1. This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only. 1

2. Chronic kidney disease (CKD) by: Rehab.Backer.Albacker 2

3. Outline: -Introduction -Pathophysiology and epidemiology -Screening -Stages -Clinical menifestations -Diagnosis and evaluation -Complications -management 3

4. Introduction: CKD is characterized by either kidney damage or aglomerular filtration rate(GFR) less than 60 mL/min/1.73m2 that persists for 3 months or more. 4

5. :Pathophysiology and epidemiology Approximately 16% of U.S population has CKD.the prevalnce is increasing,possibly because of the increased incidence of major risk factors such as DM,HTN,… 5

6. Cont. CKD can arise from progression of acute renal failure or congenital or familial diseases, or as the result of acquired conditions affecting glomerulotubular function that have developed over a period of months or years. 6

7. Screening: -Screening high risk patients for CKD allows for early detection of this condition and implementation of effective interventions to slow progression of kidney disease and treat complictions. -Use of patient-centered tool known as Screening for occult Renal disease(SCORED) survey also may help to strartify risk for CKD. 7

8. Risk factors for chronic kidney disease: DM Hypertension Hyperlipidemia Cardiovascular disease Age>60years Malignancy Family hx of chronic kidney disease Kidney stones-UTI Exposure to nephrotoxic drugs 8

9. Cont. In patients with risk factors for CKD, screening with urinalysis,aurine protein-or albumin- creatinine ratio from a first morning voided specimen,serum creatinine level measurement,and estmation of GFR. 9

10. Stages: 10 GFR (ml/min/1.73m 2 ) Description Stage >90 Kidney damage with normal or  GFR 1 60-89 Mild  GFR 2 30-59 Moderate  GFR 3 15-29 Severe  GFR 4 <15 ESRD) )Kidney failure 5

11. Clinical menifestations: Patient may be present with any of following: -Cardiovascular: HTN,CHF -Gasroenterology: Nusea,vomiting,and loss of appetite. -neurlogical: lathergy,somnolence,confusion,periphral neuropathy,and uremic seizures,pt.may show restless legs,tetany. 11

12. Cont. -Hematological: Normocytic normochromic anemia,bleeding -Endocrine/metabolic: Hyperphoshatemia,hypocalcemia,High PTH -Fluid & electrolytes problem: Hypervolemia,hyperkalemia,hypermagnesemia,Met abolic acidosis -and also uremia inhibits cellualr and humoral immunity. 12

13. Diagnosis and evaluation: -Evaluation of all patients with CKD should include urinalysis,evaluation of urine sediment,Kidney US,serum electrolytes,and measure random urine protein-creatinine ratio. -Biobsy should be considered in patients with CKD who have evidence of glomerular disease in absence of diabetes. 13

14. Complications: -Cardiovascular disease. -Anemia. -chronic kidney disease-mineral and bone disorder. 14

15. Management: Our aim to: 1- delay disease progression. 2-treat symptoms. 3-and reduce risk factors for disorders that have an increased prevalence in pt. with disease. 15

16. Cont. 1-Diet 2-ACE inhibitors 3-BP control. 4-glycemic control. 5-correction of electrolytes abnormalities. 6-Anemia:erythopoietine. 7-Pulmonary edema: Arrange for dialysis if unresposive to diuretics. 16

17. Cont. 8-Dialysis: Indications? 9-kidney transplantation is treatment of choice for most patients with end stage renal disease. 17

18. Thanks 18