1. Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function lasting more than 3 months, including decreased glomerular filtration rate (GFR) <60 mL/min/1.73m2 or markers of kidney damage.
2. Dietary management of CKD involves restricting sodium, potassium, phosphorus, and fluid intake depending on the stage of disease. Protein intake is usually moderately restricted.
3. Common complications of CKD include anemia, bone mineral disorders, cardiovascular disease, electrolyte abnormalities, acidosis, and hypertension. Treatment involves controlling risk factors and managing complications through diet, medications, dialysis or transplant.
This document presents the case of a 50-year-old female diabetic patient referred for evaluation of renal impairment. Her creatinine had risen from 1.3 to 3.8 over the past year. She has a history of diabetes, hypertension, and diabetic retinopathy. On examination, she has lower limb edema. Tests show anemia, hyperkalemia, and high HbA1c. The provisional diagnosis is chronic kidney disease likely due to her long-standing diabetes, with complications of hyperkalemia and uncontrolled diabetes. The plan is to control her blood sugar and potassium, restrict diet, and regularly monitor her kidney function and diabetes.
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 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 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.
This document provides a summary of a presentation on the management of anemia and mineral bone disorders in chronic kidney disease. It defines anemia and its causes in CKD, including relative erythropoietin deficiency and iron deficiency. It outlines the evaluation, treatment, and monitoring of anemia in CKD patients, including the use of iron supplementation, erythropoiesis-stimulating agents, and blood transfusions. It also describes chronic kidney disease-mineral bone disorder, including abnormalities in calcium, phosphorus, PTH, and vitamin D metabolism. It discusses the pathogenesis and types of CKD-MBD, including high turnover bone disease and adynamic bone disease, and their treatment through dietary phosphorus restrictions,
This document summarizes key information about anemia in chronic kidney disease (CKD). It defines CKD as kidney damage or decreased glomerular filtration rate (GFR) below 60 mL/min/1.73m2 for at least 3 months. Patients with CKD are more likely to die from cardiovascular causes than progress to end-stage renal disease. Anemia is common in CKD due to erythropoietin deficiency and has negative consequences if left untreated. The K/DOQI guidelines recommend evaluating hemoglobin levels when GFR is below 60 and treating anemia according to their guidelines if present. Intravenous iron is more effective than oral iron for treating anemia in CKD patients. Erythropoies
This document presents the case of a 50-year-old female diabetic patient referred for evaluation of renal impairment. Her creatinine had risen from 1.3 to 3.8 over the past year. She has a history of diabetes, hypertension, and diabetic retinopathy. On examination, she has lower limb edema. Tests show anemia, hyperkalemia, and high HbA1c. The provisional diagnosis is chronic kidney disease likely due to her long-standing diabetes, with complications of hyperkalemia and uncontrolled diabetes. The plan is to control her blood sugar and potassium, restrict diet, and regularly monitor her kidney function and diabetes.
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 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 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.
This document provides a summary of a presentation on the management of anemia and mineral bone disorders in chronic kidney disease. It defines anemia and its causes in CKD, including relative erythropoietin deficiency and iron deficiency. It outlines the evaluation, treatment, and monitoring of anemia in CKD patients, including the use of iron supplementation, erythropoiesis-stimulating agents, and blood transfusions. It also describes chronic kidney disease-mineral bone disorder, including abnormalities in calcium, phosphorus, PTH, and vitamin D metabolism. It discusses the pathogenesis and types of CKD-MBD, including high turnover bone disease and adynamic bone disease, and their treatment through dietary phosphorus restrictions,
This document summarizes key information about anemia in chronic kidney disease (CKD). It defines CKD as kidney damage or decreased glomerular filtration rate (GFR) below 60 mL/min/1.73m2 for at least 3 months. Patients with CKD are more likely to die from cardiovascular causes than progress to end-stage renal disease. Anemia is common in CKD due to erythropoietin deficiency and has negative consequences if left untreated. The K/DOQI guidelines recommend evaluating hemoglobin levels when GFR is below 60 and treating anemia according to their guidelines if present. Intravenous iron is more effective than oral iron for treating anemia in CKD patients. Erythropoies
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.
