E Gfr 2008
•Download as PPS, PDF•
13 likes•2,689 views
The document discusses estimated glomerular filtration rate (eGFR) and its clinical applications and limitations. It provides background on assessing kidney function, defining chronic kidney disease (CKD) stages, and estimating GFR. It also addresses limitations of eGFR including assumptions of steady state, creatinine standardization issues, and inaccuracy at higher GFR levels or with rapid changes in kidney function. The document emphasizes using eGFR in conjunction with other clinical factors for CKD evaluation and management.
Report
Share
Report
Share
Recommended
Kidney Donor evaluation
This document summarizes guidelines for evaluating kidney function in potential living donors. It recommends estimating glomerular filtration rate (GFR) using serum creatinine and/or cystatin C to assess kidney function. An initial GFR of 90 mL/min/1.73m2 or greater is acceptable for donation, while GFR between 60-89 mL/min/1.73m2 requires individual assessment. Donors with less than 60 mL/min/1.73m2 are not eligible. The guidelines provide criteria for measurement and interpretation of GFR to safely evaluate and select living kidney donors.
Hepatitis B in Dialysis and Transplantation
This document discusses hepatitis B virus (HBV) infection in patients undergoing dialysis or kidney transplantation. Some key points:
1) HBV infection is a concern for dialysis and transplant patients due to their immunosuppressed state, which increases susceptibility to infection and can cause HBV to take a more severe clinical course.
2) While HBV infection may seem relatively mild in dialysis patients, it poses significant risks if they undergo kidney transplantation, as HBV can reactivate or cause life-threatening complications after transplant.
3) Preventing HBV transmission in dialysis units is important through measures like vaccination, protective equipment, and regular screening. Prophylactic treatment is recommended for infected patients considering transplant
Cystic diseases of kidney
pathology, cystic kidney diseases, kidneys, gross, cysts, ADPKD, ARPKD, cystic nephroma, tuberous sclerosis, VHL syndrome, cystic dysplastic kidney, glomerulocystic kidney, genetic
Estimation of glomerular filtration rate
Renal function, or glomerular filtration rate (GFR), indicates the state of the kidneys and is measured by the volume of fluid filtered from the glomerular capillaries into the Bowman's capsule per unit of time. GFR can be estimated by measuring creatinine or other substances that are freely filtered but not reabsorbed or secreted by the kidneys. While creatinine clearance is commonly used to estimate GFR, it may overestimate by 10-20% due to minimal creatinine secretion. Alternative methods to more directly measure GFR include collecting urine over 24 hours or injecting inulin, though these have limitations as well.
Dialysis prescription
This document discusses guidelines for prescribing hemodialysis for acute kidney injury patients. It covers key elements of the prescription including session length and blood flow rate, dialyzer selection, dialysate composition, and ultrafiltration orders. The presentation emphasizes starting more frequent but shorter sessions at lower intensity initially and gradually increasing session length and clearance as the patient stabilizes to prevent dialysis disequilibrium syndrome.
The aging kidney and what we should (not?) do about it
A limited presentation about a) age related renal functional changes b) management of CKD, including advance care planning and transplantation referral c) management of potentially risky drugs in the elderly with CKD (NOACs)
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
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.
Hemodialysis anticoagulation
Anticoagulation lab tests
Unfractioned Heparin
Heparin induced thrombocytopenia
Low Molecular Weight Heparin (LMWH)
Heparin Free Dialysis
Regional Heparinization With Protamine Reversal
Heparin Coated Filters
Regional Citrate Anticoagulation
Citrasate
Heparinoids
Direct Thrombin Inhibitors
Platelet Inhibiting Agents
Recommended
Kidney Donor evaluation
This document summarizes guidelines for evaluating kidney function in potential living donors. It recommends estimating glomerular filtration rate (GFR) using serum creatinine and/or cystatin C to assess kidney function. An initial GFR of 90 mL/min/1.73m2 or greater is acceptable for donation, while GFR between 60-89 mL/min/1.73m2 requires individual assessment. Donors with less than 60 mL/min/1.73m2 are not eligible. The guidelines provide criteria for measurement and interpretation of GFR to safely evaluate and select living kidney donors.
Hepatitis B in Dialysis and Transplantation
This document discusses hepatitis B virus (HBV) infection in patients undergoing dialysis or kidney transplantation. Some key points:
1) HBV infection is a concern for dialysis and transplant patients due to their immunosuppressed state, which increases susceptibility to infection and can cause HBV to take a more severe clinical course.
2) While HBV infection may seem relatively mild in dialysis patients, it poses significant risks if they undergo kidney transplantation, as HBV can reactivate or cause life-threatening complications after transplant.
3) Preventing HBV transmission in dialysis units is important through measures like vaccination, protective equipment, and regular screening. Prophylactic treatment is recommended for infected patients considering transplant
Cystic diseases of kidney
pathology, cystic kidney diseases, kidneys, gross, cysts, ADPKD, ARPKD, cystic nephroma, tuberous sclerosis, VHL syndrome, cystic dysplastic kidney, glomerulocystic kidney, genetic
Estimation of glomerular filtration rate
Renal function, or glomerular filtration rate (GFR), indicates the state of the kidneys and is measured by the volume of fluid filtered from the glomerular capillaries into the Bowman's capsule per unit of time. GFR can be estimated by measuring creatinine or other substances that are freely filtered but not reabsorbed or secreted by the kidneys. While creatinine clearance is commonly used to estimate GFR, it may overestimate by 10-20% due to minimal creatinine secretion. Alternative methods to more directly measure GFR include collecting urine over 24 hours or injecting inulin, though these have limitations as well.
Dialysis prescription
This document discusses guidelines for prescribing hemodialysis for acute kidney injury patients. It covers key elements of the prescription including session length and blood flow rate, dialyzer selection, dialysate composition, and ultrafiltration orders. The presentation emphasizes starting more frequent but shorter sessions at lower intensity initially and gradually increasing session length and clearance as the patient stabilizes to prevent dialysis disequilibrium syndrome.
The aging kidney and what we should (not?) do about it
A limited presentation about a) age related renal functional changes b) management of CKD, including advance care planning and transplantation referral c) management of potentially risky drugs in the elderly with CKD (NOACs)
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
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.
Hemodialysis anticoagulation
Anticoagulation lab tests
Unfractioned Heparin
Heparin induced thrombocytopenia
Low Molecular Weight Heparin (LMWH)
Heparin Free Dialysis
Regional Heparinization With Protamine Reversal
Heparin Coated Filters
Regional Citrate Anticoagulation
Citrasate
Heparinoids
Direct Thrombin Inhibitors
Platelet Inhibiting Agents
Tunneled catheter insertion
This document provides information on inserting tunneled dialysis catheters. It discusses the preferred insertion sites being the right internal jugular vein. Potential acute complications during insertion include arterial puncture, pneumothorax, hemothorax, and air embolism. Subacute complications after insertion include suboptimal flow due to malposition, kinking, clots or fibrin sheath formation. Tunnel tract infection is also discussed as a complication requiring antibiotic treatment and catheter removal. The document provides guidance on preventing and managing these potential complications.
