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What is the kidney The kidneys weigh about a pound each Located in the retroperitoneal space About the size of an adult fist Shaped like a kidney bean.

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Presentation on theme: "What is the kidney The kidneys weigh about a pound each Located in the retroperitoneal space About the size of an adult fist Shaped like a kidney bean."— Presentation transcript:

1 What is the kidney The kidneys weigh about a pound each Located in the retroperitoneal space About the size of an adult fist Shaped like a kidney bean Attached to blood stream through renal arteries Each renal lobe is made of tiny blood vessels

2 Kidney functions Remove waste Remove excess fluid Secrete Erythropoetin to make red blood cells Regulate bone metabolism Regulate blood pressure Maintain electrolyte and acid balance

3 Healthy Kidneys and Kidney Failure

4 What and where are your kidneys Bean shaped organs Size of fist Situated either side of the backbone on back wall of body cavity At the level of waist

5 Why are the kidneys so important? The kidneys keep you healthy by: Separating the valuable nourishment from the waste products Getting rid of the waste products from the blood stream

6 How do the kidneys work?

7 The Kidneys Main Jobs (1) Removing waste products

8 The Kidneys Main Jobs (2) Fluid control

9 The Kidneys Main Jobs (3) Controlling blood pressure

10 The Kidneys Main Jobs (4) Making red blood cells RED BLOOD CELL FACTORY

11 The Kidneys Main Jobs (5) Healthy bones

12 Why did my kidneys fail? Long standing poorly controlled diabetes. Long standing hypertension Drugs Inflammation of Kidney tissue Infection Born with abnormal kidneys Hereditary conditions Often, the cause of renal failure is not known. You need to speak to the Doctor about your own medical condition

13 What happens when kidneys stop working? Waste products accumulate. You will feel lethargic and sick. You look pale and feel tired. Urine production slows or stops. Fluid accumulates. You will have bad taste Your feet, ankles will swell

14 Signs of kidney damage Damage to kidneys may or may not involve kidney failure. Some signs of damage: – Blood in urine – Protein in urine (Proteinuria) – Abnormal blood or other urine tests – Abnormal imaging tests – Abnormal kidney biopsy

15 CKD Statistics  Prevalence of CKD ≈ 800 per million population 1  Incidence of ESRD ≈ 150 – 200 per million population 1  – patients ( 10% of new ESRD ) in India get RRT 1  India CKD registry Data 1,2 ( Unpublished data, Some variables likely to be affected) :  152 centers contributing  data of approximately 30,000 patients available  Males constitute 70 % with mean age between 45 – 50 yrs of the adult population.  70 % of patients in CKD stage 4 – 5.  Diabetes as a cause of CKD ≈ 30 % of patients 1. CKD in india : Challenges and solutions. S.K.Agarwal, R.K.Srivastava; Nephron clin Pract 2009;111:c197- c www.

16 CKD symptoms Decreased appetite Nausea, vomiting Weight gain/loss Change in bowel habits Decreased sensation in hands and feet (neuropathy) Tired Decreased concentration Frail appearance Decreased sexual functioning Bronze or discolored skin

17 NKF definition of CKD The National Kidney Foundation defines CKD as kidney damage for 3 or more months based on findings of abnormal structure (Imaging studies) or abnormal function (blood or urine tests) OR GFR < 60 mL per minute for 3 or more months with or without evidence of Kidney damage

18 Detecting CKD Detect CKD with 2 simple tests: – Urine test for detecting proteinuria – Blood test for estimating glomerular filtration rate (eGFR)

19 Stages of Chronic Kidney Disease StageDescription GFR* mL/min/1.73m 2 1 Slight kidney damage with normal or increased filtration More than 90 2 Mild decrease in kidney function Moderate decrease in kidney function Severe decrease in kidney function Kidney failure requiring dialysis or transplantation Less than 15 *GFR is glomerular filtration rate, a measurement of the kidney's function.