CKD-MBD is a systemic disorder of mineral and bone metabolism due to chronic kidney disease. It is characterized by abnormalities in calcium, phosphorus, PTH, or vitamin D levels and bone abnormalities. The pathogenesis involves elevated PTH levels, hyperphosphatemia, decreased calcitriol activity, and hypocalcemia. Treatment focuses on controlling phosphate levels through diet, phosphate binders, and dialysis; maintaining normal calcium levels; and treating secondary hyperparathyroidism through calcimimetics and vitamin D analogues. The goal is to prevent skeletal and extraskeletal complications like fractures, vascular calcification, and calciphylaxis.
This document provides an overview of hyperosmolar hyperglycemic state (HHS). It describes the pathophysiology, clinical features, and treatment of HHS. HHS occurs in patients with type 2 diabetes mellitus and is often precipitated by various medical conditions and medications. It is characterized by severe hyperglycemia, hyperosmolality, and dehydration without ketosis. Treatment involves fluid resuscitation and insulin therapy. The document also reviews macrovascular and microvascular complications of diabetes, including retinopathy, nephropathy, and neuropathy.
This document provides information on chronic kidney disease (CKD) diagnosis and management. It discusses common clinical features of CKD, which are often vague until late stages. It outlines the approach to investigating patients, including lab tests and imaging studies. Management focuses on slowing progression, treating complications, and timely planning for renal replacement therapy if needed. Goals include controlling risk factors like hypertension and diabetes, treating anemia, bone disease, and other issues. Dialysis criteria include refractory symptoms, complications, or glomerular filtration rate below 10 ml/min/1.73m2.
The document discusses the treatment of heart failure in patients with chronic kidney disease. It notes that CKD is a common comorbidity in heart failure patients and that the coexistence of the two conditions increases health risks. The main treatments discussed are:
1. ACE inhibitors and ARBs to improve ventricular function, though they can worsen kidney function. Close monitoring of kidney function and electrolytes is needed.
2. Beta blockers like bisoprolol and carvedilol to improve ventricular function, though they can cause hypotension and kidney dysfunction.
3. Aldosterone antagonists to reduce heart failure worsening and increase survival, though they can cause hyperkalemia and worsen kidney function.
This document outlines learning objectives and content for a lecture on chronic kidney disease (CKD). The objectives include differentiating CKD from acute kidney injury, describing CKD progression and therapies, comparing CKD causes and risk factors, and classifying CKD stages. The content covers normal kidney function, definitions of CKD and end-stage renal disease, CKD etiologies and risk factors, CKD stages, pathophysiology, complications involving mineral bone disorders, cardiovascular issues, and management strategies including nutrition, electrolytes, anemia, and medications.
This document discusses chronic kidney disease-mineral and bone disorder (CKD-MBD). It begins with an overview of the key components involved in CKD-MBD, including calcium, phosphorus, parathyroid hormone, vitamin D, fibroblast growth factor 23, and magnesium. The document then presents two clinical cases involving patients with CKD and discusses treatment options based on their lab results. It also covers the roles of vitamin D and magnesium in vascular pathology and mortality in CKD patients. Guidelines for the treatment of secondary hyperparathyroidism from KDIGO are also summarized.
Mineral and bone disorders commonly accompany chronic kidney disease due to imbalances in calcium, phosphorus, parathyroid hormone, and vitamin D levels as kidney function declines. Treatment for secondary hyperparathyroidism and hyperphosphatemia in CKD involves controlling dietary intake, using phosphate binders such as calcium-based or non-calcium-based options, and medications like calcimimetics, calcitriol, or vitamin D analogs to regulate mineral levels and reduce cardiovascular risks from CKD-MBD. The 2017 KDIGO guidelines updated recommendations around phosphate management and treatment thresholds in earlier CKD stages based on newer evidence.