Cardiorenal syndrome DR Osama EL-Shahat
1. Cardio-renal syndrome (CRS) describes conditions where acute or chronic dysfunction in one organ induces acute or chronic dysfunction in the other organ.
2. Management of CRS is challenging and involves diuretics, ACE inhibitors, beta blockers, and dialysis. However, treatment outcomes remain poor, with high mortality and rates of rehospitalization.
3. While advances have been made, CRS continues to significantly impact morbidity and mortality. Early multidisciplinary management may help improve outcomes, but effective new therapies are still needed to better treat and prevent this challenging condition.
Hydration for contrast induced nephropathy
LVEDP-guided hydration reduces the risk of CI-AKI and major adverse events at 6 months compared to standard hydration. In a randomized controlled trial of 350 patients with chronic kidney disease undergoing cardiac catheterization, the incidence of CI-AKI was lower in those receiving LVEDP-guided intravenous fluids (8%) compared to standard hydration (23%). LVEDP-guided hydration also reduced the composite of death, myocardial infarction, or need for renal replacement therapy at 6 months. No safety issues were reported with LVEDP measurement or fluid administration in this trial.
Hif ph inhibitors for anemia in ckd
HIF PH inhibitors stabilize HIF and stimulate endogenous EPO production, facilitating erythropoiesis and improving iron metabolism in CKD patients. Compared to ESAs, HIF PH inhibitors maintain physiological EPO levels, decrease cardiovascular risks, and reduce need for rescue therapies like transfusions. By coordinating EPO production, iron transport, and hepcidin inhibition, HIF PH inhibitors provide a targeted approach to anemia in CKD.
Acute on Chronic Liver Failure (ACLF)
This document discusses acute-on-chronic liver failure (ACLF). It summarizes the definitions of ACLF provided by various societies/organizations and compares their inclusion/exclusion criteria and timeframes. It describes the progression of cirrhosis and competing risks. Triggers of ACLF decompensation vary globally. The liver failure grading system and AARC model for predicting ACLF outcomes are summarized. Organ dysfunction rather than failure should prompt ACLF diagnosis. Acute variceal bleeding alone does not constitute an acute hepatic insult.
Basic principles of hemodialysis final
This document discusses the basic principles of hemodialysis. It covers:
1) Hemodialysis aims to remove waste, correct electrolytes, and remove excess fluids via diffusion, convection, and ultrafiltration across a semi-permeable membrane.
2) Countercurrent blood-dialysate flow maintains the concentration gradient to increase solute removal efficiency.
3) Clearance depends on factors like molecular weight, blood/dialysate flow rates, and dialyzer properties. Higher blood flows and matching dialysate flows can improve clearance.
Anemia in ckd
This document discusses chronic kidney disease (CKD), anemia in CKD, and treatments for anemia in CKD. It defines CKD and its stages based on glomerular filtration rate and kidney damage. Anemia in CKD is defined based on hemoglobin levels. Causes of anemia in CKD include relative erythropoietin deficiency, iron deficiency, blood loss, shortened red blood cell lifespan, and the "uremic milieu." Iron therapy and erythropoiesis-stimulating agents (ESAs) are discussed as treatments for anemia in CKD, including criteria for starting therapy, drug options, dosing, monitoring, and dose adjustment.
Anticoagulation in hemodialysis
This document provides an overview of anticoagulation options for hemodialysis. It discusses conventional anticoagulants like unfractionated heparin and low molecular weight heparins. It also covers newer direct thrombin inhibitors and regional anticoagulation methods using citrate or prostacyclin. The risks and benefits of each option are evaluated based on bleeding risks, reversibility, cost, and ability to prevent clotting during hemodialysis procedures. Monitoring requirements and dosing protocols are also reviewed for different anticoagulant regimens.
Acute tubular necrosis
This document provides background information on acute tubular necrosis (ATN). It defines ATN and describes its causes, which can be ischemic or nephrotoxic in nature. The pathophysiology of ATN involves three phases: initiation, maintenance, and recovery. Ischemic ATN is described as occurring on a spectrum with prerenal azotemia. Nephrotoxic ATN involves direct toxicity to tubular cells. Histological examination shows differences between ischemic and toxic forms of ATN. Risk factors, history, physical exam findings, and common causes of ischemic and nephrotoxic ATN are discussed.
ADEQUACY OF HEMODIALYSIS
1. Dialysis adequacy refers to removing sufficient toxins and waste from the blood to prevent adverse health outcomes and is measured by urea clearance and nutritional intake.
2. Urea clearance is the standard measure and is expressed as Kt/V, with a target single pool Kt/V of at least 1.2 per session for patients receiving hemodialysis 3 times a week.
3. Other factors that determine adequacy include residual kidney function, nutrition as measured by normalized protein catabolic rate, and controlling symptoms like anemia, acidosis, and blood pressure.
Kidney Preservation: method and trends
This document summarizes different methods of kidney preservation for transplantation, including static cold storage and hypothermic machine perfusion. Static cold storage has traditionally been the main method, involving cooling and storing kidneys in preservation solutions. However, machine perfusion may provide advantages like reducing delayed graft function, especially for expanded criteria donors. While both methods aim to minimize damage during cold storage, machine perfusion allows monitoring and restoring organ viability before transplantation. Future areas of research include evaluating marginal kidneys and predicting transplant outcomes through biomarkers and other machine perfusion techniques.
Intra dialytic hypotension ,,, prof Alaa Sabry
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.
Diabetic kidney disease
Diabetic kidney disease, also called diabetic nephropathy, is a type of chronic kidney disease caused by damage to the kidneys as a result of diabetes. Over time, high blood glucose levels associated with diabetes can damage the tiny filters in the kidneys called glomeruli. This can progressively reduce their ability to filter waste from the blood, potentially leading to kidney failure. Symptoms of diabetic kidney disease may include swelling, poor sleep or concentration, nausea or weakness. It can be diagnosed through urine and blood tests and managed through strict control of blood sugar and blood pressure levels.
Evaluation of peritoneal membrane
The evaluation of peritoneal membrane is very important for selection of appropriate modality of peritoneal dialysis. Peritoneal membrane is a living membrane so periodic evaluation is important.
Chronic Kidney Disease: Diagnosis and management
This document discusses chronic kidney disease, including its definition, epidemiology in India, risk factors and causes, diagnosis, and management. It presents a case study of a 36-year-old lady with weakness, bone pain, edema, and mild renal failure. Her history and lab results are discussed in detail. The document reviews the stages of chronic kidney disease, main categories of causes (pre-renal, renal, post-renal), and risk factors like diabetes, hypertension, obesity, and smoking. Specific conditions that can lead to chronic kidney disease are also outlined such as diabetic nephropathy, glomerulonephritis, tubular disorders, and obstructive nephropathy.