20 Stage 5 CKD or ESRD Stage 5 CKD is more commonly called ESRD or End Stage Renal Disease. Treatment required – Some form of dialysis to maintain life – Medications – Diet modification

21 Delayed CKD detection can lead to serious consequences Lack of treatment for early complications – Diabetes - High blood pressure – Cardiovascular disease - Malnutrition Late referral to nephrologist/cardiovascular specialist or dietitian Lack of patient education for prevention or treatment options Lack of access placement prior to the start of dialysis

22 CKD risk factors Diabetes Hypertension Smoking High Cholesterol Family history of CKD Age Gender Racial /ethnic background – African American – Native American – Asian American – Pacific Islander – Hispanic

23 CKD risk factors continued Exposure to Nephrotoxic drugs – Contrast Dye – NSAIDS – Ibuprofen – Advil – Motrin – Naproxen


25 Diabetes and CKD Diabetes is the leading cause of CKD in U.S. Early kidney disease has no symptoms – When not diagnosed it can progress to kidney failure with little or no warning

26 Control your diabetes High blood sugar levels can lead to many health problems including kidney disease – 30% of people with Type 1 diabetes develop CKD – 10-40% of people with Type 2 diabetes develop CKD

27 Why CKD prevention is important with diabetes & hypertension More than 90% of patients with CKD also have diabetes, hypertension, or both Diabetes and hypertension both cause CKD and make complications worse

28 How does diabetes cause CKD? Damages small blood vessels in kidneys and other organs – Proteins begin to leak into the urine – Ability to filter waste decreases – Waste products begin to build up – Kidneys may fail – May need dialysis or transplant to live

29 When to get tested Type 1 Diabetes: 5 years after diagnosis, then annually* Type 2 Diabetes: at diagnosis, then annually* Hypertension: at diagnosis and initiation of therapy, then every 3 years if eGFR and microalbumin tests are normal Family history of kidney disease: every 3 years, as long as tests are normal These testing intervals are recommendations; physician opinion may differ *KDOQI Guideline 1

30 Help prevent or delay CKD Control Blood Sugar - Goal of A1C < 6.5 – Eat at about the same time every day – Eat a meal or snack every 3-4 hours and do not skip meals – Eat the same amount of carbohydrates in meals or snacks each day – Check blood sugar as instructed – Take your medicine and /or insulin as directed – Keep your doctor appointments; take your blood sugar record with you

31 Control blood pressure Monitor your own blood pressure – Try to keep it at 125/70 or lower Take medication as directed Limit salt and sodium intake

32 Watch your weight Achieve and maintain desirable body weight (target BMI to normal range of kg/m2)

33 If you smoke STOP

34 Take an active role in your health care Monitor your own blood pressure and blood sugar Know what your levels should be See your doctor regularly – Ask if you are on an ACE or an ARB for your BP – Ask if you had a urine test for protein – Know your eGFR – If you have CKD, know what stage

35 CKD Stage 3 Limit protein and phosphorous intake – High protein levels increase the workload of the kidney

36 CKD Stage 3, 4 or 5 Limit phosphorus intake in your diet – High levels of phosphorus can cause damage without any symptoms

37 Foods high in phosphorus Milk and dairy products Cola drinks and Chocolate Nuts and butters Pancakes, waffles and biscuits Dried beans Processed meats like hot dogs, sausage, Whole grain foods

38 Take better care of yourself Changes in diet, fluid intake and medications can be confusing and challenging. – These changes can help you feel better and slow kidney disease Go to your doctor and ask questions Take your medications as instructed Report any changes

39 It takes a team YOU DoctorNursesDietitianCommunityFamily Support groups

40 Psychologist Social Worker Dietitian Renal Nurses Multidisciplinary Team: A Collaborative Care Model At the core: Nephrologist Nurse Practitioner

41 Now is the time to ask Questions

42 Information Resources National Kidney Foundation - Missouri Kidney Program - Heartland Kidney Network - American Assoc. of Kidney Patients - Renal Support Network -

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