chronic kidney disease (ckd)

Download Chronic Kidney Disease (CKD)

Post on 14-Dec-2014

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a precise presentation over CKD made for house officers/medical interns . It focuses over signs and symptoms and in-hospital management of resulting problems , material taken majorly from medscape, CMDT and oxford hand book

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  • 1. CHRONIC KIDNEY DISEASE Dr Beenish Sohail Bhutta

2. WHAT IS CKD ? National Kidney Foundation (NKF) defines CKD as evidence of renal damage (based on abnormal UA [proteinuria, hematuria] or structural abnormalities (found with US) or GFR < 60 mL/min for 3 or more months 3. PATHOPHYSIOLOGY In CKD, reduced clearance of certain solutes principally excreted by the kidney results in their retention in the body fluids. CKD is rarely reversible and leads to progressive decline in renal function. Reduction in renal mass leads to hypertrophy of the remaining nephrons with hyperfiltration, and the GFR in these nephrons is transiently increased, placing a burden on remaining nephrons, leading to progressive glomerular sclerosis and interstitial fibrosis 4. STAGING Stage Description GFR 1 Kidney damage with normal or inc GFR 90 2 Kidney damage with mild reduction in GFR 60-89 3 Moderate dec in GFR 30-59 4 Sever dec in GFR 15-29 5 Kidney Failure 30% from baseline or dec of GFR 500800 ng/mL, or Hb is 12 even if the iron saturation is < 20%. Ferrous sulphate, gluconate or fumarate 325 mg from OD to TDS may be given, Erythropoiten (Epokine, Heamex, 50IU/Kg once or twice a week) Darbepoetin alfa ( Aranesp) is started at 0.45 mcg/kg and can be administered every 24 weeks. 25. SIDE EFFECTS of ERYTHROPOETIN: Allergic reactions Hypertension Hyperviscosity Pure red cell aplasia 26. TREATING COAGULOPATHIES Raising the Hb to 910 g/dL in anemic patients can reduce bleeding time via increased blood viscosity Desmopressin ( Minirin 25 mcg intravenously every 812 hours for two doses) is a short-lived but effective treatment for platelet dysfunction and it is often used in preparation for surgery. Dialysis 27. TREATING ACIDOSIS serum bicarbonate level should be maintained at > 21 mEq/L Administration of bicarb should begin with 2030 mEq/d divided into two doses per day and titrated as needed 28. DRUGS WHICH REQUIRE DOSE REDUCTION OR COMPLETE CESSATION Antivirals Benzodiazepines Colchicine Digoxin Exenatide Fenofibrate Gabapentin Insulin Lithium Metformin* Opioid analgesics Saxagliptin Sitagliptin Sotalol Spironolactone Sulphonylureas (all) Vildagliptin

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