Chronic kidney disease (CKD) is a progressive loss of kidney function affecting about 10% of the global population, primarily due to diabetes and hypertension. It progresses through five stages based on glomerular filtration rate (GFR), with various clinical features and complications arising in later stages. Management includes lifestyle modifications, medical therapy for complications, and renal replacement options like dialysis and transplantation.

1. SCHOOL OF CLINICAL SCIENCES
Internal Medicine
Presenters:
Amadu Wurie Timbo 22079
Chernor Mbojeh Timbo 22080
Lecturer:
Dr. Martin

2. Introduction
Definition: Chronic Kidney Disease (CKD) is a
progressive loss of kidney function over months or
years, defined by abnormalities in kidney structure or
function lasting for more than three months

3. Epidemiology:
Affects approximately 10% of the global
population.
Leading causes: diabetes mellitus and
hypertension.

4. Kidney Functions
 Regulation of fluid and electrolyte balance.
 Excretion of waste products and toxins.
 Acid-base balance.
 Endocrine functions:
• Production of erythropoietin (stimulates
red blood cell production).
• Activation of vitamin D (essential for
calcium metabolism).
• Regulation of blood pressure via renin
secretion.

5. Etiology of CKD
Primary Causes:
Diabetes mellitus (diabetic nephropathy).
Hypertension (hypertensive nephrosclerosis).

6. Secondary Causes:
•Glomerulonephritis.
•Polycystic kidney disease.
•Chronic pyelonephritis.
•Autoimmune diseases (e.g., lupus
nephritis).
•Obstructive nephropathy (e.g., kidney
stones, enlarged prostate).

8. Pathophysiology

10. Stages of CKD
Based on glomerular filtration rate (GFR):
Stage 1: GFR ≥90 mL/min/1.73 m² (kidney damage
with normal function).
Stage 2: GFR 60-89 mL/min/1.73 m² (mild
decrease).
Stage 3: GFR 30-59 mL/min/1.73 m² (moderate
decrease).
Stage 4: GFR 15-29 mL/min/1.73 m² (severe
decrease).
Stage 5: GFR <15 mL/min/1.73 m² (end-stage
kidney disease).

11. Clinical Features
Early Stages:
Often asymptomatic.
Detection via abnormal lab results (e.g., elevated
creatinine).

12. Later Stages:
•Fatigue, weakness.
•Edema (swelling in legs, face).
•Hypertension.
•Anemia.
•Metabolic acidosis.
•Hyperkalemia (risk of cardiac arrhythmias).
•Uremic symptoms: nausea, pruritus, altered
mental status.

13. Diagnosis
Laboratory Tests:
Serum creatinine and eGFR calculation.
Urine albumin-to-creatinine ratio (ACR).
Complete blood count (anemia assessment).
Electrolytes (potassium, calcium, phosphate).
Acid-base status (bicarbonate levels).

15. Imaging:
Renal ultrasound (assess kidney size, structural
abnormalities)

16. Biopsy:
Indicated in select cases to confirm etiology.

17. Management
Lifestyle Modifications:
Low-sodium, low-protein diet.
Smoking cessation.
Regular exercise.

18. Medical Therapy:
Blood Pressure Control:
Target <130/80 mmHg.
First-line agents: ACE inhibitors or ARBs.
Glycemic Control:
Target HbA1c: ~7% in diabetics.

19. Management of Complications:
Anemia: Erythropoiesis-stimulating agents (e.g.,
erythropoietin, Blood Transfusion).
Hyperphosphatemia: Phosphate binders.
Metabolic acidosis: Sodium bicarbonate.
Metabolic acidosis: Sodium bicarbonate.

20. Renal Replacement Therapy (End-Stage
CKD):
Hemodialysis.
Peritoneal dialysis.
Kidney transplantation.

21. When is it Time for Dialysis?

22. Indications for Dialysis:
Persistent GFR <15 mL/min/1.73 m² with
symptoms of uremia (e.g., fatigue, confusion,
nausea).
Fluid overload unresponsive to diuretics.
Severe hyperkalemia despite medical
management.
Metabolic acidosis refractory to treatment.
Pericarditis or other uremic complications.

23. Types of Dialysis:
Hemodialysis:
Blood is filtered through an external machine.
Typically performed 3 times a week at a dialysis
center.

24. Peritoneal Dialysis:
Uses the peritoneum as a natural filter.
Can be performed at home (e.g., continuous
ambulatory peritoneal dialysis).

25. Timing:
Early planning for dialysis is essential to ensure
vascular access (e.g., arteriovenous fistula).
Shared decision-making with the patient about
the appropriate time to initiate therapy.

26. Complications
Cardiovascular disease (leading cause of death in CKD
patients).
Hyperkalemia.
Mineral and bone disorders (secondary
hyperparathyroidism).
Anemia.
Fluid overload (pulmonary edema).

27. Prevention and Screening
Regular monitoring in high-risk individuals (e.g.,
diabetics, hypertensives).
Control of modifiable risk factors (blood pressure,
glucose levels).
Early detection and management of albuminuria.