1. Renal Disease
Filtration, glomeruli generate removal ultrafiltrate of the plasma based on size and charge of molecules
End products include urea, creatinine, uric acid, K, Na, +H, and to some extent lactic acid
Small solutes cross readily, larger substances are generally restricted
Volume of ultrafiltrate = 135–180 liters(L)/day, 99% water reabsorbed = 1–1.5 L urine excreted
Reabsorption, tubules selectively reabsorb substances from the ultrafiltrate, most notably water and Na

4. Renal Disease
Secretion, tubules secrete substances into the urine for the balance of pH, with HCO3 and H+
Hormome function, produce renin for BPH, EPO for production of red blood cells, activate vitamin D
Metabolic function, gluconeogenesis metabolize drugs and endogenous substances, fluid and electrolyte balance
Causes include trauma, infection, chronic disease, toxic metal or drug use

6. Renal Disease
Renal failure or nephritis causes, fewer total nephrons which effects function and efficacy
Urine volume or composition, reduced waste excretion, hormone production, and anemia (EPO)
Nephrotic Syndrome, proteinuria, edema, anemia, bone disease, and acidosis
Oliguric, urine output of <500ml/d or Non-oliguric at >500ml/d

10. Renal Disease
CKD, (GFR) < 60 mL/min/1.73 m2 for > 3 months with or without kidney damage or Kidney damage > 3 months
The eGFR is the estimated GFR, average of how much blood is filtered by the kidneys each minute
Typically based on imaging, markers of kidney damage, e.g., albuminuria, or urine albumin-to-creatinine ratio > 30 mg/g
Blood test for BUN >20mg/dL, Cr >1.2mg/dL and then Na >135mEq/L, and K >5mEq/L

11. Prevention and Treatment of CKD
Uremia, blood in urine build up of toxic waste products that retains blood and nitrogen substances
Aim for a healthy weight, BMI of , consume adequate calories, est. 2,000
Keep protein within a healthy level, gm/Kg, limit intake of processed foods high sodium, 1.5-2gm/d
Include a variety of simple starches, fresh fruits and vegetables, a diet low in saturated fat

12. Prevention and Treatment of CKD
Eating limiting Potassium, <2gm/Kg, limiting P to help PTH levels remain normal, 8oz. Milk
Taking renal vitamins high in water soluble B-Complex, vitamin D and iron tailored to individual requirements
Keep blood pressure at a healthy level, 125/75, Regular checkups with a doctor, serum test to measure GFR

14. Kidney function and eGFR decline with age
Reference for Population Mean eGFR from NHANES III
Age (years)
Mean eGFR (mL/min/1.73 m2)
20–29
116
30–39
107
40–49 99
50–59 93
60–69 85
70+ 75

15. STAGES OF KIDNEY DISEASE
Kidney Damage with normal or ↑ GFR
GFR ≥ 90 ml/min
Stage 2
Kidney Damage with mild ↓ GFR
GFR 60-89
Stage 3
Moderate ↓ GFR
GFR 30-59
Stage 4
Severe ↓ GFR
GFR 15-29
Stage 5
Kidney Failure
GFR <15 (dialysis)

16. ESRD and Dialysis
When kidney function stops and GFR<15mL/min renal replacement therapy is needed
Dialysis removes a blood through a man-made membrane called a dialyzer, or artificial kidney
When at stage 5 CKD, either dialysis or a kidney transplant is necessary to continue living
Limiting FLUID intake, 1000ml + Urine output, and increasing PROTEIN intake, gm/Kg

17. ESRD and Dialysis
35% of ESRD have malnutrition with >10% wt loss in 1 year and <75% of estimated KCAL/PRO needs
Water softeners, ACE inhibitors, diet high in fruits, >2gm K/d, when urinary output is only 500mg/d
1gm/d Phos intake, with Phos binders at each meal to prevent Arrythmia and hypocalcemia
Kidneys produce EPO, needed Fe+ to prevent anemia or ferritin deficiency

21. Kidney Stones
Urinary calculus, Ca build up typically formed by infection, dehydration, or PTH disorders
Treated with fluid resuscitation of 3L, with either pass of stone or surgical removal
Oxalates, coffee, cocoa, some fruits, and bitter vegetables, having binding to Ca
Dietary Ca is not a cause for stones but excessive animal protein can cause uric acid build up