SlideShare a Scribd company logo
Indications of dialysisIndications of dialysis
Dr. Mohamed AbbassDr. Mohamed Abbass
NephrologistNephrologist
PGDD,CARDIFF,UKPGDD,CARDIFF,UK
Acute kidney injury (AKI)Acute kidney injury (AKI) is anis an
abrupt or rapid decline in renalabrupt or rapid decline in renal
filtration functionfiltration function
(No universally accepted(No universally accepted
definition).definition).
It is a life-threatening conditionIt is a life-threatening condition
occurring in approximatelyoccurring in approximately 5%5% ofof
all hospitalized patients and up toall hospitalized patients and up to
30%30% of the admissions toof the admissions to
intensive care units.intensive care units.
From the definition of AKI , theFrom the definition of AKI , the
diagnosis depend ondiagnosis depend on
1- The1- The increaseincrease in serum creatininein serum creatinine
2- The2- The decreasedecrease in the GFRin the GFR
3- The3- The decreasedecrease in the urine outputin the urine output
This is theThis is the RIFLERIFLE criteriacriteria
TheThe RIFLERIFLE criteriacriteria
in serum
creatinine in GFR
In
urine output
Risk 1.5fold 25%
< 0.5 mL/ kg per
hour for six hours
Injury 2fold 50% >0.5mL/ kg per hour
for 12 hours
Failure 3fold 75% >0.5mL/ kg per hour
for 24 hours or
anuria for 12 hours
Loss Complete loss of kidney function for more than four
week (need renal replacement therapy)
ESRD Complete loss of kidney function for more than
three months ( need renal replacement therapy)
Chronic kidney diseaseChronic kidney disease
(CKD)(CKD)
kidney damage for 3 or morekidney damage for 3 or more
monthsmonths
1-Structural or functional abnormalities of1-Structural or functional abnormalities of
the kidneythe kidney
2-With or without decreased GFR.2-With or without decreased GFR.
3-Manifested by either pathologic3-Manifested by either pathologic
abnormalities or markers of kidney damage.abnormalities or markers of kidney damage.
GFR 60 mL/minute/1.73 m2 for 3GFR 60 mL/minute/1.73 m2 for 3
or more months, with or withoutor more months, with or without
markers of kidney damage.markers of kidney damage.
CKD Stages according to GFRCKD Stages according to GFR
(ml/min/1.73m(ml/min/1.73m22
))
1: Stage 11: Stage 1Kidney damage withKidney damage with
normal or GFR >90normal or GFR >90
2: Stage 22: Stage 2GFR 60:89GFR 60:89
3: Stage 33: Stage 3GFR 30:59GFR 30:59
4: Stage 44: Stage 4GFR 15:29GFR 15:29
5: Stage 5 (ESRD)5: Stage 5 (ESRD) <15<15
Causes of AKICauses of AKI
ARF can be classified into threeARF can be classified into three
groups:groups:
@-@-Pre-renalPre-renal –– this is caused bythis is caused by
ineffective perfusion of kidneysineffective perfusion of kidneys
whichwhich
are otherwise structurally normal,are otherwise structurally normal,
eg:eg:
@-Hypovolaemia@-Hypovolaemia
@-Cardiac pump failure@-Cardiac pump failure
@-Other causes of hypotension@-Other causes of hypotension
RenalRenal –– results from structuralresults from structural
damage to the glomeruli and renaldamage to the glomeruli and renal
tubulestubules
@-ATN (the most common causative@-ATN (the most common causative
condition)condition)
@-Glomerulonephritis/vasculitis@-Glomerulonephritis/vasculitis
@-Tubulointerstitial nephriti@-Tubulointerstitial nephritiss
@-Post-renal –@-Post-renal – obstruction of theobstruction of the
urinary tracturinary tract
@-Prostatic hypertrophy/carcinoma@-Prostatic hypertrophy/carcinoma
@-Bladder tumour/gynaecological@-Bladder tumour/gynaecological
malignancymalignancy
@-Neuropathic bladder@-Neuropathic bladder
Specific causesSpecific causes
The most common causes of ARFThe most common causes of ARF
seen in hospital are:seen in hospital are:
Pre-renal failure.Pre-renal failure.
Acute tubular necrosis (ATN).Acute tubular necrosis (ATN).
Obstruction.Obstruction.
The ‘Surgical Triad’The ‘Surgical Triad’
((post-operative volume depletion,post-operative volume depletion,
infection andinfection and
nephrotoxic drugs)nephrotoxic drugs)
is a common cause of hospital-is a common cause of hospital-
acquired ARFacquired ARF
Causes of CKDCauses of CKD
DiabetesDiabetes
GlomerulonephritisGlomerulonephritis
HypertensionHypertension
Autosomal dominant polycysticAutosomal dominant polycystic
kidney diseasekidney disease
Reflux nephropathyReflux nephropathy
RenovascularRenovascular
Diabetes mellitusDiabetes mellitus is now theis now the
most common identifiablemost common identifiable
cause ofcause of CKDCKD , being present, being present
in nearly 20% of new patientsin nearly 20% of new patients
Indication of dialysis in AKIIndication of dialysis in AKI
1-Hyperkalaemia greater than 6.51-Hyperkalaemia greater than 6.5
mmol/l or 6–6.5 mmol/l with ECGmmol/l or 6–6.5 mmol/l with ECG
changeschanges
2-Pulmonary edema2-Pulmonary edema
3-Metabolic acidosis causing3-Metabolic acidosis causing
circulatory compromise.circulatory compromise.
(unresponsive to medical(unresponsive to medical
management)management)
4-Uraemic encephalopathy,4-Uraemic encephalopathy,
pericarditis .pericarditis .
5-There is no absolute level of5-There is no absolute level of
urea or creatinine at which we canurea or creatinine at which we can
dialyze the patient.dialyze the patient.
6- Poisoning with (lithium,6- Poisoning with (lithium,
methanol, ethylene glycol,methanol, ethylene glycol,
aspirin, theophylline ).aspirin, theophylline ).
7- Other metabolic disturbance7- Other metabolic disturbance
refractory to medical treatmentrefractory to medical treatment
like hypercalcemia withlike hypercalcemia with
hyperphosphatemiahyperphosphatemia
Indication of dialysis in CKDIndication of dialysis in CKD
When do you start treatment?When do you start treatment?
@-@-There is no simple answer to thisThere is no simple answer to this
question.question.
Studies (usually retrospective) ofStudies (usually retrospective) of
early versus late dialysis show noearly versus late dialysis show no
obvious gain in life expectancy as aobvious gain in life expectancy as a
result of starting treatment early .result of starting treatment early .
Advantages in terms of quality of lifeAdvantages in terms of quality of life
are another matter, howeverare another matter, however
@-Dialysis should be considered when@-Dialysis should be considered when
the GFR is 10–15 ml/min, depending onthe GFR is 10–15 ml/min, depending on
symptoms.symptoms.
@-An early start of dialysis in@-An early start of dialysis in
patients with predictably steadilypatients with predictably steadily
progressive renal failure (autosomalprogressive renal failure (autosomal
dominant polycystic kidney disease –dominant polycystic kidney disease –
ADPKD – or glomerulonephritis) isADPKD – or glomerulonephritis) is
practical.practical.
Those with relatively stable renalThose with relatively stable renal
function, however , may often befunction, however , may often be
treated conservatively for longertreated conservatively for longer
Complication of HDComplication of HD
Complications of vascularComplications of vascular
access(temporary/permanent).access(temporary/permanent).
Complications during HD.Complications during HD.
Complication of long term HD.Complication of long term HD.
Complication of vascular accessComplication of vascular access
( central venous cannulation):( central venous cannulation):
immediate:immediate:
@-Arterial puncture.@-Arterial puncture.
@-Pneumothorax.@-Pneumothorax.
@-Hemothorax.@-Hemothorax.
@-Arrythmias.@-Arrythmias.
@-Air embolism.@-Air embolism.
@-Venous or cardiac perforation.@-Venous or cardiac perforation.
@-Pericardial tamponade.@-Pericardial tamponade.
@-Injury of adjacent structure like brachial@-Injury of adjacent structure like brachial
plexus or trachea.plexus or trachea.
Delayed:Delayed:
@-Like thrombosis.@-Like thrombosis.
@-Infection( endocarditis,@-Infection( endocarditis,
osteomyelitis, thrombophlebitis).osteomyelitis, thrombophlebitis).
@-Vascular stricture.@-Vascular stricture.
AKIAKI
When to refer?When to refer?
Persistence of ARF for 2-4Persistence of ARF for 2-4
weeks.weeks.
When to admit?When to admit?
Significant acid –base , fluid andSignificant acid –base , fluid and
electrolytes abnormalitieselectrolytes abnormalities
CKDCKD
When to refer?When to refer?
When GFR 60ml/min forWhen GFR 60ml/min for
mangementmangement
When to admit?When to admit?
Congestive heart failure,Congestive heart failure,
pericarditis , severe acid –base ,pericarditis , severe acid –base ,
fluid and electrolytesfluid and electrolytes
abnormalitiesabnormalities
ThAnKsThAnKs
Dr M AbbassDr M Abbass

