Myths in Nephrology 2

This document summarizes key points from a presentation on chronic kidney disease (CKD) given by Prof Meguid El Nahas at the Jordanian Society of Nephrology in 2016. It discusses how CKD prevalence is rising, and the KDIGO CKD classification and estimated GFR (eGFR) are useful tools. Maximum blood pressure reduction, proteinuria reduction, and ACE inhibitor treatment can all slow the progression of CKD. Linear declines in the reciprocal of serum creatinine over time can help predict CKD progression in individuals.

Introduction to Critical Appraisal 2015

This document outlines the critical appraisal process for evaluating clinical evidence from medical literature. It discusses key aspects of validity, including proper randomization, blinding, sample size estimation, and intention-to-treat analysis. It also addresses utility and whether results can be applied to local populations. The document provides examples of appraising studies on new treatments for chronic kidney disease and examines considerations like surrogate endpoints, statistical versus clinical significance, and assessing risks and benefits.

CKD Reclassification 2016

The document discusses revisions to chronic kidney disease (CKD) classification systems over time from 2002 to present. It notes that older classification systems defined CKD based on glomerular filtration rate (GFR) declines from normal levels for all age groups, but did not account for the normal age-related decline in GFR that occurs in older populations. More recent proposed revisions suggest defining CKD stages separately for those over age 60 to avoid misclassifying normal age-related GFR declines as disease. The document questions whether widespread prescription of renin-angiotensin-aldosterone system drugs is necessary for stage 3a "CKD" that represents normal aging rather than true kidney disease.

CKD Natural History 2014

1. The document discusses chronic kidney disease (CKD) natural history and progression. It distinguishes between community-acquired CKD (cCKD) and referred CKD with primary or secondary nephropathies (rCKD). 2. Risk factors for CKD progression include older age, male gender, race/ethnicity, genetics, hypertension, proteinuria, cardiovascular disease, and poor glycemic control. Targets for slowing progression include blood pressure <140/90 mmHg, proteinuria <1 g/day, and hemoglobin A1c <8%. 3. Studies presented examine the linear decline in reciprocal serum creatinine over time in CKD patients and validate models

CKD or C-K-D; Cardio-Kidney-Disease

This document discusses the differences between how epidemiologists and nephrologists view chronic kidney disease (CKD). Epidemiologists see CKD primarily as a predictor of cardiovascular disease (CVD) risk based on database associations. Nephrologists argue that CKD in older adults is usually actually cardiovascular-kidney damage (C-K-D), as older adults generally have underlying CVD manifested as reduced glomerular filtration rate (GFR) and albuminuria. The quality of CKD epidemiology studies is questionable as the definitions may not be clinically useful or interpreted properly. More evidence and critical thinking is needed to close the gap between these perspectives.

CKD Epidemiology 2014

This document summarizes a presentation on chronic kidney disease (CKD) epidemiology and detection. It discusses differences in CKD prevalence, causes, and stages at presentation between developed Western countries and emerging economies. CKD prevalence is increasing globally due to rising risk factors like diabetes, hypertension, obesity, and urbanization. However, CKD screening programs have overestimated disease prevalence by equating isolated findings to CKD. Targeted screening is more effective than community screening by focusing on high-risk groups like those with diabetes or cardiovascular disease in Western countries, and additional factors like infections and nephrotoxicity in emerging economies. Late diagnosis and referral remain challenges in developing regions where CKD often presents at later stages.

Poverty and CKD

This document discusses the relationship between poverty and chronic kidney disease (CKD). It presents evidence that CKD disproportionately affects those in poverty due to higher rates of underlying risk factors like obesity, diabetes, hypertension, smoking, and alcohol use among the poor. Lifestyle behaviors and risk factors are influenced by socioeconomic status, education, and environment. The poor have less access to healthcare and are less likely to receive renal replacement therapies like dialysis. Over 1 million deaths per year from CKD occur mostly among the poor. The document calls for efforts by the WHO to address CKD through poverty eradication programs.

The document is from the Sheffield Kidney Institute and provides an introduction to renal histopathology. It discusses the normal glomerulus and several types of nephropathy including minimal change nephropathy, mesangioproliferative glomerulonephritis, membranous nephropathy, membranoproliferative glomerulonephritis, diffuse proliferative glomerulonephritis, rapidly progressive glomerulonephritis, focal segmental glomerulosclerosis, diabetic glomerulosclerosis, global glomerulosclerosis, vascular hyalinosis and sclerosis, and chronic kidney disease.