Extracorporeal Therapy - Dr. Samir kamal
This document discusses extracorporeal therapies and renal replacement therapy (RRT). It describes different types of RRT including intermittent hemodialysis, continuous dialysis, and their principles and setup. It covers non-renal uses of RRT such as for sepsis, acute respiratory distress syndrome, congestive heart failure, and more. It also describes hemoperfusion, which uses activated charcoal or resin to adsorb molecules from blood, and issues around preventing clotting during the process.
Role of erythropoitin in chronic kidney disease
1) Erythropoietin (EPO) and novel EPO stimulating proteins (NESPs) play an important role in managing anemia in chronic kidney disease (CKD). EPO therapy aims to increase hemoglobin levels by 1-2 g/dl per month and reduce need for blood transfusions.
2) Intravenous or subcutaneous iron supplementation is also important to manage iron deficiency and allow effective response to EPO. The target is to achieve transferrin saturation between 20-50% and serum ferritin above 100 ng/ml.
3) Causes of resistance to EPO action include iron, folate or carnitine deficiencies, chronic infections, inflammation, and secondary hyperpar
Kidney transplantation candidate evaluation 2016 chaken maniyan
This document provides guidance on evaluating and screening potential renal transplant recipients. It discusses:
1. General concepts to consider include referring all end-stage renal disease patients for transplant evaluation once renal replacement therapy is needed within 12 months, and encouraging preemptive kidney transplantation when feasible.
2. The evaluation process involves assessing medical history and conditions, performing initial screening tests, and evaluating any cardiovascular, infectious, or other systemic diseases to identify any absolute contraindications to transplantation or conditions requiring further treatment and monitoring.
3. Cardiovascular disease is a major cause of death for transplant recipients, so candidates undergo cardiac screening and testing based on risk factors to clear them for surgery or identify any need for pre-operative cardiac
Renal replacement therapy_
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.
Hyperkalemia
This document discusses potassium homeostasis and hyperkalemia. It notes that potassium is mainly intracellular and its levels are regulated by the kidneys, sodium-potassium pump, and aldosterone. Causes of hyperkalemia include intracellular shifts, decreased excretion, and excess intake. Clinical features range from asymptomatic to muscle weakness to arrhythmias. ECG changes correlate with potassium levels and include peaked T waves, PR prolongation, and eventually a sine wave pattern. Treatment focuses on antagonizing cardiac effects with calcium, driving potassium intracellularly with insulin/beta-agonists, and removing it through cation exchange resins, diuretics, or hemodialysis.
GFR & I'ts Regulation
This document discusses glomerular filtration rate (GFR) and its regulation. GFR is a measure of the total amount of filtrate formed by the kidneys per minute. Glomerular filtration is the first step of urine formation and involves filtration of fluid through glomerular capillaries into Bowman's capsule. GFR can be estimated using measurements of inulin clearance, radioactive tracers, or creatinine-based approximations. GFR is regulated through mechanisms like autoregulation, neural regulation, hormonal regulation, and the renin-angiotensin-aldosterone system.
Acute Kidney Injury
This document discusses acute kidney injury (AKI). It begins with the anatomy and function of the kidney, explaining that the nephron is the functional unit that produces urine. It then discusses definitions of AKI and acute renal failure (ARF), noting they are not synonymous, with AKI encompassing a spectrum of injury. Common causes of AKI are also summarized, including decreased renal perfusion, intrinsic renal disease, and urinary tract obstruction. Stages of AKI severity are described using the RIFLE criteria of Risk, Injury and Failure. Incidence of AKI in intensive care unit patients is estimated between 5-20% with high mortality.
More Related Content
What's hot
Tunneled catheter insertion
This document provides information on inserting tunneled dialysis catheters. It discusses the preferred insertion sites being the right internal jugular vein. Potential acute complications during insertion include arterial puncture, pneumothorax, hemothorax, and air embolism. Subacute complications after insertion include suboptimal flow due to malposition, kinking, clots or fibrin sheath formation. Tunnel tract infection is also discussed as a complication requiring antibiotic treatment and catheter removal. The document provides guidance on preventing and managing these potential complications.
Cardiorenal syndrome DR Osama EL-Shahat
1. Cardio-renal syndrome (CRS) describes conditions where acute or chronic dysfunction in one organ induces acute or chronic dysfunction in the other organ.
2. Management of CRS is challenging and involves diuretics, ACE inhibitors, beta blockers, and dialysis. However, treatment outcomes remain poor, with high mortality and rates of rehospitalization.
3. While advances have been made, CRS continues to significantly impact morbidity and mortality. Early multidisciplinary management may help improve outcomes, but effective new therapies are still needed to better treat and prevent this challenging condition.
Hydration for contrast induced nephropathy
LVEDP-guided hydration reduces the risk of CI-AKI and major adverse events at 6 months compared to standard hydration. In a randomized controlled trial of 350 patients with chronic kidney disease undergoing cardiac catheterization, the incidence of CI-AKI was lower in those receiving LVEDP-guided intravenous fluids (8%) compared to standard hydration (23%). LVEDP-guided hydration also reduced the composite of death, myocardial infarction, or need for renal replacement therapy at 6 months. No safety issues were reported with LVEDP measurement or fluid administration in this trial.
Hif ph inhibitors for anemia in ckd
HIF PH inhibitors stabilize HIF and stimulate endogenous EPO production, facilitating erythropoiesis and improving iron metabolism in CKD patients. Compared to ESAs, HIF PH inhibitors maintain physiological EPO levels, decrease cardiovascular risks, and reduce need for rescue therapies like transfusions. By coordinating EPO production, iron transport, and hepcidin inhibition, HIF PH inhibitors provide a targeted approach to anemia in CKD.
Acute on Chronic Liver Failure (ACLF)
This document discusses acute-on-chronic liver failure (ACLF). It summarizes the definitions of ACLF provided by various societies/organizations and compares their inclusion/exclusion criteria and timeframes. It describes the progression of cirrhosis and competing risks. Triggers of ACLF decompensation vary globally. The liver failure grading system and AARC model for predicting ACLF outcomes are summarized. Organ dysfunction rather than failure should prompt ACLF diagnosis. Acute variceal bleeding alone does not constitute an acute hepatic insult.
Basic principles of hemodialysis final
This document discusses the basic principles of hemodialysis. It covers:
1) Hemodialysis aims to remove waste, correct electrolytes, and remove excess fluids via diffusion, convection, and ultrafiltration across a semi-permeable membrane.
2) Countercurrent blood-dialysate flow maintains the concentration gradient to increase solute removal efficiency.
3) Clearance depends on factors like molecular weight, blood/dialysate flow rates, and dialyzer properties. Higher blood flows and matching dialysate flows can improve clearance.
Anemia in ckd
This document discusses chronic kidney disease (CKD), anemia in CKD, and treatments for anemia in CKD. It defines CKD and its stages based on glomerular filtration rate and kidney damage. Anemia in CKD is defined based on hemoglobin levels. Causes of anemia in CKD include relative erythropoietin deficiency, iron deficiency, blood loss, shortened red blood cell lifespan, and the "uremic milieu." Iron therapy and erythropoiesis-stimulating agents (ESAs) are discussed as treatments for anemia in CKD, including criteria for starting therapy, drug options, dosing, monitoring, and dose adjustment.
