Chronic Kidney Disease

Normal Physiology of the Kidney

• Hormones – EPO, RAAS, 1-alpha-hydroxylase• Metabolic – excretion of urea/creatinine etc.• Homeostasis – acid base balance, electrolyte levels

Chronic Kidney Disease

• A progressive decline in renal function• Present for at least 3 months• Marked by increased serum creatinine and a

fall in GFR

Aetiology

Diabetes is the most important precursor to CKD.Consider the different disease processes:Vascular: increases in pressure, vasculitis Immunological: glomeruonephritisInfection: pylonephritis, UTICongenital: polycystic diseaseObstruction

Clinical features

• Pallor and malaise – due to anaemia• Pruritis – accumulation of urea + other

metabolites• Polyuria, nocturia • Bone pain – metabolic bone disease• Sleep reversal, restless legs

Staging

Management

• Aggressive BP control• ACEi, ARB, CCB• Aim <140/90

• Prevent hyperlipideamia• Statins

• Vit D supplements

Management of ESRD

Renal replacement therapy:Haemodialysis: blood taken from patient and put through dialyserPeritoneal dialysis: tube inserted into peritoneal cavity and dialysate run through

*Transplantation

HD PD• Requires hospital visit each time• Requires trained staff • Less frequent (3x week)• Need strict diet and fluid intake

• More flexible• Patient is able to be home based• Less dietary restrictions • Body image problems • More prone to infection • Frequent (1x at least per day)• Associated with DM

Questions

1. Describe how CKD can lead to metabolic bone disease (5 marks).

• Reduction in vitamin D means less Ca can be absorbed from gut

• This stimulates parathyroid gland• PTH released• Stimulates Ca resorption from bone • Bones become weak, less crystalloid

formation

Thanks for listening!Any questions just email:K.Tomlinson@warwick.ac.uk