A Critical Appraisal of Nephrology RCTs 2017

This document provides a summary and critical analysis of recent nephrology randomized controlled trials from 2015-2017. It discusses the SPRINT trial which found benefits of intensive blood pressure control but questions the validity of the findings given the increased risk of adverse events. It also summarizes the EMPA-REG trial on empaglifozin but notes the renal outcomes were from a post-hoc analysis so were hypothesis generating only. For the radiocontrast nephropathy study, it emphasizes the risk depends on patient comorbidities. Regarding the belatacept transplant trial, it argues the post-hoc analyses were underpowered and questions the statistical approach taken. Throughout, it stresses the importance of critically evaluating validity, risks, and

Reflective Thinking

This document contains presentations from the Sheffield Kidney Institute on various topics in nephrology practice. It discusses renal biopsy indications and scenarios where a biopsy may or may not be recommended. It also addresses immunosuppression treatment and whether it may be appropriate for certain patient cases. Finally, it examines the use of ACE inhibitors for chronic kidney disease, reviewing evidence on cardiovascular and renal outcomes from trials comparing ACE inhibitors to placebo. Key considerations around risks, benefits, costs and clinical utility are discussed for biopsy, immunosuppression and ACE inhibitor treatment decisions.

Long-term survival and morbidity after Acute Kidney Injury

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Tendinopathy in Hemodialysis Patients (The Hidden Face of CKD-MBD) - Dr. Gawad

Is it Hepatorenal Syndrome? - Dr. Gawad

- Recorded videos of the lecture: English Language version of this lecture is available at: https://youtu.be/-Ynxvhbcl7U Arabic Language version of this lecture is available at: https://youtu.be/QpK_toctVlw - Visit our website for more lectures: www.NephroTube.com - Subscribe to our YouTube channel: www.youtube.com/NephroTube - Join our facebook group: www.facebook.com/groups/NephroTube - Like our facebook page: www.facebook.com/NephroTube - Follow us on twitter: www.twitter.com/NephroTube

2016: Geriatric Nephrology - Beben

SDGWEP

This document discusses renal changes that occur with aging. As people age, their glomerular filtration rate and renal plasma flow decrease gradually. Structural changes in the kidneys include a loss of functioning glomeruli, thickening of basement membranes, and hyalinosis of arterioles. These changes are due to a combination of factors like hypertension, inflammation, oxidative stress, and reduced nitric oxide levels. Estimating glomerular filtration rate is challenging in elderly patients, as common equations have not been validated in this population. Care must be taken when prescribing medications to elderly patients due to their reduced kidney function and risk of adverse drug effects. Dialysis decisions should be highly individualized based on functional status and comorbidities in

Management of acute kidney injury

jhoncatunta

This document provides an overview of acute kidney injury (AKI) management. It discusses that AKI is common in hospitalized patients and associated with increased morbidity and mortality. When AKI is present, the underlying cause should be promptly investigated, with attention to potentially reversible causes. Measures to prevent AKI include optimizing volume status and avoiding nephrotoxic medications. Currently there are no approved targeted pharmacotherapies for treating AKI, and the optimal timing of renal replacement therapy is unclear.

Core curriculum lesao renal aguda

Breno Gois

This document discusses the management of acute kidney injury (AKI). It defines AKI and outlines its diagnosis and evaluation. AKI is common in hospitalized patients and associated with increased short- and long-term mortality. When present, determining the underlying cause is important as some causes are reversible. Prevention focuses on optimizing volume status and avoiding nephrotoxic drugs. Currently there are no approved pharmacotherapies for treating AKI, and the optimal timing of renal replacement therapy is unclear. Recent evidence suggests AKI increases risk for chronic kidney disease and future kidney injury.

The aging kidney and what we should (not?) do about it

CKD (Pathogensis and Progression) - Dr. Gawad

- Recorded videos of this lecture: English Language version of this lecture is available at: https://youtu.be/NQMiLXb0AXk Arabic Language version of this lecture is available at: https://youtu.be/o_I9bzxcJoQ - Visit our website for more lectures: www.NephroTube.com - Subscribe to our YouTube channel: www.youtube.com/NephroTube - Join our facebook group: www.facebook.com/groups/NephroTube - Like our facebook page: www.facebook.com/NephroTube - Follow us on twitter: www.twitter.com/NephroTube

ESAs Therapy: Friend or Foe? - Dr. Gawad

Aging kidney-structural-and-functional-changes ayman seddik

Ayman Seddik

The document discusses how aging impacts the kidneys. As people age, their kidneys undergo structural and functional changes such as loss of mass and function, granularity on the external surface, and thickening of arteries. The prevalence of conditions like diabetes, hypertension, and high cholesterol increase with age and contribute to declining kidney function. Studies show that while chronic kidney disease risk increases with age, elderly patients are less likely than younger patients to progress to end-stage renal disease, though a subset will eventually need renal replacement therapy. Nephrologists face the challenge of identifying older patients with declining kidney function who would benefit from interventions to slow progression.