Role of erythropoitin in chronic kidney diseaseAftab Siddiqui
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
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.
This document discusses chronic renal failure in children. It defines chronic kidney disease as renal injury or a glomerular filtration rate below 60 ml/min/1.73m2 for over 3 months. Common causes in children include congenital abnormalities under age 5 and glomerulonephritis after age 5. Chronic renal failure is managed through diet, treating complications like hypertension and anemia, optimizing growth, and renal replacement therapy like dialysis for end-stage renal disease.
Management of anemia in chronic kidney disease -Boushra Alsaoor
This document provides an overview of the management of anemia in chronic kidney disease. It defines anemia according to WHO criteria and notes that nearly 90% of CKD patients with a GFR below 30 mL/min have anemia. The main causes of anemia in CKD are decreased erythropoietin production and a shorter red blood cell lifespan. Treatment with erythropoiesis-stimulating agents or ESAs like epoetin and darbepoetin can help increase hemoglobin levels and improve outcomes. The goals of ESA therapy are to raise hemoglobin by 1-2 g/dL per month until it reaches 10-11.5 g/dL without exceeding 13 g/dL. Iron supplementation is
This document discusses chronic kidney disease (CKD) in children, including definitions, stages, etiology, pathogenesis, clinical manifestations, complications, treatment, and strategies to slow progression. Key points include:
- CKD is defined as kidney damage or glomerular filtration rate <60 mL/min/1.73m2 for over 3 months.
- Etiology depends on age, and includes congenital abnormalities, glomerulonephritis, cystic kidney diseases.
- Pathogenesis involves hyperfiltration injury to surviving nephrons from loss of other nephrons.
- Treatment aims to replace renal function and slow progression, including fluid/electrolyte management, nutrition, growth supplements
AKI and CKD are both conditions affecting kidney function. AKI refers to acute kidney injury and can be caused by factors like sepsis that lead to a rapid decline in kidney function over a period of days. CKD refers to chronic kidney disease, which develops over a period of months or years due to conditions like diabetes or hypertension. The prevalence of CKD stages 3-5 is around 5-7% globally. Mortality from AKI depends on the underlying cause, ranging from low to over 70% when associated with multi-organ failure from sepsis. Management of CKD focuses on slowing progression of disease and treating complications through diet, medication and preparing for renal replacement therapies like dialysis if needed.
AKI and CKD are both conditions affecting kidney function. AKI refers to acute kidney injury and can occur in hospitalized patients or those with sepsis. Mortality from AKI depends on whether it is uncomplicated or associated with other organ failure. CKD refers to chronic kidney disease, which has a prevalence of 5-7% globally. It is more common in older adults and those with hypertension, diabetes or vascular diseases. The main differences are that AKI occurs over a period of days to weeks, while CKD persists for over 3 months.
This document provides an overview of chronic kidney disease (CKD), including definitions, stages, methods for measuring glomerular filtration rate and proteinuria, risk factors for progression, complications, and management strategies. Key points covered include defining and staging CKD, estimating GFR using creatinine clearance and the MDRD equation, screening for and treating anemia, hypertension, hyperlipidemia, renal osteodystrophy, and acidosis, and preparing patients for end-stage renal disease with timely nephrology referrals and vascular access placement.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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.
CKD-MBD is a systemic disorder of mineral and bone metabolism due to chronic kidney disease. It is characterized by abnormalities in calcium, phosphorus, PTH, or vitamin D levels and bone abnormalities. The pathogenesis involves elevated PTH levels, hyperphosphatemia, decreased calcitriol activity, and hypocalcemia. Treatment focuses on controlling phosphate levels through diet, phosphate binders, and dialysis; maintaining normal calcium levels; and treating secondary hyperparathyroidism through calcimimetics and vitamin D analogues. The goal is to prevent skeletal and extraskeletal complications like fractures, vascular calcification, and calciphylaxis.