More Related Content

What's hot

14 peritoneal dialysis
14 peritoneal dialysis14 peritoneal dialysis
14 peritoneal dialysisyogesh tiwari
 
Hemodialysis vascular catheters review
Hemodialysis vascular catheters review Hemodialysis vascular catheters review
Hemodialysis vascular catheters review JAFAR ALSAID
 
Renal Replacement Therapy: modes and evidence
Renal Replacement Therapy: modes and evidenceRenal Replacement Therapy: modes and evidence
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
 
Autosomal Dominant Polycystic Kidney Disease
Autosomal Dominant Polycystic Kidney DiseaseAutosomal Dominant Polycystic Kidney Disease
Autosomal Dominant Polycystic Kidney Diseasedrsamianik
 
Hemodialysis complications
Hemodialysis complications Hemodialysis complications
Hemodialysis complications FarragBahbah
 
Dialysis various modalities and indices used
Dialysis various modalities and indices usedDialysis various modalities and indices used
Dialysis various modalities and indices usedAbhay Mange
 
Post operative complications of renal transplant
Post operative complications of renal transplantPost operative complications of renal transplant
Post operative complications of renal transplantHabrol Afzam
 
Complications of hemodialysis
Complications of hemodialysisComplications of hemodialysis
Complications of hemodialysisReynel Dan
 
ADEQUACY OF HEMODIALYSIS
ADEQUACY OF HEMODIALYSISADEQUACY OF HEMODIALYSIS
ADEQUACY OF HEMODIALYSISsaihari17
 
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysisAdequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysisIPMS- KMU KPK PAKISTAN
 