HTN in Hemodialysis Patients - A Clinical Approach of Management - Dr. Gawad

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The document discusses evidence on nutritional interventions for renal disease. It summarizes four studies that examined the relationship between BMI and mortality in patients with end-stage renal disease as well as the effectiveness of cholecalciferol supplementation in raising vitamin D levels in patients with chronic kidney disease. The studies reported mixed results, with some indicating benefits of higher BMI or cholecalciferol supplementation and others finding no clear associations or effects. Additional research is needed to better understand these relationships.

Steroid Withdrawal after kidney transplantation

This study compared outcomes of steroid withdrawal versus continued steroid therapy in kidney and heart transplant recipients. Over 1500 patients were enrolled from 1994-2002 and followed for 5-6 years on average. Results showed that steroid withdrawal led to superior patient and graft survival rates compared to controls continuing steroids. Steroid withdrawal also reduced risks of complications like osteoporosis and cataracts. However, it was associated with a small increased risk of acute rejection episodes. Overall, the study suggests that steroid withdrawal after 6 months is safe and effective for transplant recipients.

Rate of kidney function decline (KFD) and subsequent ESRD - prof. Ahmed Shokr

MNDU net

Uremic Pruritis - Pathogenesis & Management - Dr. Gawad

This document outlines the pathogenesis and management of uremic pruritus. It begins with an outline of the topics to be discussed, including dialysis adequacy and modification, xerosis, microinflammation, nervous conduction, the opioid hypothesis, various drug therapies, physical therapy using UV light, and other treatments. It then discusses various studies that have examined the relationship between increased dialysis adequacy as measured by Kt/V and the severity of pruritus. The document also reviews the role of xerosis, microinflammation mediated by cytokines like TNF-α and IL-1β, the nervous system through substances like substance P, and the opioid hypothesis in the pathogenesis of uremic pruritus.

Loin Pain Hematuria Syndrome

Wisit Cheungpasitporn

This document discusses loin pain-hematuria syndrome (LPHS), a rare condition characterized by severe flank pain and microscopic or gross hematuria. It provides background on the epidemiology, signs and symptoms, pathophysiology, diagnosis and various treatment approaches for LPHS. Specifically, it summarizes two studies that found that laparoscopic nephrectomy with renal autotransplantation resulted in better pain control and quality of life for LPHS patients. A 14-year study also found the procedure to be safe for survival and renal outcomes, despite postoperative risks. Autotransplantation is recommended for patients with severe pain requiring high doses of analgesics or those for whom extensive nonsurgical therapies failed.

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Outpatient Management of CKD Patients

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This document discusses chronic kidney disease (CKD) and its management. It provides definitions of CKD and outlines its stages according to the KDIGO classification system. Diabetes and hypertension are highlighted as leading causes of CKD globally. Early detection of CKD is important as it can be asymptomatic for long periods. Screening high-risk individuals through estimated GFR and urine albumin or protein tests is recommended. Left unmanaged, CKD can progress to end-stage renal disease requiring renal replacement therapies like dialysis, which are costly treatments.

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Hypertension and CKD 2016

The document discusses hypertension and chronic kidney disease (CKD). It notes the global scale of hypertension, risk factors for CKD progression like hypertension, and observational studies and clinical trials on blood pressure targets and treatments in CKD. It addresses questions around how to measure blood pressure in CKD, appropriate targets, and recommended antihypertensive drugs. Tailoring treatment to individual patient factors like age, race, comorbidities, CKD stage and level of proteinuria is emphasized.

Prof. el nahas.what is new in ckd.

wessam1071

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.

