End-Stage Kidney Disease - Pathology - RDT

Topic: End-stage kidney disease
Course: RDT IInd year
Faculty: Pathology

End-stage kidney disease; definition, etiology, pathogenesis, clinical features, diagnosis, treatment, case study

1. END-STAGE KIDNEY DISEASE Dr. Salman Ahmad Ansari MBBS 15/02/23

2. End-stage kidney disease Definition Etiology Pathogenesis Clinical features Diagnosis + treatment Case study(CRF)

3. End-stage kidney disease Also called end-stage renal disease(ESRD) It is the final stage of chronic kidney disease where GFR is <5% or <15 ml/min Results in death eventually No cure - can only slow the progression of the disease

4. Etiology of CKD Diseases affecting glomerulus : Chronic glomerulonephritis diabetic nephropathy Diseases affecting tubules and interstitium : Vascular: long-standing hypertension Infectious: chronic pyelonephritis Toxic: longterm use of nephrotoxic drugs(NSAIDs(aspirin), paracetamol), lead Obstruction: tumours, kidney stones

5. Pathogenesis of CKD Damage to glomerulus leads to: changes in filtration, and development of nephrotic syndrome(proteinuria, hypoalbuminemia and oedema) Damage to tubulointerstitial tissue leads to: changes in reabsorption and secretion of important substances, leading to excretion in large amounts of dilute urine

6. Stages of CKD 5 stages, depending upon the GF R Normal : GFR: 50-100% Decreased renal reserve : GFR is <50% Renal insufficiency : GFR: <25% Renal failure : GFR: <10% End-stage kidney disease : GFR: <5%

7. Clinical features Renal symptoms + extra-renal symptoms Renal symptoms : Kussmaul breathing(rapid, deep breathing) weakness, nausea, cardiac arrhythmia, diarrhoea(due to hyperkalemia) Sodium and water imbalance: congestive heart failure Hyperuricemia: uric acid crystals in joints and soft tissues - “gout” Azotaemia: high serum urea, creatinine

8. Non-renal symptoms : Anemia Yellowing of skin Congestive heart failure Pulmonary oedema Renal osteodystrophy

9. Diagnosis CBC: anemia Hyperkalemia RFT(renal function tests): increased blood urea, serum creatinine Normal Blood urea: 20-40 mg/dl Normal Serum creatinine: 0.6-1.2 mg/dl eGFR(estimated GFR): <5% or <15 ml/min Urine: albumin to creatinine ratio(ACR) USG Abdomen and Pelvis : shrunken kidneys Biopsy may be needed

10. Treatment Lifestyle modification and dietary restrictions : low salt diet (less than 2 g/day) renal diet (avoiding foods that are high in phosphorus) restricting daily protein to 0.8 g per kg body weight per day Potassium restriction in diet Treatment of underlying cause Maintenance of blood pressure : systolic BP <130 mmHg and diastolic BP <80 mmHg Antihypertensives like angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin 2 receptor blocker (ARB)\

11. Control blood sugar in diabetics : HbA1C<7% Treatment of chronic metabolic acidosis : bicarbonate Treatment of anemia : erythropoietin Treatment of uremia : Dialysis renal transplant

12. Dialysis Procedure to remove waste products and excess fluid from blood, using a machine 2 types : 1. Haemodialysis 2. Peritoneal dialysis Haemodialysis : Done using a dialysis machine and a special filter called a dialyzer Tube is attached to needle in arm. Blood passes from this to a machine and then back to the body through another tube Done 3 times a week at hospital, each session for about 4 hours

13. Peritoneal dialysis Peritoneum:

14. Peritoneal dialysis Dialysing fluid(dialysate) Uses peritoneal membrane as filter Needs to be done everyday Can be done by machine overnight while patient is sleeping

15. Kidney transplant Transfer of healthy kidney from one person into the body of a person with a poorly functioning kidney Need only 1 kidney to survive Ideally donor should be a close relative Major surgery

16. References : Harsh Mohan textbook of pathology https://www.nhs.uk/conditions/dialysis/ https://www.nhs.uk/conditions/kidney-transplant/ StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK499861/ Questions : [email protected] For notes version, scan: