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    Acute and Chronic Kidney Disease

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    Samuel kuria
    This document discusses acute kidney injury and chronic kidney disease. It covers the pathophysiology, management, investigations and treatment of AKI, stages and causes of CKD, signs and symptoms of CKD, and supportive treatments for CKD including diet, controlling blood pressure and diabetes, treating anemia and bone disease, and use of diuretics and dialysis.

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    Acute and Chronic Kidney Disease

    Uploaded by

    Samuel kuria
    34 views17 pages
    This document discusses acute kidney injury and chronic kidney disease. It covers the pathophysiology, management, investigations and treatment of AKI, stages and causes of CKD, signs and symptoms of CKD, and supportive treatments for CKD including diet, controlling blood pressure and diabetes, treating anemia and bone disease, and use of diuretics and dialysis.

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    medicine

    Original Title

    Aki-ckd

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    This document discusses acute kidney injury and chronic kidney disease. It covers the pathophysiology, management, investigations and treatment of AKI, stages and causes of CKD, signs and symptoms of CKD, and supportive treatments for CKD including diet, controlling blood pressure and diabetes, treating anemia and bone disease, and use of diuretics and dialysis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views17 pages

    Acute and Chronic Kidney Disease

    Uploaded by

    Samuel kuria
    This document discusses acute kidney injury and chronic kidney disease. It covers the pathophysiology, management, investigations and treatment of AKI, stages and causes of CKD, signs and symptoms of CKD, and supportive treatments for CKD including diet, controlling blood pressure and diabetes, treating anemia and bone disease, and use of diuretics and dialysis.

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    © All Rights Reserved
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    Acute and chronic kidney disease

    Acute kidney injury


    • Rapid ,<48hours deterioration/impairment of
    kidney function resulting in the retention of
    nitrogenous and other waste products
    normally cleared by the kidneys
    • creatinine clearance going down >50% and or
    creatinine increasing more than 0.3mg/dl or
    urine output less than 0.5ml/g/hr for 6 hours
    pathophysiology
    • With renal hypoperfusion from decreased cardiac
    output or low blood pressure vasoconstriction of
    efferent arteries occurs.
    • This is mediated by renin-angiotension-aldosterone
    axis,vasopressin and sympathetic system.this way
    glomerular filtration can be maintained even with
    hypoperfusion.
    • Afferent vasodilation also occurs via nitric oxide and
    prostaglandins maintaining glomerular perfusion
    • This autoregualtion fails if prolonged and when BP fall
    to less than 80mmhg systolic hence AKI
    management
    • Treat underling cause eg sepsis,heart failure,GE
    • Avoid nephrotoxic insults e.g drugs
    • Optimize bp,keep MAP(>60mmhg)
    • Watch for electrolytes and fluid balance
    • Relieve obstruction if present
    • Indication for acute dialysis
    • Acid base abnormalities-metabolic acidosis
    • Electrolyte e.g hyperkalemea,hypercalcemea,
    • Fluid overload-pulmonary edema
    • Uremea-pericarditis,encephalopathy,bleeding
    Investigations-AKI/CKD
    • Serial Urinalysis,urine output,osmolarity
    • Fractional excretion of sodium e.g <1% in pre-
    renal vs >2% in acute tubular necrosis
    • Urea,electrolte and creatinine
    • Calcium,phosphatevitamin D,parathyroid levels
    hemoglobin normal in AKI abnormal in CKD
    • Serologies-looking for glomerular disease eg
    HIV,ANA,HEPB/C,P-ANCA.C-ANCA etc
    • Renal ultrasound-size of kidneys,normal in
    Aki,small in CKD
    CKD
    • >3 months of reduced glomerular function of
    <60ml/min and or renal damage
    (imaging,pathology,markers)
    Stages of CKD
    aetiology
    • Diabetic glomerular disease
    • Glomerulonephritis eg post
    streptococcal,connective tissue disease,
    • Hypertensive nephropathy
    Primary glomerulopathy with hypertension
    Vascular and ischemic renal disease
    • Autosomal dominant polycystic kidney disease
    • Other cystic and tubulointerstitial nephropathy
    • Urological causes-BPHH,bladder tumor
    Signs and smptoms
    • Majority are asymptomatic till late
    • Uremic syndrome from urea other waste
    products accumulation cause symptoms late on
    • General-nausea,anorexia,malaise,fetor
    • Skin-uremic frost,pruritus
    • Neurologic-encephalopathy(decreased mental
    status,memory,attention)seizures,neuropathy
    • Cardiovascular-pericarditis,
    LVH,hypertension,cardiomyopathy,CAD,heart
    failure
    • Haematology-anemia,bleeding,thrombocytopnea
    • Metabolic-hyperkalemea,acidosis
    • Bone mineral disease-
    hypocalcemea,hyperphosphotemea results in
    hyperparathyroidism :osteoarthropathy with osteitis
    fibrosa cystica,adynamic bone disease,osteomalacia
    • Endocrine-sexual dysfunction,low VITD,impaired
    growth and development,infertility
    • Other manifestation-fluid retention,acid-base
    abnormalities ,dyslipidemea
    • Systemic inflammation-low
    albumin,cachexia,accelerated atherosclerosis
    • Anemea is universal at stage 4 and 5 CKD
    – Reduced erythropeitin production by kidneys
    – Increased bleeding due to uremea
    – Reduced levels of haematinics-fe,B2,folate
    – Iron deficiency
    – Reduced RBC survival span
    – Comorbidities-autoimmune,HIV,drugs etc
    – Hyperparathyroidism and bone marrow fibrosis
    – Chronic inflammation
    treatment
    • Supportive-
    – Diet-low salt diet,low phosphate,low potassium
    – Control DM HBA1C <7%
    – HTN-BP 130/80 ACE-I/ARB if not hyperkelemic and
    creatinine <250mmol/l
    – Anemia-target HGB 11-12g/dl erythropoetin injection
    with injection iron
    – Secondary hyperparathyroidism -from low
    calcitriol,calcium and high phosphate causing
    osteodystrophy
    – If calcium low and phosphate high use calcium
    carbonate(actal tums) or phosphate binders eg sevelamer
    – Vitamin D (calcitriol)
    • Diuresis
    – Loop diuretics eg furosemide 40mg bd-tid,torsemide
    20mg.a/e-hypokalemea,hyponatremea,hypocalcemea
    – Thiazide –HCTZ 25mg metolazone 2.5mg.as above but
    hypercalcemea,hyperlipidemea,hyperuricemea
    – Mineralocorticoid inhibitor-
    spirinolactone.hyperkalemea,gnacomastia
    • Dialysis-water,toxins and electrolytes control
    – Perioteneal dialysis and haemodialysis
    • Renal transplant

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