How to Interpret a Kidney Biopsy

Dr.Jose Luis Rodriguez Lopez

1. The document discusses how to interpret a kidney biopsy by examining glomeruli, tubules, interstitium, and vessels and correlating histological findings with clinical features like hematuria, proteinuria, and renal function. 2. Key histological findings discussed include mesangial proliferation, podocyte disruption, glomerular basement membrane thickening, glomerular sclerosis, tubular atrophy, and interstitial fibrosis. 3. Case examples are presented to demonstrate how specific histological patterns correlate with clinical signs of hematuria, proteinuria, and normal or declining renal function.

CKD PPT Chahat kalra 21MND1016 New.pptx

Chahatkalra8

This document provides information about chronic kidney disease (CKD). It discusses the definition and stages of CKD, causes and risk factors like diabetes and hypertension, clinical manifestations such as anemia and fluid retention, and the pathophysiology. It also covers the prevalence of CKD in India, recent research studies on genetic and cellular factors, and treatments including dietary modifications, dialysis, and kidney transplantation.

Bernstein Oct 29 2008 Defining Ckd And Risk Factors

guest6940925

1) Around 1 million people in North Carolina have chronic kidney disease (CKD), defined as kidney damage or decreased kidney function lasting over 3 months. 11,000 people in the state currently receive dialysis for end-stage renal disease. 2) Estimated glomerular filtration rate (eGFR) is a measure of kidney function that is calculated based on age, gender, ethnicity and serum creatinine level. An eGFR below 60 ml/min/1.73m2 for over 3 months indicates CKD. 3) Major risk factors for CKD include diabetes, hypertension, family history of kidney disease, African American or Native American ethnicity. Early detection of risk factors and treatment can help prevent or

Chronic renal failure

Critical Appraisal of some HD RCTs

1) The document discusses several clinical trials in hemodialysis (HD) patients including HEMO, MPO, FHN, BP control, and SHARP. 2) It emphasizes the importance of critically evaluating clinical trials and considering factors like risks, benefits, and costs when applying interventions to patients. 3) The document cautions that subgroup analyses from clinical trials generate hypotheses but do not provide evidence, and interventions should not be applied without evidence of benefits outweighing risks.

Undergraduate nurses year three FINAL reviewed October 2020

Renal Association

This document provides an overview of acute kidney injury (AKI) for undergraduate nurses. It defines AKI, discusses risk factors and causes, and outlines steps for identifying, managing, and referring patients with AKI. Key points include: - AKI is a spectrum of injury that can lead to renal failure if unrecognized. It is identified by rises in creatinine and decreases in urine output. - Patients with chronic conditions, sepsis, hypotension, or those on certain medications are at higher risk. Causes include reduced renal blood flow (pre-renal), direct kidney damage (intrinsic), or urinary tract obstruction (post-renal). - For patients with AKI, nurses should monitor vital

CKDu

Indrajith Udaya Kumara

This document discusses Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. It provides background on areas affected and key facts about CKDu cases and deaths. It explores potential environmental and lifestyle factors contributing to CKDu, including fluoride, cadmium, arsenic, and cyanobacterial toxins. Symptoms of CKDu are described. The document concludes with suggestions to increase awareness and promote strategies like safe water consumption and handling to address CKDu.

Pcp in a box module 1

MohibaAgha

1. The document provides information on chronic kidney disease (CKD) management in primary care, including screening, evaluation, goals of care, and complications. 2. It emphasizes the primary care provider's important role in early CKD detection through testing at-risk patients, managing blood pressure and diabetes, and referring to nephrology as appropriate. 3. A collaborative care model between primary care and nephrology can improve outcomes through coordinated management and addressing patient safety issues in CKD.

injuria renal 4.pptx

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Slowing progression of ckd general

MohamedKhamis77

This document discusses slowing the progression of chronic kidney disease (CKD). It notes that CKD is a growing problem fueled by conditions like hypertension, diabetes, and obesity. Early intervention can help slow CKD progression and add years of life without dialysis. Key risk factors for CKD progression include hypertension, proteinuria, hyperglycemia, and smoking. The document recommends simple screening methods for at-risk populations like measuring blood pressure, weight, and urine tests. Managing comorbidities and controlling blood pressure and proteinuria are emphasized as the most important ways to preserve kidney function.

Kidney Donor Profile Index (KDPI)

Goutham Kumar

The document introduces the Kidney Donor Profile Index (KDPI), which was developed to provide a more precise measure of donor kidney quality than the existing Expanded Criteria Donor system. The KDPI is calculated based on 10 donor factors using a statistical model. A higher KDPI indicates a higher risk kidney with potentially shorter graft survival. While KDPI aims to improve organ allocation, there are limitations in its predictive ability and it may disadvantage certain patient groups. Overall, KDPI provides a more detailed assessment of donor quality than binary ECD classification but its role in allocation is still debated.