Anticoagulation in hemodialysis
This document provides an overview of anticoagulation options for hemodialysis. It discusses conventional anticoagulants like unfractionated heparin and low molecular weight heparins. It also covers newer direct thrombin inhibitors and regional anticoagulation methods using citrate or prostacyclin. The risks and benefits of each option are evaluated based on bleeding risks, reversibility, cost, and ability to prevent clotting during hemodialysis procedures. Monitoring requirements and dosing protocols are also reviewed for different anticoagulant regimens.
Acute tubular necrosis
This document provides background information on acute tubular necrosis (ATN). It defines ATN and describes its causes, which can be ischemic or nephrotoxic in nature. The pathophysiology of ATN involves three phases: initiation, maintenance, and recovery. Ischemic ATN is described as occurring on a spectrum with prerenal azotemia. Nephrotoxic ATN involves direct toxicity to tubular cells. Histological examination shows differences between ischemic and toxic forms of ATN. Risk factors, history, physical exam findings, and common causes of ischemic and nephrotoxic ATN are discussed.
ADEQUACY OF HEMODIALYSIS
1. Dialysis adequacy refers to removing sufficient toxins and waste from the blood to prevent adverse health outcomes and is measured by urea clearance and nutritional intake.
2. Urea clearance is the standard measure and is expressed as Kt/V, with a target single pool Kt/V of at least 1.2 per session for patients receiving hemodialysis 3 times a week.
3. Other factors that determine adequacy include residual kidney function, nutrition as measured by normalized protein catabolic rate, and controlling symptoms like anemia, acidosis, and blood pressure.
Kidney Preservation: method and trends
This document summarizes different methods of kidney preservation for transplantation, including static cold storage and hypothermic machine perfusion. Static cold storage has traditionally been the main method, involving cooling and storing kidneys in preservation solutions. However, machine perfusion may provide advantages like reducing delayed graft function, especially for expanded criteria donors. While both methods aim to minimize damage during cold storage, machine perfusion allows monitoring and restoring organ viability before transplantation. Future areas of research include evaluating marginal kidneys and predicting transplant outcomes through biomarkers and other machine perfusion techniques.
Intra dialytic hypotension ,,, prof Alaa Sabry
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.
Diabetic kidney disease
Diabetic kidney disease, also called diabetic nephropathy, is a type of chronic kidney disease caused by damage to the kidneys as a result of diabetes. Over time, high blood glucose levels associated with diabetes can damage the tiny filters in the kidneys called glomeruli. This can progressively reduce their ability to filter waste from the blood, potentially leading to kidney failure. Symptoms of diabetic kidney disease may include swelling, poor sleep or concentration, nausea or weakness. It can be diagnosed through urine and blood tests and managed through strict control of blood sugar and blood pressure levels.
Evaluation of peritoneal membrane
The evaluation of peritoneal membrane is very important for selection of appropriate modality of peritoneal dialysis. Peritoneal membrane is a living membrane so periodic evaluation is important.
Chronic Kidney Disease: Diagnosis and management
This document discusses chronic kidney disease, including its definition, epidemiology in India, risk factors and causes, diagnosis, and management. It presents a case study of a 36-year-old lady with weakness, bone pain, edema, and mild renal failure. Her history and lab results are discussed in detail. The document reviews the stages of chronic kidney disease, main categories of causes (pre-renal, renal, post-renal), and risk factors like diabetes, hypertension, obesity, and smoking. Specific conditions that can lead to chronic kidney disease are also outlined such as diabetic nephropathy, glomerulonephritis, tubular disorders, and obstructive nephropathy.
Extracorporeal Therapy - Dr. Samir kamal
This document discusses extracorporeal therapies and renal replacement therapy (RRT). It describes different types of RRT including intermittent hemodialysis, continuous dialysis, and their principles and setup. It covers non-renal uses of RRT such as for sepsis, acute respiratory distress syndrome, congestive heart failure, and more. It also describes hemoperfusion, which uses activated charcoal or resin to adsorb molecules from blood, and issues around preventing clotting during the process.
Role of erythropoitin in chronic kidney disease
1) Erythropoietin (EPO) and novel EPO stimulating proteins (NESPs) play an important role in managing anemia in chronic kidney disease (CKD). EPO therapy aims to increase hemoglobin levels by 1-2 g/dl per month and reduce need for blood transfusions.
2) Intravenous or subcutaneous iron supplementation is also important to manage iron deficiency and allow effective response to EPO. The target is to achieve transferrin saturation between 20-50% and serum ferritin above 100 ng/ml.
3) Causes of resistance to EPO action include iron, folate or carnitine deficiencies, chronic infections, inflammation, and secondary hyperpar
Kidney transplantation candidate evaluation 2016 chaken maniyan
This document provides guidance on evaluating and screening potential renal transplant recipients. It discusses:
1. General concepts to consider include referring all end-stage renal disease patients for transplant evaluation once renal replacement therapy is needed within 12 months, and encouraging preemptive kidney transplantation when feasible.
2. The evaluation process involves assessing medical history and conditions, performing initial screening tests, and evaluating any cardiovascular, infectious, or other systemic diseases to identify any absolute contraindications to transplantation or conditions requiring further treatment and monitoring.
3. Cardiovascular disease is a major cause of death for transplant recipients, so candidates undergo cardiac screening and testing based on risk factors to clear them for surgery or identify any need for pre-operative cardiac
Renal replacement therapy_
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.
Hyperkalemia
This document discusses potassium homeostasis and hyperkalemia. It notes that potassium is mainly intracellular and its levels are regulated by the kidneys, sodium-potassium pump, and aldosterone. Causes of hyperkalemia include intracellular shifts, decreased excretion, and excess intake. Clinical features range from asymptomatic to muscle weakness to arrhythmias. ECG changes correlate with potassium levels and include peaked T waves, PR prolongation, and eventually a sine wave pattern. Treatment focuses on antagonizing cardiac effects with calcium, driving potassium intracellularly with insulin/beta-agonists, and removing it through cation exchange resins, diuretics, or hemodialysis.
What's hot (20)
Kidney transplantation candidate evaluation 2016 chaken maniyan
Kidney transplantation candidate evaluation 2016 chaken maniyan
Viewers also liked
GFR & I'ts Regulation
This document discusses glomerular filtration rate (GFR) and its regulation. GFR is a measure of the total amount of filtrate formed by the kidneys per minute. Glomerular filtration is the first step of urine formation and involves filtration of fluid through glomerular capillaries into Bowman's capsule. GFR can be estimated using measurements of inulin clearance, radioactive tracers, or creatinine-based approximations. GFR is regulated through mechanisms like autoregulation, neural regulation, hormonal regulation, and the renin-angiotensin-aldosterone system.
