1. Laboratory 9- Week of 9 November 2015
End stage renal disease

2. Pathology-focus on end-stage renal disease
Outline of todays talk
Pathology-focus on end-stage renal disease
urea and creatinine-what are they and how do they end up in the blood
blood plasma urea and creatinine versus urinary urea and creatinine
Contributing pathologies and parameters
types 1 and 2 diabetes-glucose management
atherosclerosis-lipids and lipoproteins
hypertension
body fat-contributing to 3 above pathologies platelet reactivity contributing to 3 above pathologies
nutrient intake

3. End stage renal disease (ESRD) Pathology
inability to produce waste products, maintain fluid and electrolyte balance, and produce hormones

4. ESRD Pathology End-stage renal disease-associations
diabetes (types 1 and 2)-poor glucose management- upsets lipids and lipoproteins and dumps excess glucose into the renal tubules causing damage to their function and ultimately ESRD
atherosclerosis-upset lipids and lipoproteins which may be caused by diabetes -atherosclerosis may also cause hypertension
hypertension-may be caused by diabetes and hence atherosclerosis or atherosclerosis without diabetes
hypertension can damage the glomerular membrane resulting in renal tubule damage due to proteins and other molecules not normally found beyond minimal amounts in the renal tubules

5. ESRD Pathology End-stage renal disease-associations
body fat-particularly so abdominal fat which can trigger type 2 diabetes, atherosclerosis, hypertension, and hence chronic kidney disease
platelet reactivity is less in ESRD-why?

6. ESRD Pathology End-stage renal disease-associations
all above pathologies contribute to ESRD risk

7. Nutrient intake management with ESRD
Dietary:
Fluid limited-why?
Sodium limited-why?
Potassium limited-why?
Carbohydrate management-why?
Calcium-why?
Phosphorous-why?

8. Management with ESRD
Also want to control plasma triglycerides,
cholesterol, HDL-c, LDL-c, blood pressure
BMI to control atherosclerosis and hence further hypertension- this can be done by diet
pre- and post- ESRD onset