏ Not using herbal remedies in people with CKD.
30. Contd.
๏ Metformin can be continued in G1-G3a; its use should be
reviewed in G3b; and it should be discontinued in G4-G5.
๏ People with CKD should not be denied therapies for other
conditions such as cancer but there should be appropriate
dose adjustment of cytotoxic drugs according to knowledge
of GFR.
31. Cautionary Notes For Prescribing In People
With CKD
Agents Cautionary notes
1. Antihypertensives
ACE-Is,ARBs,
aldosterone antagonists
-Avoid in people with suspected functional renal artery
stenosis
- Start at lower dose in people with GFR o45 ml/min/1.73
m2
- Assess GFR and measure serum potassium within 1 week
of starting or following any dose escalation
- Temporarily suspend during intercurrent illness, planned
IV radiocontrast administration,bowel preparation, or prior
to major surgery
- Do not routinely discontinue in people with GFR <30
ml/min/1.73 m2 as they are nephroprotective
2.Beta-blockers Reduce dose by 50% in people with GFR <30 ml/min/1.73
m2
3.Digoxin Reduce dose based on plasma concentrations
32. Condt.
Agents Cauti0nary note
4.Analgesics
NSAIDS
- Avoid in people with GFR <30 ml/min/1.73 m2
- Prolonged therapy is not recommended in people with
GFR <60 ml/min/1.73 m2
- Avoid in people taking RAAS blocking agents
5. Antimicrobials
Penicillin
Risk of crystalluria when GFR <15 ml/min/1.73 m2 with high
doses
6. Macrolides Reduce dose by 50% when GFR <30 ml/min/1.73 m
7.Aminoglycosides -Reduce dose and/or increase dosage interval when GFR
<60 ml/min/1.73 m2
- Avoid concomitant ototoxic agents such as furosemide
8.Antifungals -Avoid amphotericin unless no alternative when GFR <60
ml/min/1.73 m2
- Reduce maintenance dose of fluconazole by 50% when
GFR <45 ml/min/1.73 m2
9. Lipid-lowering drugs
Statin
Fenofibrate
No increase in toxicity for simvastatin dosed at 20 mg / day
Increases SCr by approximately 0.13 mg/dl
33. Referral To Specialists
KDIGO recommendation is in the following circumstances
1) AKI or abrupt sustained fall in GFR;
2) GFR <30 ml/min/1.73 m2 (GFR categories G4-G5)
3) consistent finding of significant albuminuria (ACR >300
mg/g [>30 mg/mmol]
4) progression of CKD
5)urinary red cell casts, RBC >20 per high power field
sustained and not readily explained
6) CKD and hypertension refractory to treatment with 4 or
more antihypertensive agents
7) persistent abnormalities of serum potassium;
8) recurrent or extensive nephrolithiasis.
9) hereditary kidney disease
34. Care Of The Patient With Progressive CKD
๏ KDIGO suggested that people with progressive CKD should
be managed in a multidisciplinary care setting.
๏ The multidisciplinary team should include or have access to
dietary counseling, education and counseling about different
RRT modalities, transplant options, vascular access surgery,
and ethical, psychological, and social care.
35. Timing The Initiation Of RRT
๏ Suggested that dialysis to be initiated when one or more of
the fol are present:
1) Symptoms or signs attributable to kidney failure
(serositis, acid-base or electrolyte abnormalities, pruritus)
2) Inability to control volum status or blood pressure
3) Progressive deterioration in nutritional status
refractory to dietary intervention
4) Cognitive impairment
This often but not invariably occurs in the GFR range between
5 -10 ml/min/1.73 m2.
36. Contd.
๏ Living donor preemptive renal transplantation in adults
should be considered when the GFR is <20 ml/min/1.73 m2,
and there is evidence of progressive and irreversible CKD
over the preceding 6โ12 months.
37. Structure And Process Of Comprehensive
Conservative Management
๏ Conservative management for people who choose not to
pursue RRT and should be supported by a comprehensive
management program.
๏ All CKD care providers should be able to deliver advance
care for people with a recognized need for end-of-life care.
๏ Coordinated end-of-life care should be available to people
and families through either primary care or specialist care.
38. Contd.
๏ This program should include protocols for symptoms and
pain management, psychological care, spiritual care, and
culturally sensitive care for the dying patient and their family
whether at home or in a hospital setting.