Acute Kidney Injury
This document discusses acute kidney injury (AKI). It begins with the anatomy and function of the kidney, explaining that the nephron is the functional unit that produces urine. It then discusses definitions of AKI and acute renal failure (ARF), noting they are not synonymous, with AKI encompassing a spectrum of injury. Common causes of AKI are also summarized, including decreased renal perfusion, intrinsic renal disease, and urinary tract obstruction. Stages of AKI severity are described using the RIFLE criteria of Risk, Injury and Failure. Incidence of AKI in intensive care unit patients is estimated between 5-20% with high mortality.
Acute Kidney Injury
the presentation highlights on the approach of a patient with AKI: i.e History, physical findings, investigations
The Pathophysiology Of Acute Renal Failure
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
Acute and chronic renal failure
This document discusses acute and chronic renal failure. It defines renal failure and describes how acute failure has a sudden onset and may be reversible, while chronic failure progresses slowly over months and can lead to permanent damage. Causes of acute failure include reduced blood flow or obstruction, while chronic failure may result from conditions like diabetes, hypertension, or glomerulonephritis. Symptoms depend on the type and stage of renal failure. Treatment involves managing fluid, electrolytes, diet, and potentially dialysis or transplantation.
Acute renal failure
This document discusses acute renal failure (ARF) and its causes, definitions, and classifications. It describes the key components of the nephron and how ARF results from a reduction in glomerular filtration rate (GFR). ARF can be classified as pre-renal, renal, or post-renal based on its underlying cause and pathophysiology. The most common type of renal ARF is acute tubular necrosis (ATN), which results from intrinsic injury to the renal tubules.
02 Sperati Prevention And Management Of Acute Renal Failure
This document summarizes key aspects of acute renal failure (ARF), including epidemiology, causes, evaluation, diagnosis, management, and controversies in renal replacement therapy. It discusses common causes of ARF like prerenal azotemia, acute tubular necrosis, and rhabdomyolysis. Evaluation involves assessing urine output, electrolytes, fractional excretion of sodium, and distinguishing prerenal from intrinsic renal failure. Management is generally conservative and supportive, with renal replacement therapy as needed. Ongoing research aims to determine the optimal dose and modality of renal replacement therapy.
PREVIEW OF EMT/EMT SHOCK & RESUSCITATION POWERPOINT TRAINING PRESENTATION
This document provides an overview of a powerpoint presentation on shock and resuscitation. It discusses ethical issues in resuscitation including withholding attempts, irreversible death, and do not resuscitate orders. It also covers providing emotional support for family members. Signs of irreversible death and details about do not resuscitate orders are described. The document then reviews anatomy and physiology of the respiratory and cardiovascular systems as well as causes, types, signs, and treatments of shock. Specific information is given on pediatric and geriatric assessments for shock.
Acute renal failure (arf)
This document discusses acute kidney injury (AKI), formerly known as acute renal failure. It defines AKI and provides causes and characteristics of pre-renal, renal, and post-renal AKI. Pre-renal AKI is caused by decreased renal perfusion due to issues like volume depletion or heart failure. Renal AKI can be caused by issues affecting the glomeruli, interstitium, or tubules, such as acute tubular necrosis. Post-renal AKI is due to urinary tract obstruction. The document outlines evaluation of AKI including history, exam, urine and serum tests, imaging, and novel biomarkers. It also discusses complications of AKI and general management strategies.
Assessing kidney function — measured
The document discusses methods of measuring and estimating glomerular filtration rate (GFR) to assess kidney function. It outlines two main methods - directly measuring GFR using exogenous or endogenous filtration markers in the blood or urine, and estimating GFR using equations like Cockcroft-Gault and MDRD study equation. While direct measurement is most accurate, estimated GFR using equations is sufficient for detecting, monitoring, and managing chronic kidney disease in most patients. Estimates are less accurate in populations without known chronic kidney disease.
Prof. el nahas.what is new in ckd.
The document discusses recent changes to chronic kidney disease (CKD) classification and definitions. It summarizes the new KDIGO classification system which further divides stage 3 CKD into 3A and 3B based on glomerular filtration rate. It also discusses the new definition of albuminuria using albumin-to-creatinine ratio and notes limitations of estimating glomerular filtration rate using formulas in the general population for distinguishing early CKD stages. The document emphasizes calculating GFR is not the same as directly measuring it.
Pathophysiology of acute kidney injury
short speech describing the major pathophysiological processes responsible for acute kidney injury understood.
Aki icu
This document discusses the diagnosis and management of acute kidney injury (AKI) in the intensive care unit (ICU). It defines AKI and outlines biomarkers that can help identify it earlier than creatinine. Common causes of AKI in the ICU include sepsis, major surgery, low cardiac output, and medications. The document reviews risk factors for developing AKI and strategies for preventing it, such as fluid management and avoiding nephrotoxins. It discusses general management of established AKI including nutrition, anticoagulation, and dialysis. The impact of renal replacement therapy on outcomes is also addressed.
Acute Renal Failure Overview
Acute renal failure, also known as acute kidney injury, is defined as an abrupt loss of kidney function that develops within 7 days. It is characterized by a decrease in creatinine clearance and increases in blood urea nitrogen and creatinine levels. Acute renal failure can be caused by pre-renal issues that decrease blood flow to the kidneys, intrinsic renal issues that damage the kidneys, or post-renal issues that obstruct urine flow. The condition is diagnosed through blood and urine tests and imaging and treated by addressing the underlying cause, giving intravenous fluids, and providing renal replacement therapies like hemodialysis in severe cases.
Acute renal failure
Acute renal failure (ARF) is defined as a rapid reduction in kidney function resulting in build-up of waste products. It can be prerenal (functional), renal (structural), or postrenal (obstruction). Common causes include decreased blood flow, nephrotoxins, and urinary tract obstruction. Patients may present with edema, electrolyte abnormalities, and uremic symptoms. Diagnosis involves urine and blood tests. Treatment focuses on treating the underlying cause, fluid management, and sometimes dialysis.
Treatment of Hypertension Treatment of Hypertension
This document summarizes guidelines for treating hypertension. It defines hypertension and classifications of blood pressure. The goals of treatment are to reduce risks of stroke, heart disease, heart failure, and kidney disease. Lifestyle changes and medication are used to achieve a target blood pressure of less than 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease. Initial drug therapy typically involves thiazide diuretics alone or combined with other classes of drugs depending on individual risk factors and medical conditions. Special considerations are given to treating hypertension in pregnancy, kidney disease, heart disease and other compelling indications.
Creatinine clearance: When Does It Matter?
This document provides information on estimating kidney function and adjusting drug dosing in patients with chronic kidney disease (CKD). It describes the differences between creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR), and their respective formulas (Cockcroft-Gault and MDRD/CKD-EPI). While both CrCl and eGFR can be used to estimate kidney function and guide drug dosing, CrCl may be preferred in the elderly and for drugs with a narrow therapeutic index. The document reviews drug classes that commonly require dosage adjustments in CKD and provides an example case of adjusting anticoagulation therapy in a patient with CKD.
