chronic kidney disease

structural or functional abnormalities of the kidneys for >=3 mo and manifested by either: kidney damage OR GFR <60ml/hr/1.73m²

• urine protein (albumin of globulin)
• albuminuria (normal <30mg/gmCr)
• -microalbuminuria 30-300
• -macro >300

for screening and staging of CKD, ages 18-70yo, pts with diabetic kidney disease, chronic kidney disease in middle age, blacks with hypertensive chronic kidney disease, pts with kidney transplant

used 4 adjusting drug therapy, preferred method, older pts

extremeties of age, prego, malnutrition, skeletal muscle disease, para or quadriplegic, vegetarians and people with rapidly changing kidney fxn

• elderly >60
• familyy hx of CKD
• ethnic minorities-african amer(4X), american indian (2X), hispanic (1.5), alaskan
• low income or education

• diabetes(40-50% risk of CKD)
• HTN(systolic more indicative)
• autoimm disease
• envir toxins (i.e. heavy metal
• drug toxicity

• uncontrolled proteinuria
• uncontrolled BP
• poor glycemic control
• smoking
• -all associated with a faster rate of GFR decrease

• diabetes
• HTN
• glomerulonephritis
• cystic kidney disease

kidney damage prob with markers with normal or dec GFR, >=90ml/min

kidney damage with mild decr GFR, 60-89ml/min

mod decr GFR, 30-59

severe decr GFR, 15-29ml/min

kidney failure, <15 or RRT

uremia and malnutrition

anemia

renal osteodystrophy

metabolic acidosis is most common

dehy, edema

complications from initiating insult to kidneys

HTN-also initiation factor and complication of CKD because CKD progression can result in HTN if not treated appropriately

anemia, mild decr in serum calcium

• hyperphosphatemia
• renal bone disease
• dyslipidemia
• neuropathy
• left ventricular hypertrophy

uremia, malnutrition, metabolic acidosis

advanced age, male, HTN, dyslipidemia, DM, tobacco use, menopause

decr GFR, proteinuria, RAAS overactivity, fluid overload, abn calc and phos metabolism, anemia, inflammation, uremic toxins, homocysteinemia, malnutrition

• socio-demographic profile(older age, ethnic background, low income/education, family history)
• AND
• clinical profile(DM, HTN, autoimm diseases, recovery from acute renal failure-envir or drug-induced)

• estimate GFR using MDRD,
• screen for proteinuria(albumin)-diabetes age 12-70 annually, pts with uncontrolled BP, persons with FH of CKD or >60 yrs of age of belong to ethnic risk group,
• stage,
• identify complications,
• screen for co-morbid conditions

make sure persistent b4 make an intervention, albumin excretion >30 mg on 2 or more consecutive urine samples separated by at least 1-2 weeks

• prevention
• slow progression
• prevent and treat complications
• manage co-morbidities
• timely referral
• RRT

>=65%, reduction in urea from pre-dialysis to post-dialysis

>=1.2, determines adequecy of dialysis

1.5%

2.5%

3.86%

4.25%

1-1.5L

2L

2.5-3L

0-2 points, lower number of ags, higher points

1 point per yr

4 ppints

3-4 points

4 points

need for dialysis in the postop period or the failure of the serum cr to fall below 4mg/dl or 30% ofo pre-transplant value

2nd dose anaphylaxis, moAb

1st dose rxn-cytokine release-give benadryl prophylaxis, moAb

ATG-rabbit, ATGAM-equine, not equiv, thrombocy, leukopenia, polyclonal ab

HTN, edema, wt gain, hyperglyc, osteopor, cataracts, leukocytosis, hypophos, delayed wound healing, acne, steroid psychosis, adren insuff, cushing's, growth retard, N/V

leukopenia, anemia, thrombocytopenia, lots of drug INX

GI (N/V/D), delayed wound healing, drug inx w antacids, iron, acyclovir

sandimmune and neoral w/ generics, CNS toxicity (tremor, seizures), nephrotox, hyperkal, hypomag, htn, dyslipi, gingivial hyperplasia, hirsutism

similar SE to CsA plus plus transplant DM, similar drug inx to CsA

profound dyslipidemia