This document provides an overview of hyperosmolar hyperglycemic state (HHS). It describes the pathophysiology, clinical features, and treatment of HHS. HHS occurs in patients with type 2 diabetes mellitus and is often precipitated by various medical conditions and medications. It is characterized by severe hyperglycemia, hyperosmolality, and dehydration without ketosis. Treatment involves fluid resuscitation and insulin therapy. The document also reviews macrovascular and microvascular complications of diabetes, including retinopathy, nephropathy, and neuropathy.
This document provides information on chronic kidney disease (CKD) diagnosis and management. It discusses common clinical features of CKD, which are often vague until late stages. It outlines the approach to investigating patients, including lab tests and imaging studies. Management focuses on slowing progression, treating complications, and timely planning for renal replacement therapy if needed. Goals include controlling risk factors like hypertension and diabetes, treating anemia, bone disease, and other issues. Dialysis criteria include refractory symptoms, complications, or glomerular filtration rate below 10 ml/min/1.73m2.
The document discusses the treatment of heart failure in patients with chronic kidney disease. It notes that CKD is a common comorbidity in heart failure patients and that the coexistence of the two conditions increases health risks. The main treatments discussed are:
1. ACE inhibitors and ARBs to improve ventricular function, though they can worsen kidney function. Close monitoring of kidney function and electrolytes is needed.
2. Beta blockers like bisoprolol and carvedilol to improve ventricular function, though they can cause hypotension and kidney dysfunction.
3. Aldosterone antagonists to reduce heart failure worsening and increase survival, though they can cause hyperkalemia and worsen kidney function.
This document outlines learning objectives and content for a lecture on chronic kidney disease (CKD). The objectives include differentiating CKD from acute kidney injury, describing CKD progression and therapies, comparing CKD causes and risk factors, and classifying CKD stages. The content covers normal kidney function, definitions of CKD and end-stage renal disease, CKD etiologies and risk factors, CKD stages, pathophysiology, complications involving mineral bone disorders, cardiovascular issues, and management strategies including nutrition, electrolytes, anemia, and medications.
This document discusses chronic kidney disease-mineral and bone disorder (CKD-MBD). It begins with an overview of the key components involved in CKD-MBD, including calcium, phosphorus, parathyroid hormone, vitamin D, fibroblast growth factor 23, and magnesium. The document then presents two clinical cases involving patients with CKD and discusses treatment options based on their lab results. It also covers the roles of vitamin D and magnesium in vascular pathology and mortality in CKD patients. Guidelines for the treatment of secondary hyperparathyroidism from KDIGO are also summarized.
Mineral and bone disorders commonly accompany chronic kidney disease due to imbalances in calcium, phosphorus, parathyroid hormone, and vitamin D levels as kidney function declines. Treatment for secondary hyperparathyroidism and hyperphosphatemia in CKD involves controlling dietary intake, using phosphate binders such as calcium-based or non-calcium-based options, and medications like calcimimetics, calcitriol, or vitamin D analogs to regulate mineral levels and reduce cardiovascular risks from CKD-MBD. The 2017 KDIGO guidelines updated recommendations around phosphate management and treatment thresholds in earlier CKD stages based on newer evidence.
Role of erythropoitin in chronic kidney diseaseAftab Siddiqui
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
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.
This document discusses chronic renal failure in children. It defines chronic kidney disease as renal injury or a glomerular filtration rate below 60 ml/min/1.73m2 for over 3 months. Common causes in children include congenital abnormalities under age 5 and glomerulonephritis after age 5. Chronic renal failure is managed through diet, treating complications like hypertension and anemia, optimizing growth, and renal replacement therapy like dialysis for end-stage renal disease.
