Chronic Kidney Disease

Definition:

↓ GFR (<60 mL\min) or kidney damage for > 3 months

Stage 1 Kidney damage + normal GFR GFR > 90
Stage 2 Kidney damage + ↓ GFR GFR: 60-89
Stage 3 Moderate ↓ GFR GFR: 30-59
Stage 4 Severe ↓ GFR GFR: 15-29
Stage 5 Kidney failure GFR <15 or dialysis

CKD 1

 

Causes:

  • MCC is diabetes, followed by HTN
  • Chronic GN
  • Interstitial nephritis, polycystic kidney injury, obstructive uropathy

 

Clinical features:

  • HTN: secondary to salt\water retention (↓ GFR -> stimulate renin-angiotensin -> ↑ aldo)
  • CHF: due to volume overload, HTN, anemia
  • Normocytic normochromic anemia: due to ineffective erythropoiesis
  • ↓ renal clearance of phosphate -> hyperphosphatemia -> ↓ renal production of 1,25 dihydroxyl vit D -> hypocalcemia -> secondary hyperparathyroidism -> renal osteodystrophy
  • Pruritus
  • Electrolytes disturbances: hyperkalemia, hypermagnesemia, metabolic acidosis

 

Diagnosis:

  • Same investigations done in AKI
  • Renal US: small kidneys

 

Treatment:

  • Diet: low protein (0.7-0.8 g\kg\d), low salt (if volume overload), restrict K, Mg, P
  • ACEI: dilate efferent arterioles -> ↓ progression to ESRD
  • For hyperphosphatemia -> give calcium citrate (phosphate binder)

CKD 3

 


Download the PDF version: here


References:

  • Step up to medicine
  • Master the boards

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

%d bloggers like this:
search previous next tag category expand menu location phone mail time cart zoom edit close