CHRONIC KIDNEY

DISEASE

CAESAR AYUDI
dr. WIDODO Sp.PD KGH, FINASIM
SMF ILMU PENYAKIT DALAM

TOPICS
Background
Definition
Causes
Clinical Findings

Labs and Imaging

Complications
Treatment
Prognosis

BACKGROUND

Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic

processes associated with abnormal kidney function and a progressive decline in glomerular
filtration rate (GFR).

The term end-stage renal disease represents a stage of CKD where the accumulation of
toxins, fluid, and electrolytes normally excreted by the kidneys results in the uremic
syndrome.

More than 10% of U.S. adults may have CKD

More than 20 million, aged 20 years or older

REFERENCE: HTTP://WWW.CDC.GOV/DIABETES/PUBS/FACTSHEETS/KIDNEY.HTM (CDC, 2010)

Prevalence of CKD in the world continues to increase. Its related with

CVD, DM and aging with comorbid disease.

The general Medicare population with recognized CKD was 9.8% in

2007 and the general Medicare expenditures on CKD were 27.6% of total
cost in 2007.(Reference: http://www.usrds.org/2009/pdf/V1_09_09.PDF)

The most frequent cause of CKD in North America and Europe is diabetic
nephropathy,most often secondary to type 2 diabetes mellitus

DEFINITION

According NKF-K/DOQI

Kidney damage >= 3 months

GFR <60ml/min/1,73 m2 >= 3 months with or without kidney damage

STAGE OF CKD

CAUSES OF CKD ACCORDING NFK-K/DOQI

Diabetic Kidney
Disease

DM I
DM II

Non-Diaetic Kidney
Disease
Glomerular
Disease
Tubulointerstitial
Disease
Cystic Disease
HT,
microangiopathy

Transplantation
Disease
Chronic
Rejection
Drug Toxicity
Glomerulopathy
Transplant

PATHOPHYSIOLOGY OF CKD
Underlying
agent

ProgressiveChronic

Decrease
kidney mass

Nephrosclerosis

Tubulus damage
Interstitial
inflammation

Hyperfiltration
Hypertrophy

CLINICAL FINDINGS

Basicly, symptoms of CKD related to decline of renal functions

Failure of secretion function, decline GFR,

reabsorbtion disorder.

Failure of hormonal function.

LABS AND IMAGING

LABS

Elevation of BUN and creatinine serum

Urine sediment abnormalities
Fluid, electrolyte and acid-base disorder
Hematologic abnormalities
Hemostasis abnormalities

IMAGING
Finding of small echogenic kidneys
Radiological evidence of renal
osteodystrophy

COMPLICATIONS
HYPERKALEMIA
ACID-BASE DISORDER
CARDIOVASCULAR
HEMATOLOGIC

NEUROLOGIC
DISORDERS OF MINERAL METABOLISM
ENDOCRINE DISORDERS

TREATMENT
Treatment for
initiations factors

Control the balance

of water-sodium

Control the balance

of electrolyte and
acid base
disorders

Diet low protein

high calorie

Management of
Hipertension

Prevention and
treatment of
metabolic bone
disease

Management of
Anemia

Detection and
treatment of
infection

Pay attention to the

treatment and
patient safety
(medicine)

Dialysis

Transplantation

CKD-PROGNOSIS

THANK YOU