Acute tubular necrosis
Acute tubular necrosisAcute tubular necrosis
Acute tubular necrosisRafaqat Ali
 
Renal replacement therapy_
Renal replacement therapy_Renal replacement therapy_
Renal replacement therapy_shashank agrawal
 
Peritoneal dialysis part1
Peritoneal dialysis part1Peritoneal dialysis part1
Peritoneal dialysis part1FarragBahbah
 
Fistula (Arteriovenous fistula -AVF)
Fistula (Arteriovenous fistula -AVF)Fistula (Arteriovenous fistula -AVF)
Fistula (Arteriovenous fistula -AVF)mohamed hassan abbass
 
Continuous renal replacement therapy crrt
Continuous renal replacement therapy crrtContinuous renal replacement therapy crrt
Continuous renal replacement therapy crrtMEEQAT HOSPITAL
 

What's hot (20)

Hepatorenal syndrome
Hepatorenal syndromeHepatorenal syndrome
Hepatorenal syndrome
 
14 peritoneal dialysis
14 peritoneal dialysis14 peritoneal dialysis
14 peritoneal dialysis
 
Complications of peritoneal dialysis
Complications of peritoneal dialysisComplications of peritoneal dialysis
Complications of peritoneal dialysis
 
Hemodialysis vascular catheters review
Hemodialysis vascular catheters review Hemodialysis vascular catheters review
Hemodialysis vascular catheters review
 
Renal Replacement Therapy: modes and evidence
Renal Replacement Therapy: modes and evidenceRenal Replacement Therapy: modes and evidence
Renal Replacement Therapy: modes and evidence
 
Autosomal Dominant Polycystic Kidney Disease
Autosomal Dominant Polycystic Kidney DiseaseAutosomal Dominant Polycystic Kidney Disease
Autosomal Dominant Polycystic Kidney Disease
 
Hemodialysis complications
Hemodialysis complications Hemodialysis complications
Hemodialysis complications
 
Dialysis various modalities and indices used
Dialysis various modalities and indices usedDialysis various modalities and indices used
Dialysis various modalities and indices used
 
Post operative complications of renal transplant
Post operative complications of renal transplantPost operative complications of renal transplant
Post operative complications of renal transplant
 
Complications of hemodialysis
Complications of hemodialysisComplications of hemodialysis
Complications of hemodialysis
 
ADEQUACY OF HEMODIALYSIS
ADEQUACY OF HEMODIALYSISADEQUACY OF HEMODIALYSIS
ADEQUACY OF HEMODIALYSIS
 
SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)
SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)
SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)
 
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysisAdequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
 
Acute tubular necrosis
Acute tubular necrosisAcute tubular necrosis
Acute tubular necrosis
 
Obstructive Uropathy of Urology
Obstructive Uropathy of UrologyObstructive Uropathy of Urology
Obstructive Uropathy of Urology
 
Hepatorenal
HepatorenalHepatorenal
Hepatorenal
 
Renal replacement therapy_
Renal replacement therapy_Renal replacement therapy_
Renal replacement therapy_
 
Peritoneal dialysis part1
Peritoneal dialysis part1Peritoneal dialysis part1
Peritoneal dialysis part1
 
Fistula (Arteriovenous fistula -AVF)
Fistula (Arteriovenous fistula -AVF)Fistula (Arteriovenous fistula -AVF)
Fistula (Arteriovenous fistula -AVF)
 
Continuous renal replacement therapy crrt
Continuous renal replacement therapy crrtContinuous renal replacement therapy crrt
Continuous renal replacement therapy crrt
 

Viewers also liked

Acute renal failure
Acute renal failureAcute renal failure
Acute renal failureShahab Riaz
 
04 Differential Diagnosis Of Acute Renal Failure
04 Differential Diagnosis Of Acute Renal Failure04 Differential Diagnosis Of Acute Renal Failure
04 Differential Diagnosis Of Acute Renal Failureguest2379201
 
Hemodialysis and peritoneal dialysis
Hemodialysis and peritoneal dialysisHemodialysis and peritoneal dialysis
Hemodialysis and peritoneal dialysisaneez103
 
25 chen acute renal failure
25 chen   acute renal failure25 chen   acute renal failure
25 chen acute renal failureDang Thanh Tuan
 
Nephritis2008.
Nephritis2008.Nephritis2008.
Nephritis2008.Deep Deep
 
Acute Renal Failure Overview
Acute Renal Failure OverviewAcute Renal Failure Overview
Acute Renal Failure OverviewTDFG7
 
Contrast Induced Nephropathy
Contrast Induced NephropathyContrast Induced Nephropathy
Contrast Induced NephropathyWaleed El-Refaey
 
pediatrics.Glomerulonephritis.(dr.adnan hamawandi)
pediatrics.Glomerulonephritis.(dr.adnan hamawandi)pediatrics.Glomerulonephritis.(dr.adnan hamawandi)
pediatrics.Glomerulonephritis.(dr.adnan hamawandi)student
 
Contrast induced-Acute Kidney Injury
Contrast induced-Acute Kidney InjuryContrast induced-Acute Kidney Injury
Contrast induced-Acute Kidney Injurysmujeeb11
 
Acute renal failure
Acute renal failureAcute renal failure
Acute renal failureChandan N
 
Chronic Kidney Disease Undergradute Case Study- Nutrition and Diet Therapy
Chronic Kidney Disease Undergradute Case Study-  Nutrition and Diet TherapyChronic Kidney Disease Undergradute Case Study-  Nutrition and Diet Therapy
Chronic Kidney Disease Undergradute Case Study- Nutrition and Diet TherapyTimothy Zagada
 