Management of anemia in chronic kidney disease -Boushra Alsaoor
This document provides an overview of the management of anemia in chronic kidney disease. It defines anemia according to WHO criteria and notes that nearly 90% of CKD patients with a GFR below 30 mL/min have anemia. The main causes of anemia in CKD are decreased erythropoietin production and a shorter red blood cell lifespan. Treatment with erythropoiesis-stimulating agents or ESAs like epoetin and darbepoetin can help increase hemoglobin levels and improve outcomes. The goals of ESA therapy are to raise hemoglobin by 1-2 g/dL per month until it reaches 10-11.5 g/dL without exceeding 13 g/dL. Iron supplementation is
This document discusses chronic kidney disease (CKD) in children, including definitions, stages, etiology, pathogenesis, clinical manifestations, complications, treatment, and strategies to slow progression. Key points include:
- CKD is defined as kidney damage or glomerular filtration rate <60 mL/min/1.73m2 for over 3 months.
- Etiology depends on age, and includes congenital abnormalities, glomerulonephritis, cystic kidney diseases.
- Pathogenesis involves hyperfiltration injury to surviving nephrons from loss of other nephrons.
- Treatment aims to replace renal function and slow progression, including fluid/electrolyte management, nutrition, growth supplements
AKI and CKD are both conditions affecting kidney function. AKI refers to acute kidney injury and can be caused by factors like sepsis that lead to a rapid decline in kidney function over a period of days. CKD refers to chronic kidney disease, which develops over a period of months or years due to conditions like diabetes or hypertension. The prevalence of CKD stages 3-5 is around 5-7% globally. Mortality from AKI depends on the underlying cause, ranging from low to over 70% when associated with multi-organ failure from sepsis. Management of CKD focuses on slowing progression of disease and treating complications through diet, medication and preparing for renal replacement therapies like dialysis if needed.
AKI and CKD are both conditions affecting kidney function. AKI refers to acute kidney injury and can occur in hospitalized patients or those with sepsis. Mortality from AKI depends on whether it is uncomplicated or associated with other organ failure. CKD refers to chronic kidney disease, which has a prevalence of 5-7% globally. It is more common in older adults and those with hypertension, diabetes or vascular diseases. The main differences are that AKI occurs over a period of days to weeks, while CKD persists for over 3 months.
This document provides an overview of chronic kidney disease (CKD), including definitions, stages, methods for measuring glomerular filtration rate and proteinuria, risk factors for progression, complications, and management strategies. Key points covered include defining and staging CKD, estimating GFR using creatinine clearance and the MDRD equation, screening for and treating anemia, hypertension, hyperlipidemia, renal osteodystrophy, and acidosis, and preparing patients for end-stage renal disease with timely nephrology referrals and vascular access placement.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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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.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
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.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
2. Criteria for definition CKD
CKD is defined as abnormalities of kidney structure or function , present for more than 3 months,
with implications for health. These may include the following:
● Markers of kidney damage
Albuminuria (ACR more than equal to 30mg/ 24h).
Urine sediment abnormalities
Electrolyte abnormalities due to tubular disorders
Abnormalities detected through histology
Structural abnormalities detected through imaging
History of kidney transplant
● Decreased GFR < 60ml/min/1.73m2
3. DIET
● Adequate calories , vitamin and iron.
● Low sodium diet - restrictions of sodium intake to less than 2.3g/day.(volume
overload pts and hypertensive pts)
● Low potassium diet - 2 to 3 g/day ( oliguric pts and hyperkalemic pts), avoid coconut
water, banana)
● Low phosphorous diet - avoid dairy products.
● Protein usually moderate - if pts in early ckd not on RRT (0.8-0.9g/kg/day)
If pts with ckd and RRT (1.1-1.3g/kg/day)
● Fluid restriction - early stages not much of restriction
● Late stages mostly in volume overload state, hypervolmeic hyponatremia
4. Diabetes and CKD
● Most common risk of hypoglycemia - mostly insulin and oha’s (sulphonylureas) are
not metobilized , exception glipizide which is renofriendly and do not cause
hypoglycemia.
