CKD (Pathogensis and Progression) - Dr. Gawad
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CKD (Pathogensis and Progression) - Dr. Gawad
- 1. Chronic Kidney Disease Pathogenesis and Progression Mohammed Abdel Gawad Nephrology Consultant - Alexandria - Egypt MD Nephrology - Mansoura University NephroTube Founder/Admin drgawad@gmail.com NephroTube Webinar July 2020
- 2. To download the lecture with full animations contact me drgawad@gmail.com For more Nephrology lectures visit www.NephroTube.com
- 5. Chronic Kidney Disease Pathogenesis and Progression
- 8. Afferent Arteriole Efferent Arteriole ↑ Intraglomerular Pressure 2014;14(9):523 www.NephroTube.com
- 9. Afferent Arteriole Efferent Arteriole ↑ Intraglomerular Pressure 2014;14(9):523 www.NephroTube.com
- 15. Chronic Kidney Disease Pathogenesis and Progression
- 16. Why it is important to delay CKD progression? Matshushita K et al. The Lancet, vol 375, p. 2073-2081, 2010, Kidney International. Levey AS, de Jong PE, Coresh J, et al.
- 18. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 19. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 20. Glycemic Control in CKD Target HbA1c
- 21. Glycemic Control in CKD Target HbA1c
- 22. Glycemic Control in CKD Target HbA1c
- 23. Glycemic Control in CKD Target HbA1c 22% increase in mortality from any cause
- 26. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 27. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 28. Blood Pressure Control in CKD Why to treat HTN in CKD? Kidney International 78, 14-18 (July (1) 2010) El Nahas, KI 2010 HTN is a precipitating & initiating factor of CKD
- 29. Blood Pressure Control in CKD Why to treat HTN in CKD? HTN is a prognostic marker for CKD progression Bakris et al. American Journal of Kidney Diseases, Vol 36, No 3 (September), 2000: pp 646-661
- 30. Proteinuria & CKD Why Proteinuria is an important issue? Relationship Between Baseline Proteinuria and Subsequent GFR Decline J Am Soc Nephrol. 2003;14:3217-3232
- 31. Blood Pressure Control in CKD Life Style
- 32. Blood Pressure & Proteinuria Control in CKD When to start anti-HTN therapy? When to start? ≥ ≥
- 33. Blood Pressure & Proteinuria Control in CKD When to start anti-HTN therapy? When to start? ≥ ≥
- 34. Blood Pressure & Proteinuria Control in CKD Mechanism of action of ACE-I & ARBs? In HTN & CKD ↑ Intraglomerular Pressure Afferent Arteriole Efferent Arteriole M.Gawad. www.nephrotube.blogspot.com
- 35. Blood Pressure & Proteinuria Control in CKD Mechanism of action of ACE-I & ARBs? In HTN & CKD ↑ Intraglomerular Pressure ACE-I & ARBs Afferent Arteriole Efferent Arteriole M.Gawad. www.nephrotube.blogspot.com
- 36. Blood Pressure & Proteinuria Control in CKD Mechanism of action of ACE-I & ARBs? Afferent Arteriole Efferent Arteriole In HTN & CKD ACE-I & ARBs ↓ Intraglomerular Pressure
- 37. Blood Pressure & Proteinuria Control in CKD Mechanism of action of ACE-I & ARBs? Afferent Arteriole Efferent Arteriole In HTN & CKD ACE-I & ARBs ↓ Intraglomerular Pressure
- 38. Blood Pressure & Proteinuria Control in CKD When to start anti-HTN therapy? There is insufficient evidence to recommend combining an ACE-I with ARBs to prevent progression of CKD.
- 40. September 2019, 14 (9) 1336-1345
- 41. September 2019, 14 (9) 1336-1345
- 42. ACE-i use with Heart Failure
- 43. Blood Pressure & Proteinuria Control in CKD When to start anti-HTN therapy??
- 44. Blood Pressure & Proteinuria Control in CKD When to start anti-HTN therapy??
- 45. Blood Pressure & Proteinuria Control in CKD What is the target of BP in CKD?
- 46. Blood Pressure & Proteinuria Control in CKD What is the target of BP in CKD?
- 47. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 48. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 49. Hyperuricemia When to start therapy?
- 50. Uric Acid and CKD What is the relation? What is the Evidence?
- 51. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 52. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 54. Newly CKD Lipid profile: Total chloesterol LDL HDL TG No need for follow up Detect 2ry causes: – smoking status – alcohol consumption – blood pressure – body mass index or other measure of obesity – fasting blood glucose – renal function - Nephrotic Syndrome – liver function (transaminases) – thyroid-stimulating hormone (TSH) if dyslipidaemia is present. - Medications
- 55. Newly CKD Lipid profile: Total chloesterol LDL HDL TG No need for follow up Detect 2ry causes: – smoking status – alcohol consumption – blood pressure – body mass index or other measure of obesity – fasting blood glucose – renal function - Nephrotic Syndrome – liver function (transaminases) – thyroid-stimulating hormone (TSH) if dyslipidaemia is present. - Medications
- 56. When to treat? Life style is mandatory in all stratigies if on dialysis if on statin or statin/ezetimibe Continue if not on statin or statin/ezetimibe Dont initiate if not on dialysis Age: 18-49 Start Statins if: - known coronary disease (myocardial infarction or coronary revascularization) - diabetes mellitus - prior ischemic stroke - estimated 10-year incidence of coronary death or non-fatal myocardial infarction > 10% Age: ≥50 GFR <60 Statin or statin/ezetimibe GFR ≥60 Statins
- 62. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 63. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 64. CKD & Acidosis Pathogenesis Normal Acid Base Reclamation & formation of HCO3
- 65. CKD – Metabolic Acidosis Reclamation & formation of HCO3 CKD & Acidosis Pathogenesis
- 66. When is the drug to be used? Oral HCO3 (unless contraindicated) When to start HCO3 therapy? When serum HCO3 < 22 mmol/L What is the therapy target? Maintain serum HCO3 within normal CKD & Acidosis Management
- 68. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 69. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 72. g/kg/d g/kg/d
- 73. CKD Complications & Management Malnutrition
- 74. CKD & Malnutrition How can I minimize and treat malnutrition in CKD? Optimization of dialysis Control of metabolic acidosisCorrection of anemia Correction of underlying infections or inflammatory processes Prevention of low-protein or low-calorie diets
- 75. Diet - Protein Intake What to take care from? (U-shaped Curve) Recommended Protein intake leads to reduction of accumulation of uremic toxins Insufficient protein intake may lead to loss of lean body mass, and malnutrition Excess dietary protein leads to the accumulation of uremic toxins & decrease GFR M.Gawad. www.nephrotube.blogspot.com
- 76. Always talk with your patient about MALNUTRITION and its bad consequences
- 77. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 78. • Glycemic control • BP control & Proteinuria • Hyperuricemia • Hyperlipidemia • Acidosis • Diet • Others How to prevent CKD progression?
- 81. Thank You