AKI and CKD.pptx

acute and chronic renal diesease

1. AKI and CK D By , DARSHAN

2. AKI Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop AKI In uncomplicated AKI; mortality is low even when RRT is required In AKI associated with sepsis and multi-organ failure, mortality is 50-70% CKD Prevalence of CKD stages 3-5 in many countries is around 5-7% More prevalent in people aged 65 years and older Substantially higher in the patients with HTN, DM and vascular diseases 2

3. AKI: Definition AKI is defined as – Increase in Serum Cr by 0.3 mg/dl within 48 hours OR Increase in Serum Cr to 1.5 times of baseline, which is known or presumed to have occurred within the prior 7 days OR Urine volume <0.5 ml/kg/h for 6 hours.

4. Causes

5. Clinical Features Asymptomatic elevations in the plasma creatinine abnormalities on urinalysis Signs and symptoms resulting from loss of kidney function: decreased or no urine output, flank pain, edema, hypertension, or discolored urine

6. Clinical Features Symptoms and/or signs of renal failure: weakness easy fatiguability (from anemia) vomiting, mental status changes or Seizures edema Systemic symptoms and findings: fever Joint pain

7. D i a g n o si s Detailed history Blood urea nitrogen and serum creatinine CBC, peripheral smear, and serology Urinalysis Urine electrolytes Ultrasonography, CT Serolog y: Anti DNA, HBV, HCV , cryoglobulin, urinary Myoglobulin , HBsAG

8. Complications of AKI Uraemia Hyper / hypovolemia Hyponatremia Hyperkalemia Hyperphosphatemia / hypocalcemia Metabolic acidosis Bleeding Infection risk Cardiac –pericarditis, arrhythmia &pericardial effusion Malnutrition

9. Treatment Optimization of hemodynamic and volume status Avoidance of further renal insults by medications Optimization of nutrition If necessary, institution of renal replacement therapy

10. CKD: Definition (criteria) Kidney damage for >= 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest by either: Pathological abnormalities or Markers of kidney damage, including abnormalities in the composition of blood and urine, or abnormalities in the imaging tests GFR <60 ml/min/1.73m2 for >=3 months, with or without kidney damage

11. S t aging Stage Description GFR (ml/min/1.73m2) I Kidney damage with normal or increased GFR >=90 II Kidney damage with mild decrease in GFR 60-89 III Kidney damage with moderate decrease in GFR 30-59 IV Kidney damage with severe decrease in GFR 15-29 V Kidney failure <15 (or dialysis)

12. Causes

13. Clinical features Most asymptomatic till GFR falls below 30 ml/min GFR < 20 ml/min- affect almost all systems Tiredness, breathlessness- anemia, fluid overload Itching , weight loss, nausea, vomiting and hiccups Advanced renal failure- metabolic acidosis, muscular twitching, drowsiness and coma

14. Investigations 16

15. Management Aims of management in CKD are To monitor renal function To prevent or slow further renal damage To limit complications of renal failure To treat risk factors for cardiovascular diseases To prepare for RRT, if appropriate

16. Management Conservative Slowing the Progession Limiting the adverse effects Preparing for Renal Replacement Therapy Definitive RENAL REPLACEMENT THERAPY (RRT) Dialysis: Hemodialysis Peritoneal Dialysis Renal Transplantation Live Cadaveric

17. Limiting the adverse effects of CKD Anemia Fluid and electrolyte balance Acidosis Cardiovascular disease and lipids Renal Osteodystrophy Infection

18. Anaemia Defined as Hemoglobin < 13.5 g/dl in males < 12 g/dl in females Nor m oc y tic normoch r omi c anaemia – as e a r l y as in S t a g e III CK D or universally by Stage IV CKD Primary cause : insufficient production of Erythropoetin

19. Other factors causing anemia Iron deficiency/Folate and Vit B12 deficiency Chronic inflammation Hyperparathyroidism / bone marrow fibrosi s Decreased erythropoiesis Decreased RBC survival Increased blood loss Occult gastrointestinal bleeding Platelet dysfunction Blood loss during hemodialysis Blood sampling

20. Anemia - goals Target Hb : not more than 11.5g/dl Check Hb monthly while on ESAs (Erythropoeisis stimulating agents) Iron studies monthly when started on ESA On stable ESA Therapy : Iron studies can be done 3 times in a monthl

21. Anemia – treatment options Oral iron IV Iron Dextran IV Iron Sucrose IV Sodium Ferric Gluconate Complex Folic acid and Vitamin B 12 supplements Erythropoetin Stimulating Agents : Epoetin alfa* Epoetin beta Darbepoetin alfa Epoetin alfa / beta : 50 -100 IU / Kg SC per week Darbepoetin alfa : 40 mcg SC every 2 weeks

22. Bone disorder (CKD-MBD) Renal bone disease – significantly increase mortality in CKD patients Hyperphosphatemia – one of the most important risk factors associated with cardiovascular disease in CKD patients

23. Preparation for Renal Replacement Therapy Patients of CKD Stage IV approaching Stage V should be referred for Vascular access if hemodialysis is preferred Peritoneal dialysis catheter placement if peritoneal dialysis is preferred AVF is most preferred access for HD patients Ideally created 6 months prior to start of HD Non dominant upper extremity And that arm is to be preserved – no iv lines AVG : 3-6 weeks prior to start of HD PD Catheter : 2 weeks prior to start of HD

24. Differences between AKI & CKD

25. Thank You