Chronic kidney disease in internal medicine.pptx

It basically talks about the chronic kidney disease

1. Chronic kidney disease DR SYDNEY MPISA

2. Outline Definition Etiology Presentation Investigations Management Complications

3. Definition Kidney damage for ≥3 months, as defined by structura l or functional abnormalities of the kidney, with or without decreased GFR Or GFR less than 60ml/min/1.73m2 with or without structural damage.

4. Stages of CKD

5. Etiology Diabetes Hypertension Obstructive uropathies Glomerulonephropathies Infections-HIV -Malaria Drugs Autoimmune disease APCKD Pyelonephritis

6. Presentation Symptoms Nausea Loss of appetite Fatigue Muscle cramps Pruritus Dry skin Slowed mentation Insomnia Reduced urine flow Signs Pallor Uremic frost Pericardial rub Pleural rub Anasarca High blood pressure

7. AKI vs CKD

8. Investigations Serum urea, creatinine Serum electrolytes (Na, K, Ca, Ph) FBC Iron studies Urinalysis, urine casts, urine m/c/s KUB USS Renal biopsy ECG, ECHO

9. Management Dietary modifications Treatment of complications Dialysis Transplant

10. Diet modifications Sodium restriction Potassium restriction Salt and water Phosphorous restriction

11. Anemia Caused by 1-EPO deficiency 2-reduced red cell survival 3-blood loss 4-iron deficiency due to anorexia 5-bone marrow fibrosis 6-anemia of chronic disease

12. Treatment of the anemia Rule out iron deficiency before EPO supplements Rule out other causes of anemia EPO 20-50units/kg sc 3 times a week EPO side effects: hypertension, red cell aplasia, seizures, thromboembolism

13. Hypertension Caused by: 1-salt and water retention 2-hyper-reninnemia 3-symphathetic over-activity 4-increased endothelin/ deficiency of NO 5-imbalance of prostaglandins and kinins

14. Hyperkalemia Due to drugs like: 1-NSAIDS, beta blockers, K sparing diuretics, ACEi Due to endogenous issues like hemolysis, infection and trauma Reduced excretion of the potassium

15. Management of hyperkalemia Medical emergency- 5Ps 1- Protect the heart first with 10mls of 10% Calcium gluconate over 10minutes 2-Push the potassium into the cells with salbutamol nebulization or 10iu iv insulin with 50mls of 50% dextrose or Sodium bicarbonate 3- Potassium binders (kayexalate) 4-Peritoneal dialysis or hemodialysis 5-Pee the potassium (use diuretics like frusemide)

16. Hemodialysis A form of renal replacement therapy which involves using a semipermeable membrane to filter small solutes from the blood Peritoneal dialysis another form of RRT which uses the peritoneum as the membrane through which dialysate and blood exchange solutes

17. Indications for dialysis Acidosis=pH<7.1 Electrolyte imbalances-hyperkalemia with ECG changes/>6.5mmol/l Fluid overload-pulmonary edema Uremia symptoms-bleeding, seizures, encephalopathy

18. Complications of dialysis 1-amyloidosis 2-dialysis disequilibrium syndrome 3-sepsis 4-blocked catheters 5-thrombosis 6-hypotension Sclerosing Peritonitis Hyperglycemia Hypoalbunemia Right sided pleural effusions Failure of membrane

19. Kidney transplant Best form of renal replacement therapy Types of donors 1-live donor 2-brain dead donor 3-cardiac death donor

20. ……………..Questions?.............. END OF LECTURE

21. Take home 1-What are the 2 commonest causes of CKD? 2-What causes anemia in CKD? 3-Compare and contrast AKI vs CKD? 4-How do you manage Hyperkalemia? 5-What are the ECG changes of hyperkalemia? 6-What are the indications of dialysis? 7-What commonly kills patients with CKD?