Acute Poststreptococcal Glomerulonephritis
Acute Poststreptococcal GlomerulonephritisAcute Poststreptococcal Glomerulonephritis
Acute Poststreptococcal GlomerulonephritisHakimah Suhaimi
 
19 Acute Glomerulonephritis
19 Acute Glomerulonephritis19 Acute Glomerulonephritis
19 Acute Glomerulonephritisghalan
 
John murtagh’s practice tips 6th ed
John murtagh’s practice tips      6th edJohn murtagh’s practice tips      6th ed
John murtagh’s practice tips 6th edmohamed hassan abbass
 

Viewers also liked (20)

Acute renal failure
Acute renal failureAcute renal failure
Acute renal failure
 
Hepatitis c with renal disease
Hepatitis c with renal diseaseHepatitis c with renal disease
Hepatitis c with renal disease
 
Hcv 4 ttt
Hcv 4 tttHcv 4 ttt
Hcv 4 ttt
 
04 Differential Diagnosis Of Acute Renal Failure
04 Differential Diagnosis Of Acute Renal Failure04 Differential Diagnosis Of Acute Renal Failure
04 Differential Diagnosis Of Acute Renal Failure
 
Hemodialysis and peritoneal dialysis
Hemodialysis and peritoneal dialysisHemodialysis and peritoneal dialysis
Hemodialysis and peritoneal dialysis
 
Antihypertensive drugs
Antihypertensive drugsAntihypertensive drugs
Antihypertensive drugs
 
25 chen acute renal failure
25 chen   acute renal failure25 chen   acute renal failure
25 chen acute renal failure
 
Hyperkalemia
HyperkalemiaHyperkalemia
Hyperkalemia
 
Nephritis2008.
Nephritis2008.Nephritis2008.
Nephritis2008.
 
Acute Renal Failure Overview
Acute Renal Failure OverviewAcute Renal Failure Overview
Acute Renal Failure Overview
 
Contrast induced nephropathy
Contrast  induced nephropathyContrast  induced nephropathy
Contrast induced nephropathy
 
Contrast Induced Nephropathy
Contrast Induced NephropathyContrast Induced Nephropathy
Contrast Induced Nephropathy
 
pediatrics.Glomerulonephritis.(dr.adnan hamawandi)
pediatrics.Glomerulonephritis.(dr.adnan hamawandi)pediatrics.Glomerulonephritis.(dr.adnan hamawandi)
pediatrics.Glomerulonephritis.(dr.adnan hamawandi)
 
Contrast induced-Acute Kidney Injury
Contrast induced-Acute Kidney InjuryContrast induced-Acute Kidney Injury
Contrast induced-Acute Kidney Injury
 
A Case of Acute Kidney Injury (ARF)
A Case of Acute Kidney Injury (ARF)A Case of Acute Kidney Injury (ARF)
A Case of Acute Kidney Injury (ARF)
 
Acute renal failure
Acute renal failureAcute renal failure
Acute renal failure
 
Chronic Kidney Disease Undergradute Case Study- Nutrition and Diet Therapy
Chronic Kidney Disease Undergradute Case Study-  Nutrition and Diet TherapyChronic Kidney Disease Undergradute Case Study-  Nutrition and Diet Therapy
Chronic Kidney Disease Undergradute Case Study- Nutrition and Diet Therapy
 
Acute Poststreptococcal Glomerulonephritis
Acute Poststreptococcal GlomerulonephritisAcute Poststreptococcal Glomerulonephritis
Acute Poststreptococcal Glomerulonephritis
 
19 Acute Glomerulonephritis
19 Acute Glomerulonephritis19 Acute Glomerulonephritis
19 Acute Glomerulonephritis
 
John murtagh’s practice tips 6th ed
John murtagh’s practice tips      6th edJohn murtagh’s practice tips      6th ed
John murtagh’s practice tips 6th ed
 

Similar to Spotlight on indication of dialysis

Anemia Indian scenario In Chronic Kidney Disease Patients
Anemia Indian scenario In Chronic Kidney Disease Patients Anemia Indian scenario In Chronic Kidney Disease Patients
Anemia Indian scenario In Chronic Kidney Disease Patients Dr Ashutosh Ojha
 
Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.
Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.
Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.Damian Fogarty
 
uremia, treatment, symptoms , 12222.pptx
uremia, treatment, symptoms , 12222.pptxuremia, treatment, symptoms , 12222.pptx
uremia, treatment, symptoms , 12222.pptxddjumanalieva97
 
Chronic Kidney Disease: Diagnosis and management
Chronic Kidney Disease: Diagnosis and managementChronic Kidney Disease: Diagnosis and management
Chronic Kidney Disease: Diagnosis and managementkkcsc
 
Diagnosis & medical management of ckd
Diagnosis & medical management of ckdDiagnosis & medical management of ckd
Diagnosis & medical management of ckdKavinda Theekshana
 
CLD EMER SEMINAR Eyael.pptx
CLD EMER SEMINAR Eyael.pptxCLD EMER SEMINAR Eyael.pptx
CLD EMER SEMINAR Eyael.pptxeyaelsurafel65
 
Ckd icd 9-cm classification
Ckd icd 9-cm classificationCkd icd 9-cm classification
Ckd icd 9-cm classificationMohamedKhamis77
 