Acute Renal Failure in Neonates
This document discusses acute renal failure in neonates, including:
1. The causes of acute renal failure in neonates including pre-renal, intrinsic renal, and post-renal failure.
2. The assessment of neonates with acute renal failure involving a thorough history, physical exam, lab tests including urinalysis and renal function tests, and imaging like ultrasound and voiding cystourethrography.
3. Key factors in evaluating acute renal failure in neonates are differentiating pre-renal from intrinsic renal failure using urine indices, identifying associated anomalies, assessing for urinary tract obstruction, and monitoring for complications like Potter sequence.
Cerebellum by dr.gourav thakre 20 03-2012
This document provides an overview of the cerebellum, including its external features, subdivisions, cytoarchitecture, connections, circuitry, development, blood supply, and functions. Key points include:
- The cerebellum is located in the posterior cranial fossa and is divided into hemispheres, vermis, and lobes.
- It contains three layers - molecular, Purkinje cell, and granular layers. Purkinje cells are the sole output.
- Afferents include mossy and climbing fibers from the spinal cord, brainstem, and cortex. Efferents project to brainstem and thalamus.
- Functions include maintenance of posture and coordination of voluntary movement. It is involved
Cerebellum
The cerebellum is located at the back of the brain below the occipital and temporal lobes. It consists of two hemispheres, a vermis, and four lobes. The cerebellum contains grey matter on the outside forming the cerebellar cortex with three layers, and white matter on the inside. It receives input from climbing fibers in the medulla and mossy fibers from other brain regions. The cerebellum is divided into three sections based on function - vestibulocerebellum regulates tone and equilibrium, spinocerebellum regulates tone and movement, and corticocerebellum regulates skilled movement. The cerebellum plays an important role in motor control and coordination through these functions.
Viewers also liked (20)
02 Sperati Prevention And Management Of Acute Renal Failure
02 Sperati Prevention And Management Of Acute Renal Failure
PREVIEW OF EMT/EMT SHOCK & RESUSCITATION POWERPOINT TRAINING PRESENTATION
PREVIEW OF EMT/EMT SHOCK & RESUSCITATION POWERPOINT TRAINING PRESENTATION
Treatment of Hypertension Treatment of Hypertension
Treatment of Hypertension Treatment of Hypertension
Similar to E Gfr 2008
Cystatin-C-as-a-Marker-of-Renal-Function.pptx
The document discusses cystatin C as a marker for renal function and compares it to creatinine. It notes that cystatin C is superior to creatinine for estimating glomerular filtration rate (GFR) and detecting early stages of chronic kidney disease. Unlike creatinine, cystatin C levels are unaffected by factors like age, muscle mass, and gender. Multiple studies cited found cystatin C to be more accurate than creatinine-based estimates for detecting early renal impairment in diabetes patients and predicting cardiovascular outcomes. The document concludes cystatin C is a more sensitive GFR marker that can improve detection of kidney disease.
INTERPRETATION OF RENAL FUNCTION TESTS.pdf
The document discusses renal function tests and their interpretation. It provides information on various tests used to evaluate kidney function, including blood urea nitrogen, serum creatinine, and creatinine clearance. It defines different types of azotemia and outlines stages of chronic kidney disease based on estimated glomerular filtration rate and albumin-creatinine ratio. The document also discusses equations used to estimate glomerular filtration rate, including MDRD4, CKD-EPI, Cockcroft-Gault, and Jelliffe, noting their uses and limitations.
Pitfalls in estimating renal failure in the elderly by eGFR
The document discusses methods of estimating glomerular filtration rate (GFR) including direct and indirect assessments. Direct assessments involve clearance tests using exogenous or endogenous substances like inulin, iohexol, creatinine, and cystatin C. Indirect assessments utilize estimating equations like Cockcroft-Gault, MDRD, and CKD-EPI which take factors like age, sex, and creatinine levels into account. The CKD-EPI equation is currently recommended for GFR estimation in adults. Age-related declines in GFR are also discussed.
Interpretation of renal diagnostic tests
This document discusses methods for assessing renal function and damage, including estimated glomerular filtration rate (eGFR) and albuminuria. It describes the functions of the nephron including filtration, reabsorption, and secretion. Endogenous and exogenous markers for measuring GFR are discussed, along with the limitations of creatinine as an endogenous marker. Different formulas for estimating GFR, such as Cockcroft-Gault, MDRD, and CKD-EPI, are summarized along with their derivation populations. The performance of estimating equations compared to direct measurement of GFR is also reviewed.
Correlation of Serum Creatinine Based Calculation of Glomerular Filtration Ra...
INTRODUCTION GFR is best index of kidney function in health and disease and accurate values are needed for optimal decision making in clinical settings. Estimated GFR eGFR based on serum creatinine is first line test of kidney function. CG formula is creatinine based equation and widely applied. Tc99m DTPA Diethylene Triamine Penta Acetic acid is the most commonly used radiopharmaceutical for GFR studies. The Gate method has been most common in the routine setting. AIM AND OBJECTIVES To study correlation of serum creatinine based calculation of GFR with measured ratio isotope GFR in healthy individuals and CKD patients. To assess the accuracy of GFR as calculated by CG GFR formulae using serum creatinine against measured RI GFR Tc 99m DTPA . METHODS This study observational study, which is done in department of medicine and department of nuclear medicine at Army Hospital RandR, Delhi Cantt in CKD and healthy individuals. Our study includes a total of 100 subjects with varying renal functions which includes 50 healthy individual and 50 CKD patients. RESULTS In this study it has been observed that in healthy group CG GFR has weak correlation with DTPA GFR r = 0.104 with p 0.471 . Lt Col (Dr.) Rahul Soni | Dr. Jayita Debnath "Correlation of Serum Creatinine Based Calculation of Glomerular Filtration Rate with Measured Radio Isotope Glomerular Filtration Rate in Healthy Individuals and Chronic Kidney Disease Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38443.pdf Paper Url: https://www.ijtsrd.com/medicine/other/38443/correlation-of-serum-creatinine-based-calculation-of-glomerular-filtration-rate-with-measured-radio-isotope-glomerular-filtration-rate-in-healthy-individuals-and-chronic-kidney-disease-patients/lt-col-dr-rahul-soni
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
Approach to Chronic Kidney Diseases
1) The document discusses the approach to chronic kidney disease (CKD). It defines CKD and outlines its stages based on glomerular filtration rate and albuminuria levels.
2) Risk factors for CKD mentioned include diabetes, hypertension, family history of kidney disease, use of certain medications, and prior acute kidney injury. The pathogenesis of CKD involves initial injury followed by adaptive hyperfiltration and long-term damage to remaining nephrons.
3) Evaluation of patients with suspected CKD involves obtaining a history, physical exam, lab tests including serum creatinine and urine analysis, and imaging like renal ultrasound. A kidney biopsy may be done if disease-specific therapy is still possible.
Gagal ginjal
1. Chronic kidney disease (CKD) is defined as kidney damage or decreased kidney function lasting at least 3 months. It is staged based on glomerular filtration rate (GFR) from normal kidney function to kidney failure.
