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DR.MGM
BCPS
Definition
Chronic kidney disease is defined as either kidney damage or GFR <60 mL/min/1.73 m2 for 3 months. Kidney
damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine
tests or imaging studies.
Normal levels of GFR vary with age, gender,
and body size.
Hyperkalemia
Reduced GFR inadequate potassium excretion &
decreased delivery of sodium to DT.
COMPLICATIONS
Metabolic acidosis
CKD 3
1. Ammonium excretion begins to fall.
2. Reduction in titratable acid excretion (primarily
as phosphate).
3. Decreased bicarbonate reabsorption.
4. Body utilizes bone to buffer the excess
hydrogen ions.
COMPLICATIONS
Renal Osteodystrophy:
Decreased renal clearance of phosphorus resulting in
retention of phosphate and elevation of serum
parathyroid hormone (PTH)
Decreased production of Calcitriol.
CKD2 reduced calcitriol level & elevated PTH
CKD3 Subtle signs of bone.
bone pain, difficulty in walking, and/or skeletal
deformities with more advanced disease.
COMPLICATIONS
Anemia:
Normochromic, normocytic. Due to reduced renal
erythropoietin production
Microcytosis may reflect iron deficiency or
aluminum excess
Macrocytosis may be associated with vitamin B12 or
folate deficiency.
Occurs at a GFR of 30-58ml/min/1.73m².
COMPLICATIONS
Hypertension:
Volume expansion
Activation of the renin-angiotensin system.
May be due to medications used to treat the
underlying renal disease.
can be present in the earliest stages of CKD and its
prevalence increases with progressive declines in
GFR..
COMPLICATIONS
Dyslipidemia and atherosclerosis:
Young adults (25 to 34 years) with CKD have at least a 100-
fold higher risk for CVD related mortality compared to the
general population.
40 to 50 % of patients with CKD have triglyceride levels
greater than 200 mg/dL (2.26 mmol/L).
20 to 30% have total cholesterol levels greater than 240
mg/dL (6.2 mmol/L), 10 to 45 % have LDL cholesterol
levels greater than 130 mg/dL (3.4 mmol/L).
COMPLICATIONS
Dyslipidemia and atherosclerosis:
lipoprotein lipase activity is reduced in advanced
renal failure; the increase in parathyroid hormone
secretion may play a contributory role.
A circulating lipase inhibitor also may be retained in
renal failure.
COMPLICATIONS
Endocrine Dysfunction:
Thyroid function
alterations in the production, distribution, and
excretion of thyroid hormones.
Sick euthyroid syndrome: low T4 and T3, a normal
TSH level, normal or decreased TBG levels or TRH
stimulation test results.
COMPLICATIONS
Endocrine Dysfunction:
Gonadal hormones
Delayed puberty ( average delay 2.5 years)
In males, reduced levels of free testosterone,
dihydrotestosterone, adrenal androgens, and
increases LH & FSH
Postpubertal females low estrogen, elevated LH and
FSH, and loss of the LH pulsatile pattern. These
disturbances result in anovulation.
COMPLICATIONS
Growth impairment:
Metabolic acidosis
Renal osteodystrophy
Alterations in GH metabolism
COMPLICATIONS
Uremia: With the onset of ESRD
Uremic state:
anorexia
nausea,
vomiting
growth retardation
platelate dysfunction
pericardial disease
peripheral neuropathy
central nervous system abnormalities ranging from
loss of concentration and lethargy to seizures,
coma and death.
COMPLICATIONS
Neurodevelopment
Neurologic findings range from seizures and severe
mental retardation to subtle deficits resulting in poor
school performance.
Uremia, malnutrition & Aluminum.
Frequency by CKD stage* (GFR mL/min 1.73 m2)
Assessment/tests CKD stage 5 (GFR <15 or
CKD stage 2 (GFR 60 to 89) CKD stage 3 (GFR 30 to 59) CKD stage 4 (GFR 15 to 29)
replacement therapy)
Height/length; Height z-
3-6 months 3-6 months 3-4 months 1-3 months
score[2,3]
Weight (dry wt if on dialysis)[2,3] 3-6 months 3-6 months 3-4 months 1 monthly
Weight/height index[2,3] 3-6 months 3-6 months 3-4 months 1-3 months
Dietary interview[2,3] 6-12 months 6 months 3-4 months 1-3 months
Serum electrolytes and
6-12 months 6 months 1-3 months 1-3 months
albumin[2,4]
Proteinuria reduction
Lifestyle intervention for BMI <85th percentile for age and sex
HDL <35 mg/dl Moderate to vigorous physical activity 60 minutes daily
Pharmacologic intervention not currently recommended for isolated low HDL