CHRONIC

KIDNEY
DISEASE
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1.
Definition
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is defined as abnormalities of
kidney structure or function,
present for >3 months
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2.
Epidemiology
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11-13 % in global
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3.
Etiology
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✖ Glomerulonephritis
✖ Diabetes Mellitus
✖ Hypertension
✖ Obstructive uropathy
✖ Renal artery stenosis
✖ SLE
✖ Nephrotoxin agent
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4.
Risk Factors
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Modifiable Non Modifiable

✖ Hypertension ✖ Genetic (uromodullin

✖ Obesity mutation, APOL1

✖ Dyslipidemia
mutation)
✖ Age
✖ Diabetes Mellitus
✖ Gender
✖ Smoking
✖ Race
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5.
Classification
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6.
Management
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To prevent the
progressivity of the
disease
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BLOOD PRESSURE MONITORING

If urine albumin If urine albumin
excretion <30 mg/24 excretion >30 mg/24
hrs with BP >140/90 hrs with BP >130/80
mmHg mmHg

Maintain a BP that is Maintain a BP that is

consistently ≤140/90 consistently ≤140/90
mmHg mmHg
ARB or ACE-I can be used
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LOWERING PROTEIN INTAKE

In adults with GFR

<30 ml/min/ 1.73 m2 Avoid high protein
(categories G4-G5) intake (41.3 g/kg/day)
in adults with CKD at
risk of progression
0.8 g/kg/day
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GLYCEMIC CONTROL

prevent or delay progression of the

microvascular complications of diabetes

Target : HbA1c <7%

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LOWERING SALT INTAKE

to <90 mmol (<2 g) per day

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LIFESTYLE MODIFICATION
✖ people with CKD should be
encouraged to undertake physical
activity compatible with
cardiovascular health and tolerance
(at least 30 minutes 5 times per
week)
✖ achieve a healthy weight
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7.
Follow Up
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REFER TO SPECIALIST, IF:
✖ AKI or abrupt sustained fall in
GFR;
✖ GFR <30 ml/min/1.73 m2
(GFR categories G4-G5);
✖ a consistent finding of
significant albuminuria (ACR
>300 mg/g [>30 mg/mmol] or
AER >300 mg/24 hours,
approximately equivalent to
PCR >500 mg/g [>50
mg/mmol] or PER >500 mg/24
hours);
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✖ progression of CKD;
✖ urinary red cell casts, RBC
420 per high power field
sustained and not readily
explained;
✖ CKD and hypertension
refractory to treatment with 4
or more antihypertensive
agents;
✖ persistent abnormalities of
serum potassium;
✖ recurrent or extensive
nephrolithiasis;
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8.
Prevention
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9.
Complication
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✖ Anemia
Hb concentration is <13.0 g/dl (<130 g/l) in males
and <12.0 g/dl (<120 g/l) in females
✖ Metabolic bone disease.
✖ Acidosis
Serum bicarbonate concentrations <22 mmol/l
✖ Cardiovascular disease
✖ Peripheral arterial disease
✖ AKI
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Thank
you!