2. The most common causes of CKD are diabetes, hypertension, glomerulonephritis, and polycystic kidney disease. As CKD progresses, patients experience complications such as anemia, bone disease, cardiovascular disease, and metabolic acidosis.
3. Management of CKD focuses on slowing progression, treating complications, and preparing for renal replacement therapy if kidney failure occurs. Key interventions include blood pressure control, diabetes management, treatment of anemia, and dietary modifications.
Ckd Micro1
- The global prevalence of end-stage renal disease (ESRD) has increased dramatically from 426,000 cases in 1990 to over 2 million cases in 2010.
- Chronic kidney disease (CKD) affects 10-15% of the population but often goes undetected. Stages of CKD are defined based on glomerular filtration rate (GFR) and the presence of kidney damage or complications.
- People with CKD are at high risk for cardiovascular disease even with mild reductions in GFR. Management involves screening high-risk groups, controlling risk factors like blood pressure and proteinuria, and treating complications like anemia and bone disease.
Chronic Kidney Disease & Diabetic Kidney Diseases
The document provides guidance from NICE on testing and managing chronic kidney disease (CKD) and diabetic kidney disease. It recommends testing people with diabetes, hypertension, cardiovascular disease or a family history of CKD to check for renal disease. It advises measuring estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) annually. Abnormal results should be confirmed with a repeat test. The guidance outlines treatment targets for blood pressure and referral criteria for nephrology assessment. It discusses the rationale for the guidelines, including evidence that angiotensin-converting enzyme inhibitors (ACEi) can slow CKD progression independently of blood pressure lowering.
Pruebas de función renal - 2015
This document summarizes various methods for estimating glomerular filtration rate (GFR) using creatinine and other biomarkers. It discusses the Cockcroft-Gault equation developed in 1976, the Modification of Diet in Renal Disease (MDRD) study from 1999, and the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation from 2009. These equations use variables like creatinine, age, sex and race to estimate GFR. More recent methods estimate GFR using cystatin C levels. The document also reviews biomarkers for detecting acute kidney injury, including neutrophil gelatinase-associated lipocalin, kidney injury molecule 1, interleukin 18, and liver-type fatty acid binding
Gliclazide in DKD - Case Study.pptx
1) This case study describes a 60-year-old female patient with type 2 diabetes, hypertension, and dyslipidemia who is showing signs of declining kidney function and diabetic kidney disease.
2) Her HbA1c, blood pressure, lipids, and urine albumin levels have worsened over the past year despite treatment with metformin, glimepiride, and other medications.
3) Treatment options discussed include adding a DPP-4 inhibitor or SGLT2 inhibitor, or switching from glimepiride to gliclazide to help control blood sugar levels while avoiding further kidney damage and hypoglycemia. Gliclazide is presented as a safer option compared to other sulf
E gfr for web
1. The publication of new UK guidelines for Chronic Kidney Disease in 2005 led to changes in how renal impairment is classified and estimated glomerular filtration rate (eGFR) is now routinely reported.
2. While eGFR provides a quick assessment of kidney function, it should not be used to calculate drug dosages because it is standardized to a body surface area of 1.73m2 and can over or under estimate renal function in individuals.
3. The Cockcroft-Gault equation, which estimates creatinine clearance based on creatinine levels, age, gender and weight, is preferable for calculating drug dosages in patients with renal impairment.
Kideny function test
Renal function tests can help screen and monitor patients for kidney disease. The creatinine and BUN can be elevated by factors other than kidney disease, such as increased protein intake or muscle breakdown. To determine if acute renal failure is prerenal or renal (ATN), fractional excretion of sodium and urea are used, with prerenal azotemia having FENa <1% and FEUrea <35%. Estimating glomerular filtration rate (GFR) stages chronic kidney disease.
ภาวะแทรกซ้อนทางไตในผู้ป่วยเบาหวาน
This document discusses diabetic kidney disease (DKD). It begins by outlining the prevalence and scope of DKD, defining DKD, and listing the optimal management of DKD as topics. It then provides details on the diagnosis of DKD, including the earliest clinical evidence being microalbuminuria. It discusses screening guidelines and measuring urinary protein. It outlines the stages of chronic kidney disease and strategies for treating DKD, including blood glucose control, blood pressure control, and lifestyle modifications. Target HbA1c levels for preventing DKD complications are also discussed.
Lupus Nephritis Guideline Review 2022
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
Pharmacotherapy of renal failure
The document discusses renal failure and chronic kidney disease (CKD). It defines acute and chronic renal failure and how they are diagnosed using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR). CKD is diagnosed if abnormalities are present for over 3 months. The document outlines management of CKD including treatment of complications like anemia, electrolyte imbalances, mineral metabolism abnormalities, and medication dosing considerations. It emphasizes regularly monitoring kidney function and adjusting medications according to glomerular filtration rate.
Chronic kidney disease how a deeper understanding of the disease is impacting...
The document discusses chronic kidney disease and its complications. It notes that CKD is a major public health issue that is increasing in frequency and prevalence. CKD is recognized as an independent risk factor for cardiovascular disease and other adverse health outcomes. The document reviews definitions and staging of CKD, tests used to evaluate kidney function like estimated GFR, complications of CKD like cardiovascular disease, and considerations for clinical studies in CKD.
MSDApril2013 diabetes renal-2
This document discusses diabetic nephropathy and chronic kidney disease. It covers the stages of chronic kidney disease, risk factors for diabetic nephropathy like hypertension and smoking, and treatments to slow progression like controlling blood pressure and blood sugar levels. It also provides information on different drug treatments for diabetes like DPP-4 inhibitors and sulfonylureas and their use in patients with renal impairment.
Similar to E Gfr 2008 (20)
Pitfalls in estimating renal failure in the elderly by eGFR
Pitfalls in estimating renal failure in the elderly by eGFR
Correlation of Serum Creatinine Based Calculation of Glomerular Filtration Ra...
Correlation of Serum Creatinine Based Calculation of Glomerular Filtration Ra...
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
Chronic kidney disease how a deeper understanding of the disease is impacting...
Chronic kidney disease how a deeper understanding of the disease is impacting...
Recently uploaded
Digital Artifact 1 - 10VCD Environments Unit
Digital Artifact 1 - 10VCD Environments Unit - NGV Pavilion Concept Design
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Your Skill Boost Masterclass: Strategies for Effective UpskillingExcellence Foundation for South Sudan
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Advanced Java[Extra Concepts, Not Difficult].docx
This is part 2 of my Java Learning Journey. This contains Hashing, ArrayList, LinkedList, Date and Time Classes, Calendar Class and more.
Executive Directors Chat Leveraging AI for Diversity, Equity, and Inclusion
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Main Java[All of the Base Concepts}.docx
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
RPMS TEMPLATE FOR SCHOOL YEAR 2023-2024 FOR TEACHER 1 TO TEACHER 3
RPMS Template 2023-2024 by: Irene S. Rueco
clinical examination of hip joint (1).pdf
described clinical examination all orthopeadic conditions .