Pharmacotherapy of Chronic Renal Failure Detailed.pptx
Pharmacotherapy of Chronic Renal Failure Detailed.pptxPharmacotherapy of Chronic Renal Failure Detailed.pptx
Pharmacotherapy of Chronic Renal Failure Detailed.pptxSreenivasa Reddy Thalla
 
Renal impairment and anaesthesia
Renal impairment and anaesthesiaRenal impairment and anaesthesia
Renal impairment and anaesthesiaErrol Williamson
 
a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan
a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwana-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan
a-comprehensive-approach-to-kidney-disease-and-hypertension by HazwanMohd Hanafi
 
Chronic Kidney Disease.pdf
Chronic Kidney Disease.pdfChronic Kidney Disease.pdf
Chronic Kidney Disease.pdfAmanyireDickson1
 
AKIforResidentsInternalMedicine2022.pptx
AKIforResidentsInternalMedicine2022.pptxAKIforResidentsInternalMedicine2022.pptx
AKIforResidentsInternalMedicine2022.pptxhcahoustonim
 

Similar to Spotlight on indication of dialysis (20)

Anemia Indian scenario In Chronic Kidney Disease Patients
Anemia Indian scenario In Chronic Kidney Disease Patients Anemia Indian scenario In Chronic Kidney Disease Patients
Anemia Indian scenario In Chronic Kidney Disease Patients
 
Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.
Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.
Dr Damian Fogarty: Renal Failure-Detecting, Averting, Managing.
 
uremia, treatment, symptoms , 12222.pptx
uremia, treatment, symptoms , 12222.pptxuremia, treatment, symptoms , 12222.pptx
uremia, treatment, symptoms , 12222.pptx
 
Chronic Kidney Disease: Diagnosis and management
Chronic Kidney Disease: Diagnosis and managementChronic Kidney Disease: Diagnosis and management
Chronic Kidney Disease: Diagnosis and management
 
CHRONIC GLOMERULONEPHRITIS
CHRONIC GLOMERULONEPHRITISCHRONIC GLOMERULONEPHRITIS
CHRONIC GLOMERULONEPHRITIS
 
Diagnosis & medical management of ckd
Diagnosis & medical management of ckdDiagnosis & medical management of ckd
Diagnosis & medical management of ckd
 
CLD EMER SEMINAR Eyael.pptx
CLD EMER SEMINAR Eyael.pptxCLD EMER SEMINAR Eyael.pptx
CLD EMER SEMINAR Eyael.pptx
 
Gagal ginjal
Gagal ginjalGagal ginjal
Gagal ginjal
 
CKD(1).pptx
CKD(1).pptxCKD(1).pptx
CKD(1).pptx
 
diabetic nephropathy
diabetic nephropathydiabetic nephropathy
diabetic nephropathy
 
Ckd icd 9-cm classification
Ckd icd 9-cm classificationCkd icd 9-cm classification
Ckd icd 9-cm classification
 
Pharmacotherapy of Chronic Renal Failure Detailed.pptx
Pharmacotherapy of Chronic Renal Failure Detailed.pptxPharmacotherapy of Chronic Renal Failure Detailed.pptx
Pharmacotherapy of Chronic Renal Failure Detailed.pptx
 
CRF copy.pptx
CRF copy.pptxCRF copy.pptx
CRF copy.pptx
 
Uremia
UremiaUremia
Uremia
 
Renal impairment and anaesthesia
Renal impairment and anaesthesiaRenal impairment and anaesthesia
Renal impairment and anaesthesia
 
a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan
a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwana-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan
a-comprehensive-approach-to-kidney-disease-and-hypertension by Hazwan
 
E gfr for web
E gfr for webE gfr for web
E gfr for web
 
Chronic Kidney Disease.pdf
Chronic Kidney Disease.pdfChronic Kidney Disease.pdf
Chronic Kidney Disease.pdf
 
CME: Acute Renal failure
CME: Acute Renal failureCME: Acute Renal failure
CME: Acute Renal failure
 
AKIforResidentsInternalMedicine2022.pptx
AKIforResidentsInternalMedicine2022.pptxAKIforResidentsInternalMedicine2022.pptx
AKIforResidentsInternalMedicine2022.pptx
 

More from mohamed hassan abbass

More from mohamed hassan abbass (16)

STEAL SYNDROME.pptx
STEAL SYNDROME.pptxSTEAL SYNDROME.pptx
STEAL SYNDROME.pptx
 
Renal Papillary Necrosis.pptx
Renal Papillary Necrosis.pptxRenal Papillary Necrosis.pptx
Renal Papillary Necrosis.pptx
 
cerebral salt wasting.pptx
cerebral salt wasting.pptxcerebral salt wasting.pptx
cerebral salt wasting.pptx
 
DKA IN ESRD.ppt.pptx
DKA IN ESRD.ppt.pptxDKA IN ESRD.ppt.pptx
DKA IN ESRD.ppt.pptx
 
Emphysematous Pyelonephritis.pptx
Emphysematous  Pyelonephritis.pptxEmphysematous  Pyelonephritis.pptx
Emphysematous Pyelonephritis.pptx
 
Xanthogranulomatous Pyelonephritis.pptx
Xanthogranulomatous Pyelonephritis.pptxXanthogranulomatous Pyelonephritis.pptx
Xanthogranulomatous Pyelonephritis.pptx
 
Sickle cell nephropathy SCN
Sickle cell nephropathy SCNSickle cell nephropathy SCN
Sickle cell nephropathy SCN
 
