CHRONIC RENAL DISEASE (CKD)
 Irreversible deterioration in renal function which
usually develops over a period of years loss of
the excretory, metabolic and endocrine functions
of the kidney.
 End-stage renal disease or failure (ESRD or ESRF):
When death is likely without RRT (CKD stage 5).
Clinical assessment of Renal Fx:
Measured GFR: labelled EDTA or inulin, Creatinine
clearance.
Estimated GFR:
1. Cockcroft and Gault equation.
(140 – Age )x Body Wt (kg)
Serum Cr (µmol/l)
2. MDRD formula:
Modification of Diet in Renal Disease.
3. Others.
Risk factor of CKD:
 Diabetes Mellitus
 Hypertension
 Cardiovascular Disease
 Obesity
 Metabolic Syndrome
 Age and Race
 Acute Kidney Injury
 Malignancy
 Family history of CKD
 Kidney Stones
 Infections like Hep C and HIV
 Autoimmune diseases
 Nephrotoxics like NSAIDS
Manifestation of CKD:
 Abnormal Sodium-Water metabolism
Edema, Hypertension
 Acid-base abnormalities
Metabolic Acidosis.
 Abnormal haematopoiesis.
Anaemia of CKD.
 Cardiovascular Abnormalities
LVH, CAD, Diastolic Dysfunction
 Abnormal Calcium-Phosphorus metabolism
Hyperphosphatemia, pruritus, arthralgia
Hyperparathyroidism
Renal Osteodystrophy
Causes of anemia in CKD:
Why atherosclerosis is very common in CKD??
Investigation: refer AKI investigation
Complication:
 Cardiovascular Cx: IHD, Pericarditis, HTN, LVH,
Vascular calcification.
 Anemia.
 Renal bone disease.
 Fluid overload.
 Hyper K, acidosis.
Pathogenesis of renal osteodystrophy:
Referral Criteria of CKD pt to a nephrologist:
1. Age < 40 years
2. Stage 4 CKD or worse (eGFR < 30 mL/min/1.73 m2)
3. Rapid deterioration in renal function.
(Fall in eGFR > 5 ml/min/1.73 m2/yr or > 10
mL/min/1.73 m2 over 5 yrs)
4. Significant proteinuria
(PCR > 100 mg/mmol or ACR > 70 mg/mmol)
5. Significant haematuria.
Aims of management in CKD:
 to prevent or slow further renal damage.
 to limit the adverse physiological effects of renal
impairment on the skeleton and on haematopoiesis.
 to treat risk factors for cardiovascular disease.
 to prepare for RRT.
Management:
 Diagnostic work up to decide underlying etiology
 Treatment of Hypertension and Dyslipidemia
(atorvastatin, statin)
 Treatment of Anemia(recombinant human
erythropoietin)
 Treatment of Hyperphosphatemia (CaCO3,
aluminium hydroxide, carbonate, sevelamer)
 Avoidance of Dehydration & Nephrotoxic agents
 Proper Dosing of Drugs
 Preparation for Renal Replacement Therapy