chronic kidney disease - chronic renal insufficiency

Download Chronic Kidney Disease - Chronic Renal Insufficiency

Post on 29-Nov-2014




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  • 1. Chronic Kidney Disease Darrell Gray, II MD Internal Medicine Tenwek Hospital
  • 2. Definitions
    • CKD = > 3 months of glomerular filtration rate (GFR) +/- kidney damage as evidenced by serology, imaging or pathology
    • GFR= (140 age) x LBW (kg) x Constant
    • serum Creat (in mol/L)
    • Constant: 1.23 for men; 1.04 for women
  • 3. How do we apply GFR? . . . in Staging
  • 4. How does CKD develop?
    • Common pathway
    Initial Pathologic Insult Reduced Nephron Mass Glomerular Injury Growth Promoters Acting on Intact Glomeruli End-Stage Kidney Glomerular Hypertrophy on intact Glomeruli
  • 5. Ok, but what are the clinical features?
    • General
      • Malaise, nausea, anorexia, pruritis, metallic taste, uremic fetor (fishy breath), coma
    • By system
      • Skin: White crystals in and on skin (uremic frost), dry scaly skin, easy bruising
      • Neurologic: encephalopathy, neuropathy, seizures
      • Cardiovascular: HTN, HL, CHF, pericarditis, friction rub
      • GI: gastritis, ulcers, AVMs, pancreatitis
  • 6. More clinical features
      • Metabolic: Acidosis, K+, PO4, Ca, PTH
        • Acidosis and hyperkalemia can become profound when GFR< 20
      • Hematologic: Anemia, bleeding
        • Typically when GFR