ENCAPSULATING PERITONEAL SCLEROSIS (EPS)
ENCAPSULATING PERITONEAL SCLEROSIS  (EPS)ENCAPSULATING PERITONEAL SCLEROSIS  (EPS)
ENCAPSULATING PERITONEAL SCLEROSIS (EPS)
 
Arterial Blood Gases- ABG
Arterial Blood Gases- ABG Arterial Blood Gases- ABG
Arterial Blood Gases- ABG
 
Spotlight on complication during hemodialysis
Spotlight on complication during hemodialysisSpotlight on complication during hemodialysis
Spotlight on complication during hemodialysis
 
Cystinosis (Cystine disorders )
Cystinosis (Cystine disorders )Cystinosis (Cystine disorders )
Cystinosis (Cystine disorders )
 
Amc handbook of clinical assessment 2007
Amc handbook of clinical assessment 2007Amc handbook of clinical assessment 2007
Amc handbook of clinical assessment 2007
 
BARTTER’S - GITELMAN’S - LIDDLE’S
BARTTER’S - GITELMAN’S - LIDDLE’SBARTTER’S - GITELMAN’S - LIDDLE’S
BARTTER’S - GITELMAN’S - LIDDLE’S
 
Kamc crrt training
Kamc crrt trainingKamc crrt training
Kamc crrt training
 
Hepatitis c virus associated with renal disease
Hepatitis c virus associated with renal diseaseHepatitis c virus associated with renal disease
Hepatitis c virus associated with renal disease
 
Analgesic nephropathy
Analgesic nephropathyAnalgesic nephropathy
Analgesic nephropathy
 

Recently uploaded

Creating Accessible Public Health Communications
Creating Accessible Public Health CommunicationsCreating Accessible Public Health Communications
Creating Accessible Public Health Communicationskatiequigley33
 
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptx
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptxTemporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptx
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptxDr. Rabia Inam Gandapore
 
Circulation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationCirculation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationMedicoseAcademics
 
Non-Invasive assessment of arterial stiffness in advanced heart failure patie...
Non-Invasive assessment of arterial stiffness in advanced heart failure patie...Non-Invasive assessment of arterial stiffness in advanced heart failure patie...
Non-Invasive assessment of arterial stiffness in advanced heart failure patie...Catherine Liao
 
Factors Affecting child behavior in Pediatric Dentistry
Factors Affecting child behavior in Pediatric DentistryFactors Affecting child behavior in Pediatric Dentistry
Factors Affecting child behavior in Pediatric DentistryDr Simran Deepak Vangani
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxdrtabassum4
 
Cardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac PumpingCardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac PumpingMedicoseAcademics
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
 
Arterial health throughout cancer treatment and exercise rehabilitation in wo...
Arterial health throughout cancer treatment and exercise rehabilitation in wo...Arterial health throughout cancer treatment and exercise rehabilitation in wo...
Arterial health throughout cancer treatment and exercise rehabilitation in wo...Catherine Liao
 
Compare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from homeCompare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from homeCatherine Liao
 
5cl adbb 5cladba cheap and fine Telegram: +85297504341
5cl adbb 5cladba cheap and fine Telegram: +852975043415cl adbb 5cladba cheap and fine Telegram: +85297504341
5cl adbb 5cladba cheap and fine Telegram: +85297504341Sherrylee83
 
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t...
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t..."Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t...
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t...Catherine Liao
 
Introducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European UnionIntroducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European UnionGolden Helix
 
1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf
1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf
1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdfKs doctor
 
Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...Catherine Liao
 
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.GawadHemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.GawadNephroTube - Dr.Gawad
 
Young at heart: Cardiovascular health stations to empower healthy lifestyle b...
Young at heart: Cardiovascular health stations to empower healthy lifestyle b...Young at heart: Cardiovascular health stations to empower healthy lifestyle b...
Young at heart: Cardiovascular health stations to empower healthy lifestyle b...Catherine Liao
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramLevi Shapiro
 
ANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptx
ANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptxANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptx
ANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptxBright Chipili
 
Effects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial healthEffects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial healthCatherine Liao
 

Recently uploaded (20)

Creating Accessible Public Health Communications
Creating Accessible Public Health CommunicationsCreating Accessible Public Health Communications
Creating Accessible Public Health Communications
 
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptx
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptxTemporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptx
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptx
 
Circulation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulationCirculation through Special Regions -characteristics and regulation
Circulation through Special Regions -characteristics and regulation
 
Non-Invasive assessment of arterial stiffness in advanced heart failure patie...
Non-Invasive assessment of arterial stiffness in advanced heart failure patie...Non-Invasive assessment of arterial stiffness in advanced heart failure patie...
Non-Invasive assessment of arterial stiffness in advanced heart failure patie...
 
Factors Affecting child behavior in Pediatric Dentistry
Factors Affecting child behavior in Pediatric DentistryFactors Affecting child behavior in Pediatric Dentistry
Factors Affecting child behavior in Pediatric Dentistry
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
 
Cardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac PumpingCardiovascular Physiology - Regulation of Cardiac Pumping
Cardiovascular Physiology - Regulation of Cardiac Pumping
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
 
Arterial health throughout cancer treatment and exercise rehabilitation in wo...
Arterial health throughout cancer treatment and exercise rehabilitation in wo...Arterial health throughout cancer treatment and exercise rehabilitation in wo...
Arterial health throughout cancer treatment and exercise rehabilitation in wo...
 