● We can reduce the dose of insulin and avoid sulphonylureas.
● Metformin : risk of lactic acidosis,acute uremia and contraindicated in pts with gfr
<30ml
● Gliptans are safe , mainly linagliptan( metobolised through liver) and also studies
shows that it will help in decrease in proteinuria.
● SGLT2 inhibitors - gfr upto 60 ml can be given below that less efficacy commonly
used are CANAGLIFOSIN and EMPAGLIFOSIN and also slow down CKD
progression.
● Meglinitides not recommended
● Incretins will cause renal impairment and not used in renal failure.
● Most safest is INSULIN if gfr less than 30ml stop oha and switch to insulin.
5.
6.
7. Cardiovascular manifestation
● Leading cause of mortality in CKD patients
● 50% of ESRD patients die from a cardiac disease
● In younger patients there is 500 fold higher risk in comparison to age
related controls.
● Prevalence of HTN in a CKD Patients is 90%.
● HTN directly correlates with LVH , which in turn directly correlates with
diastolic dysfunction.
● HTN is also a risk factor for CAD
8. Hypertension and ckd
● Low sodium diet
● Anti hypertensive of choice are ACE inhibitors and ARBS
● It will help in reduction of proteinuria and ckd progression.
● Contraindiacation : if potassium > or= 5.5 meq
● Serum creatinine increase by >30 per from the baseline.
● Target blood pressure in CKD is <130/80 mmhg.
9. ● Metabolic acidosis - sodium bicarbonate are used and target should be 22-24
● Increase potassium - low potassium diet and potassium binders are given
mostly we use SPS( sodium polyesterene sulfonate),SPS exchanges sodium
for potassium and binds it in the gut, primarily in the large intestine,
decreasing the total body potassium level by approximately 0.5-1 mEq/L.
● Patiromer recently approved drug by FDA. Powder form 8.4g/16.8/25.2g/
packet.
● Mao: binds and remove potassium from GI tract particularyat colon and also
increases fecal excretion.
● Volume overload : with diuretics (loop diuretics and can increases the dose
accordingly)
10. Anemia and CKD
● Target :10 -11.5 g/dl
● Usually seen in stage 3 to 5 ckd - 57% incidence
● Usually it will contribute to LVH, develops diastolic dysfunction and leads to cardiac
failure .
● Independently influence the rate of fall in GFR.
Why anemia??
● 1) Due to absolute or relative deficiency of EPO
● 2) anemia of chronic disease
● 3) decrease number of RBC ( survival time decreased in ckd)
● 4) iron deficiency anemia
● 5) increased PTH will cause bone marrow fibrosis
● 6) uremic bleeding
11.
12. How to correct anemia??
● 1 step : reticulocyte production index
If it is less than 2 confirms hypoproliferative anemia
● 2nd step : check MCV ( low or normal)
● 3rd step : check serum ferritin and percentage saturation of transferrin.
● If both are low give iron first. Because there is no use of giving EPO if
iron levels are not corrected.
● So iron therapy indicated if serum ferritin less than 200mg/dl and TSAT
<20%
● Iron therapy : iron sucrose, Ferric carboxymaltose(500 mg / 1 gram) and iron
isomaltose.
13. ESA( erythropoietin stimulating agents)
● Indicated only if S.ferritin more than 500 and TSAT > 25%.
● Hemoglobin less than 10gmdl
● 1st gen : Epoietin alpha given 50-100 units / kg. 3 times per week in
dialysis patients and once weekly in ckd.
● 2 nd gen : Darbopoetin ( 0.45mg/kg/ once a week) iv or sc and dosing
can be extended to every 4th week on reaching the target level of hb.
14. CKD- mineral bone disease
A systemic disorder of mineral and bone metabolism due to CKD ,
manifested by either one or combination of the following
● Abnormalities of calcium, phosphorus,PTH or vitamin D
metabolism
● Abnormalities in bone turnover, mineralization, volume, linear
growth or strength
● Vascular or other soft tissue calcification.