Pollock and Snow "DEIA in the Scholarly Landscape, Session One: Setting Expec...
Pollock and Snow "DEIA in the Scholarly Landscape, Session One: Setting Expec...National Information Standards Organization (NISO)
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.ANATOMY AND BIOMECHANICS OF HIP JOINT.pdf
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
CACJapan - GROUP Presentation 1- Wk 4.pdf
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)Academy of Science of South Africa
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.Azure Interview Questions and Answers PDF By ScholarHat
Azure Interview Questions and Answers PDF By ScholarHat
Advantages and Disadvantages of CMS from an SEO Perspective
Advantages and Disadvantages of CMS from an SEO Perspective
Recently uploaded (20)
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Your Skill Boost Masterclass: Strategies for Effective Upskilling
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Executive Directors Chat Leveraging AI for Diversity, Equity, and Inclusion
Executive Directors Chat Leveraging AI for Diversity, Equity, and Inclusion
Film vocab for eal 3 students: Australia the movie
Film vocab for eal 3 students: Australia the movie
Digital Artefact 1 - Tiny Home Environmental Design
Digital Artefact 1 - Tiny Home Environmental Design
RPMS TEMPLATE FOR SCHOOL YEAR 2023-2024 FOR TEACHER 1 TO TEACHER 3
RPMS TEMPLATE FOR SCHOOL YEAR 2023-2024 FOR TEACHER 1 TO TEACHER 3
Pollock and Snow "DEIA in the Scholarly Landscape, Session One: Setting Expec...
Pollock and Snow "DEIA in the Scholarly Landscape, Session One: Setting Expec...
South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)
Azure Interview Questions and Answers PDF By ScholarHat
Azure Interview Questions and Answers PDF By ScholarHat
Advantages and Disadvantages of CMS from an SEO Perspective
Advantages and Disadvantages of CMS from an SEO Perspective
E Gfr 2008
- 1. e GFR : Implications, Limitations & Clinical applications Malvinder S. Parmar MB, MS, FRCPC, FACP, FASN Associate Professor, Northern Ontario Medical School Assistant Professor, University of Ottawa
- 2. ‘ EGFR’ vs ‘ e GFR’ What is the difference?
- 3. EGFR
- 8. Kidney failure – rapidly growing
- 9. Incident ESRD Patients by Age Group, Canada, 1981-2004* (Age-specific Rates Per Million Population) *Estimates are used for years 2002-2004 inclusive to account for underreporting. Source: Canadian Organ Replacement Register, Canadian Institute for Health Information (2005)
- 11. Lots of stage 3, little stage 4 and stage 5 Either patients die after stage 3, or Don’t progress beyond stage 3, and Some are misclassified
- 12. CKD Staging
- 13. Serum Creatinine Predicts Mortality Hypertension Detection and Follow-up Program - 1989 Shulman NB et al. Hypertension. 1989 ; 13(5 Suppl):I80-193. 0 12 24 36 48 60 72 84 96 Months of Follow-up Cumulative Mortality % >220, n = 72 177-220, n = 78 150-176, n = 147 133-175, n = 326 106-132, n = 2142 <106, n = 8003 Creatinine 40 50 60 30 20 10 0
- 14. CKD & Risk of Death Go et al NEJM 2004
- 20. ‘Normal’ GFR & Age Similar declines in NHANES 1988-94 and 1999-2000 Coresh et al JASN 2005
- 21. GFR [Inulin clearance] with age In subjects without kidney disease Stevens LA NEJM 2006
- 22. Low GFR is common in Older Adults Coresh et al JASN 2005
- 24. Stable serum creatinine from 20-100 How is this possible?
- 25. Changes in GFR & Muscle Mass with Age Serum Creatinine GFR Muscle Mass
- 30. GFR prediction equations Cockroft-Gault (140 - age) x weight/72 x S cr (x 0.85 if female) MDRD 1 [6v] 170 x S cr -0.999 x age -0.176 x (0.762 if female) x (1.180 if black) xS u -0.170 x Alb +0.318 MDRD 2 [4v] 186 x S cr -1.154 x age -0.203 x (1.212 if black) x (0.742 if female) Jelliffe 1 98 - 0.8 x (age - 20)/S cr (x 0.90 if female) Jelliffe 2 Male: 100/S cr - 12 Female: 80/S cr - 7 Mawer Male: weight x [29.3 - (0.203 x age)] x [1 - (0.03 x S cr )]/(14.4 x S cr ) x (70/weight) Female: weight x [25.3 - (0.175 x age)] x [1 - (0.03 x S cr )]/(14.4 x S cr ) x (70/weight) Bjornsson Male: [27 - (0.173 x age)] x weight x 0.07/S cr Female: [25 - (0.175 x age)] x weight x 0.07/S cr Gates Male: (89.4 xS cr -1.2 ) + (55 - age) x (0.447 xS cr -1.1 ) Female: (60 xS cr -1.1 ) + (56 - age) x (0.3 xS cr -1.1 )
- 32. Measured & Estimated GFR [ e GFR]
- 34. Scatter increases as GFR approaches physiological levels [ Froissart et al 2005 ]
- 40. Instrument to instrument variation in reported creatinine given a true creatinine value of 100 µ mol/L
- 41. Calibration and population estimates Stage 3 12.5% Stage 3 3.2% -20 umol/L NHANES (Clase et al JASN 2002) MDRD – Cleveland Clinic Foundation, Kinetic Jaffe, Beckman Astra CX3 NHANES - White Sands, Kinetic Jaffe, Hitachi 737 (20 umol/L>CCF)
- 43. Stage of kidney function CKD Staging As LV Function
- 45. e GFR reporting in Ontario [MDS]
- 48. Complications progress as KF declines Stevens LA NEJM 2006
- 49. Anemia & CKD Anemia begins early & progresses as kidney function declines
- 51. Parmar, MS BMJ 2002
- 52. Patient with CKD: Approach Stage 1 CKD Stage 2 CKD Stage 3 CKD, stable Detection Triage Management New patient with CKD Primary care Non-renal specialty e.g. diabetes, cardiac, care of elderly, vascular surgery, hypertension Direct admission to kidney unit Primary care investigation, management and monitoring Specialist nephrology Known patient with CKD Stage 3 CKD, progressive Stage 4 CKD Stage 5 CKD Laboratory results
- 56. Incidence of Contrast Nephropathy GFR [mi/min] >60 <60 >60 <60 LVEF [%] >40 >40 <40 <40 Marenzi et al NEJM 2006
- 60. Incidence of CN [>25% increase in creatinine] Marenzi et al NEJM 2006 Overall, CN occurred in 66 [19%]
- 61. Incidence of CN, based on GFR Marenzi et al NEJM 2006
- 62. Incidence of CN based on LVEF Marenzi et al NEJM 2006
- 64. Thank you “ A classic is a book that has never finished saying what it has to say” Italo Calvino (1923-1985), Italian Writer
- 65. MDRD & Creatinine clearance