Ckd Micro1

v-crete.co.uk

- 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.

Kidney disease

sonals58

Medicity Hospital is a top tier multispecialty and super specialty hospital located in Kharghar, Navi Mumbai. It has a wide range of medical specialties and services including diagnostics and is equipped with modern equipment. Chronic kidney disease (CKD) describes abnormal kidney function and/or structure. It is common, often asymptomatic, and frequently exists with other conditions like cardiovascular disease and diabetes. CKD can be detected through simple tests and treatment may prevent progression, complications, and cardiovascular disease. However, CKD is often unrecognized without symptoms and may be diagnosed at an advanced stage.

Introduction to renal failure and dialysis

Dr Narinder Sharma

This document summarizes key aspects of kidney function and disease. It discusses urine formation through glomerular filtration and tubular processes. It outlines factors that increase risk of kidney disease like diabetes and hypertension. Three simple tests - BUN, eGFR and UACR - can identify kidney disease. Renal failure can be acute or chronic. Causes of chronic kidney disease include diabetes, hypertension, glomerulonephritis, polycystic kidney disease and others. Stages of chronic kidney disease and indications for starting dialysis are presented.

Renal fibrosis Mechanisms and Mediators

This document discusses chronic kidney disease (CKD) mechanisms and future therapies. It provides global statistics on the prevalence and incidence of CKD, end-stage renal disease (ESRD), and renal replacement therapy. It examines CKD detection programs worldwide and the stages of kidney scarring. The role of transforming growth factor beta 1 (TGFβ1) in fibrosis is discussed, along with potential therapies targeting TGFβ1 signaling pathways. Pre-clinical studies in animal models are summarized. The challenges of translating experimental therapies to clinical trials are also reviewed.

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This document discusses chronic kidney disease (CKD) and its genetics and epidemiology. It contains the following key points: 1. Genetic factors like mutations in the UMOD gene which encodes uromodulin can cause rare inherited forms of interstitial kidney disease like Uromodulin-Associated Kidney Disease. 2. Common genetic variants in the MHC region and other loci influence risk for CKD conditions like IgA nephropathy which demonstrates geographic variation in prevalence that correlates with differences in genetic risk scores. 3. The prevalence of CKD rises with age and is higher in some racial groups, with over 30% of older African Americans having CKD according to some studies.

Design and Conduct of Clinical Trials 2016

This document provides an overview of how to design, conduct, and report a clinical trial based on a presentation from Prof Meguid El Nahas at the Sheffield Kidney Institute. It discusses ethical considerations like the Declaration of Helsinki, trial design elements like objectives and endpoints, conducting trials according to good clinical practice, statistical analysis, interpreting and reporting results, and how to appraise clinical trials based on factors like validity of results and risk-benefit analysis. The overall document offers guidance on the end-to-end process for clinical research.

Obesity in CKD and Renal Transplantation 2017

This document discusses obesity and chronic kidney disease (CKD). It notes that obesity is associated with an increased risk of CKD and accelerated progression of CKD. While weight loss is generally recommended for obese patients with CKD, forced weight loss on dialysis can be harmful and is not associated with improved post-transplant outcomes. Transplantation may provide a survival benefit over dialysis even for obese patients.

CKD MBD 2017

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.

Critical appraisal 2018

The document discusses a collaboration between Prof Arif Khwaja of the Sheffield Kidney Institute and Prof Meguid El Nahas of the Global Kidney Academy called the "Double Act". It also discusses the Sheffield Kidney Institute from 2001 to 2018 and presents the "5 Whats" framework for critically appraising evidence including considering what an intervention is for, the validity of evidence, relevance/utility, risk-benefit ratio, and cost-benefit ratio. There are repeated references to thinking critically and the "5 Whats" framework.

How to write a paper 2019

PVI, PeerView Institute for Medical Education

This document provides guidance on how to write a medical research paper. It discusses key sections of a paper like the title, abstract, introduction, methods, results, and references. For the abstract, it recommends including 2-3 lines of introduction, the aim, materials and methods, main results with data/statistics, and a conclusion. For methods, it suggests describing the population, inclusion/exclusion criteria, experimental protocol, and statistical analysis. It also provides examples of titles, abstracts, introductions and emphasizes objectively reporting results with facts and data rather than telling a story.

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