15. CKD and mineral bone disease
3 major disease and major abnormalities
3 major disease
● High bone turnover disease: 90% (osteitis fibrous cystica)
● Low bone turnover disease : 10% (adynamic bone disease)
● Miscellaneous: Osteomalacia and osteoporosis.
3 major abnormalities
● Biochemical abnormalities
● Bone changes
● Calcification
16. High bone turnover disease
● Secondary hyperparathyroidism is the major cause.
● Usually GFR will be less than 50-70 ml/my
● As GFR declines tendency for phosphorus to increase by FGF-23
● Phosphorus can convert normal endothelial cells to osteoblasts.
FGF-23
● Produced by osteocytes, which will inhibit Na/p cotransport at PCT
● It will increases phosphorus excretion
● Receptor for FGF23 is
● But the same time it will inhibit 1alpha hydroxylase enzymes(which helps in converting 25
hydroxylase D3 to 1,25 hydroxylase D3) causing decreased calcium and phosphorus
absorption from GIT.
17. Ckd patients with secondary hyperparathyroidism :
● Decreased serum calcium.
● Decreased calcitriol
● Decreased kotho resistance
Features of high bone turnover disease
● Increased PTH ( normal is 50 - 100pg ) in CKD ( 150 to 300pg/ml)
● Increase phosphorus (>5.5) but target will be less than 5.5 mg/dl
● Decreased adjusted serum calcium (<8.4) target will be 8.4 to 9.5mg/dl
● Decreased calcitriol
● Features: bone pain, fractures, increased bone mass with decreased mineralization.
18. Low bone turnover disease
● Also known as adynamic bone disease
● Seen in 19%of cases
● PTH decreases and bone mass will decrease
● PTH markedly reduced due to increase calcium from exogenous route or high
calcium dialysate.
Features
● Decreased PTH <200pg/ml due to increased calcium exogenous
● Widespread medical calcification
● Death due to coronary calcification
● Decreased bone mass and high secondary mineralization.
19. Management CKD-MBD
Low bone turnover:
● Stop calcium/ vitamin D
● Low calcium or zero calcium dialysate.
● Vitamin k2 analogues.
High bone turnover :
● Most common wil be low serum calcium and high phosphorus combination
● Control by dietary restrictions ( avoid dairy products)
● Phosphate binders
20. Phosphate binders
● Calcium based :calcium
carbonate
300-1200mg/8hourly
orally
● calcium acetate 667 mg
● Non calcium based :
metal based -
LANTHANUM
(500/750/1000mg)
● Non metal based:
SEVALAMER
(400mg/800 mg)
21.
22. Vitamin d supplement
● Active vitamin D- calcitriol 0.25mcg to 1 mcg PO daily.
● 19- nor 1,25dihydroxyvitamin D2 paricalcitol 1-5 mcg PO daily in pre
dialysis patients or 2-10 mcg iv with each dialysis pts.
● It is an synthetic vit D analog with lower incidence of hypercalcemia.
● Doxerxcakciferol 1-5 mcg in pre dialysis pts or 5-20mcg thrice weekly
with dialysis.
23. Cinacalcet
● Increased serum calcium
● Increased serum phosphorus
● Increased PTH (>1000)
● All mainly due to tertiary hyperparathyroidism
● Can be treated with cinacalcet which is calcium receptor agaonist
● Which will down regulate PTH
● dose will be 30mg-120mg PO.
24. Parathyroidectomy
Indication
● Serum PTH >800pg/dl
● Tertiary hyperparathyroidism
● Parathyroid adenoma
● Severe hypercalcemia not controlled with medications
● Severe extra skeletal calcification.
25. Take home (CKD)
● GFR and stages
● Uremic symptoms
● Anemia
● Bone mineral changes
● Blood pressure
● Cardiac
● Diuretics usage
● Electrolytes
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