Compare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from homeCompare home pulse pressure components collected directly from home
Compare home pulse pressure components collected directly from home
 
5cl adbb 5cladba cheap and fine Telegram: +85297504341
5cl adbb 5cladba cheap and fine Telegram: +852975043415cl adbb 5cladba cheap and fine Telegram: +85297504341
5cl adbb 5cladba cheap and fine Telegram: +85297504341
 
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t...
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t..."Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t...
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor t...
 
Introducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European UnionIntroducing VarSeq Dx as a Medical Device in the European Union
Introducing VarSeq Dx as a Medical Device in the European Union
 
1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf
1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf
1130525--家醫計畫2.0糖尿病照護研討會-社團法人高雄市醫師公會.pdf
 
Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...Relationship between vascular system disfunction, neurofluid flow and Alzheim...
Relationship between vascular system disfunction, neurofluid flow and Alzheim...
 
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.GawadHemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
Hemodialysis: Chapter 2, Extracorporeal Blood Circuit - Dr.Gawad
 
Young at heart: Cardiovascular health stations to empower healthy lifestyle b...
Young at heart: Cardiovascular health stations to empower healthy lifestyle b...Young at heart: Cardiovascular health stations to empower healthy lifestyle b...
Young at heart: Cardiovascular health stations to empower healthy lifestyle b...
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
ANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptx
ANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptxANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptx
ANATOMY OF THE LOWER URINARY TRACT AND MALE [Autosaved] [Autosaved].pptx
 
Effects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial healthEffects of vaping e-cigarettes on arterial health
Effects of vaping e-cigarettes on arterial health
 

