| Anaemia complications | Imbalance of homeostatis
Since no |
| Function of Kidneys | Acid base balance
Electrolyte & balance
Remove toxins and waste products
Control BP
Produce Erythropoietin/renin/calcitriol |
| Definition of CKD | Abnormalities of kidney structure or function, present for ≥3 months, with implications for health such as:
A glomerular filtration rate less than 60 mL/minute/1.73 m², or the presence of one or more of the following markers of kidney damage:
albuminuria/proteinuria,
Urine sediment abnormalities (e.g., haematuria)
Abnormalities (Electrolyte, histology, imaging)
History of kidney transplantation. |
| Range of CKD classification (GFR & Albumin) | G1 90+ ml/min/1.73m^2
G2 60-89
G3a 45-59
G3b 30-44
G4 15-29
G5 less than 15
Albumin
A1 lower than 30 mg/g
A2 30-300
A3 300 + |
| Renal Causes of CKD | Glomerulonephritis
Inherited diseases, such as polycystic kidney disease
Chronic pyelonephritis
Interstitial nephritis
Outflow obstruction
Myeloma |
| Systemic causes of CKD | Heart failure
Reno vascular disease
SLE (Lupus)
Vasculitis |
| Drug causes of CKD | NSAIDs
Lithium
Antibiotics
Diuretics
LMW Heparin |
| Complications of CKD | Cardiovascular disease
Peripheral neuropathy
Renal mineral and bone disorder ( bone pain/disturbed Vitamin D, Calcium, PTH and phosphate metabolism)
Renal anaemia |
| Cardiovascular complications | Hypertension and dyslidaemia, which in turn can contribute to the progression of renal failure, activation of inflammatory mediators and RAAS system, leading to accelerated atherosclerosis. |
| Cardiovascular management | Aspirin, statins, ACE inhibitors or angiotensin receptors blockers and beta blockers.
For Optimal control of glycaemia and blood pressure. |
| Neuropathy complications | Stroke, cognitive dysfunction, encephalopathy, through to autonomic and peripheral neuropathies. (affects the level of electrolytes) Peripheral neuropathy as a result of kidney disease is referred to as uremic neuropathy. |
| neuropathy management | Renal replacement therapy
Risk factors
Complications |
| Renal mineral and bone disorder complications | Mineral bone disorder
Decreased Calcitriol (Vit D-absorb Ca)
Low calcium, high phosphate
Hight PTH- increase calcium from bones (pain, shape) |
| Renal mineral and bone disorder management | Gut phosphate binders/diet/dialysis
Calcitriol (1,25 (OH) Vitamin D) analogues- increase calcium absorption and suppress PTH
Calcimimetic agents- reduce calcium by acting on calcium sensing receptors in parathyroid to reduce PTH. |
| Anaemia complications | Imbalance of homeostatis
Since decreased eythropoietin, so lower red bone marrow, decreased RBC count |
| anaemia management | Hb 100- 120g/L
Check B12, Folate, Iron
Supplement Iron poorly absorbed in CKD
ESAs
improves QOL
Avoids blood transfusion |
| Stages of CKD management | 1/2- ACE inhibitor, Statin, Bp control, Glycaemic control
3/4- Education-Renal replacement Therapy,
Anaemia- epo stimulating agent/Iron
2' Hyperparathyroidism- Diet/phosphate and calcium control
Metabolic acidosis- Sodium bicarbonate
5- Renal replacement therapy, Haemodialysis, Peritoneal dialysis,
Renal transplant |
| Haemodialysis vs Peritoneal Dialysis | HD
Staff required
Has to happen in HD unit
Cardiac Risk
6 weeks
Difficult to access with veins
PD
No staff required
Can happen anywhere
Safer for Cardiac risk
2 weeks
Difficult to access with adhesions |
| What does Dialysis help maintain | Maintain Euvolaemia (sodium & water)
maintains electrolytes
Dialysate bicarbonate diffuses blood into correct acidosis |
| Renal transplant benefits | Improved patient survival
Correct symptoms and metabolism
improved QOL and Family QOL |