Spotlight on indication of dialysis

  • 1. Indications of dialysisIndications of dialysis Dr. Mohamed AbbassDr. Mohamed Abbass NephrologistNephrologist PGDD,CARDIFF,UKPGDD,CARDIFF,UK
  • 2.
  • 3. Acute kidney injury (AKI)Acute kidney injury (AKI) is anis an abrupt or rapid decline in renalabrupt or rapid decline in renal filtration functionfiltration function (No universally accepted(No universally accepted definition).definition).
  • 4. It is a life-threatening conditionIt is a life-threatening condition occurring in approximatelyoccurring in approximately 5%5% ofof all hospitalized patients and up toall hospitalized patients and up to 30%30% of the admissions toof the admissions to intensive care units.intensive care units.
  • 5. From the definition of AKI , theFrom the definition of AKI , the diagnosis depend ondiagnosis depend on 1- The1- The increaseincrease in serum creatininein serum creatinine 2- The2- The decreasedecrease in the GFRin the GFR 3- The3- The decreasedecrease in the urine outputin the urine output This is theThis is the RIFLERIFLE criteriacriteria
  • 6. TheThe RIFLERIFLE criteriacriteria in serum creatinine in GFR In urine output Risk 1.5fold 25% < 0.5 mL/ kg per hour for six hours Injury 2fold 50% >0.5mL/ kg per hour for 12 hours Failure 3fold 75% >0.5mL/ kg per hour for 24 hours or anuria for 12 hours Loss Complete loss of kidney function for more than four week (need renal replacement therapy) ESRD Complete loss of kidney function for more than three months ( need renal replacement therapy)
  • 7. Chronic kidney diseaseChronic kidney disease (CKD)(CKD)
  • 8. kidney damage for 3 or morekidney damage for 3 or more monthsmonths 1-Structural or functional abnormalities of1-Structural or functional abnormalities of the kidneythe kidney 2-With or without decreased GFR.2-With or without decreased GFR. 3-Manifested by either pathologic3-Manifested by either pathologic abnormalities or markers of kidney damage.abnormalities or markers of kidney damage.
  • 9. GFR 60 mL/minute/1.73 m2 for 3GFR 60 mL/minute/1.73 m2 for 3 or more months, with or withoutor more months, with or without markers of kidney damage.markers of kidney damage.
  • 10. CKD Stages according to GFRCKD Stages according to GFR (ml/min/1.73m(ml/min/1.73m22 )) 1: Stage 11: Stage 1Kidney damage withKidney damage with normal or GFR >90normal or GFR >90 2: Stage 22: Stage 2GFR 60:89GFR 60:89 3: Stage 33: Stage 3GFR 30:59GFR 30:59 4: Stage 44: Stage 4GFR 15:29GFR 15:29 5: Stage 5 (ESRD)5: Stage 5 (ESRD) <15<15
  • 11. Causes of AKICauses of AKI ARF can be classified into threeARF can be classified into three groups:groups: @-@-Pre-renalPre-renal –– this is caused bythis is caused by ineffective perfusion of kidneysineffective perfusion of kidneys whichwhich are otherwise structurally normal,are otherwise structurally normal, eg:eg: @-Hypovolaemia@-Hypovolaemia @-Cardiac pump failure@-Cardiac pump failure @-Other causes of hypotension@-Other causes of hypotension
  • 12. RenalRenal –– results from structuralresults from structural damage to the glomeruli and renaldamage to the glomeruli and renal tubulestubules @-ATN (the most common causative@-ATN (the most common causative condition)condition) @-Glomerulonephritis/vasculitis@-Glomerulonephritis/vasculitis @-Tubulointerstitial nephriti@-Tubulointerstitial nephritiss
  • 13. @-Post-renal –@-Post-renal – obstruction of theobstruction of the urinary tracturinary tract @-Prostatic hypertrophy/carcinoma@-Prostatic hypertrophy/carcinoma @-Bladder tumour/gynaecological@-Bladder tumour/gynaecological malignancymalignancy @-Neuropathic bladder@-Neuropathic bladder
  • 14. Specific causesSpecific causes The most common causes of ARFThe most common causes of ARF seen in hospital are:seen in hospital are: Pre-renal failure.Pre-renal failure. Acute tubular necrosis (ATN).Acute tubular necrosis (ATN). Obstruction.Obstruction.
  • 15. The ‘Surgical Triad’The ‘Surgical Triad’ ((post-operative volume depletion,post-operative volume depletion, infection andinfection and nephrotoxic drugs)nephrotoxic drugs) is a common cause of hospital-is a common cause of hospital- acquired ARFacquired ARF
  • 16. Causes of CKDCauses of CKD DiabetesDiabetes GlomerulonephritisGlomerulonephritis HypertensionHypertension Autosomal dominant polycysticAutosomal dominant polycystic kidney diseasekidney disease Reflux nephropathyReflux nephropathy RenovascularRenovascular
  • 17. Diabetes mellitusDiabetes mellitus is now theis now the most common identifiablemost common identifiable cause ofcause of CKDCKD , being present, being present in nearly 20% of new patientsin nearly 20% of new patients
  • 18. Indication of dialysis in AKIIndication of dialysis in AKI
  • 19. 1-Hyperkalaemia greater than 6.51-Hyperkalaemia greater than 6.5 mmol/l or 6–6.5 mmol/l with ECGmmol/l or 6–6.5 mmol/l with ECG changeschanges 2-Pulmonary edema2-Pulmonary edema 3-Metabolic acidosis causing3-Metabolic acidosis causing circulatory compromise.circulatory compromise. (unresponsive to medical(unresponsive to medical management)management)
  • 20. 4-Uraemic encephalopathy,4-Uraemic encephalopathy, pericarditis .pericarditis . 5-There is no absolute level of5-There is no absolute level of urea or creatinine at which we canurea or creatinine at which we can dialyze the patient.dialyze the patient.
  • 21. 6- Poisoning with (lithium,6- Poisoning with (lithium, methanol, ethylene glycol,methanol, ethylene glycol, aspirin, theophylline ).aspirin, theophylline ). 7- Other metabolic disturbance7- Other metabolic disturbance refractory to medical treatmentrefractory to medical treatment like hypercalcemia withlike hypercalcemia with hyperphosphatemiahyperphosphatemia
  • 22. Indication of dialysis in CKDIndication of dialysis in CKD
  • 23. When do you start treatment?When do you start treatment? @-@-There is no simple answer to thisThere is no simple answer to this question.question. Studies (usually retrospective) ofStudies (usually retrospective) of early versus late dialysis show noearly versus late dialysis show no obvious gain in life expectancy as aobvious gain in life expectancy as a result of starting treatment early .result of starting treatment early . Advantages in terms of quality of lifeAdvantages in terms of quality of life are another matter, howeverare another matter, however
  • 24. @-Dialysis should be considered when@-Dialysis should be considered when the GFR is 10–15 ml/min, depending onthe GFR is 10–15 ml/min, depending on symptoms.symptoms.
  • 25. @-An early start of dialysis in@-An early start of dialysis in patients with predictably steadilypatients with predictably steadily progressive renal failure (autosomalprogressive renal failure (autosomal dominant polycystic kidney disease –dominant polycystic kidney disease – ADPKD – or glomerulonephritis) isADPKD – or glomerulonephritis) is practical.practical. Those with relatively stable renalThose with relatively stable renal function, however , may often befunction, however , may often be treated conservatively for longertreated conservatively for longer
  • 27. Complications of vascularComplications of vascular access(temporary/permanent).access(temporary/permanent). Complications during HD.Complications during HD. Complication of long term HD.Complication of long term HD.
  • 28. Complication of vascular accessComplication of vascular access ( central venous cannulation):( central venous cannulation): immediate:immediate: @-Arterial puncture.@-Arterial puncture. @-Pneumothorax.@-Pneumothorax. @-Hemothorax.@-Hemothorax. @-Arrythmias.@-Arrythmias. @-Air embolism.@-Air embolism. @-Venous or cardiac perforation.@-Venous or cardiac perforation. @-Pericardial tamponade.@-Pericardial tamponade. @-Injury of adjacent structure like brachial@-Injury of adjacent structure like brachial plexus or trachea.plexus or trachea.
  • 29. Delayed:Delayed: @-Like thrombosis.@-Like thrombosis. @-Infection( endocarditis,@-Infection( endocarditis, osteomyelitis, thrombophlebitis).osteomyelitis, thrombophlebitis). @-Vascular stricture.@-Vascular stricture.
  • 30. AKIAKI When to refer?When to refer? Persistence of ARF for 2-4Persistence of ARF for 2-4 weeks.weeks. When to admit?When to admit? Significant acid –base , fluid andSignificant acid –base , fluid and electrolytes abnormalitieselectrolytes abnormalities
  • 31. CKDCKD When to refer?When to refer? When GFR 60ml/min forWhen GFR 60ml/min for mangementmangement When to admit?When to admit? Congestive heart failure,Congestive heart failure, pericarditis , severe acid –base ,pericarditis , severe acid –base , fluid and electrolytesfluid and electrolytes abnormalitiesabnormalities