whole genome sequencing new and its types including shortgun and clone by clone
Understanding Chronic Kidney Disease: Causes, Stages, Symptoms, and Treatment
1.
2. Involves progressive, irreversible loss of
kidney function
Defined as either presence of
• Kidney damage
Pathological abnormalities
• Glomerular filtration rate (GFR)
<60 ml/min for 3 months or longer
3. CKD
death
Complications
Screening
for CKD
risk factors
CKD risk
reduction;
Screening for
CKD
Diagnosis
& treatment;
Treat
comorbid
conditions;
Slow
progression
Estimate
progression;
Treat
complications;
Prepare for
replacement
Replacement
by dialysis
& transplant
Normal
Increased
risk
Kidney
failure
Damage GFR
4. Stage Description
GFR
(ml/min/1.73 m2)
Prevalence*
N
(1000s)
%
1
Kidney Damage with
Normal or GFR
90 5,900 3.3
2
Kidney Damage with
Mild GFR
60-89 5,300 3.0
3 Moderate GFR 30-59 7,600 4.3
4 Severe GFR 15-29 400 0.2
5 Kidney Failure < 15 or Dialysis 300 0.1
*Stages 1-4 from NHANES III (1988-1994). Population of 177 million with age 20. Stage 5 from USRDS (1998), includes
approximately 230,000 patients treated by dialysis, and assuming 70,000 additional patients not on dialysis. GFR estimated
from serum creatinine using MDRD Study equation based on age, gender, race and calibration for serum creatinine. For
Stage 1 and 2, kidney damage estimated by spot albumin-to-creatinine ratio 17 mg/g in men or 25 mg/g in women in two
measurements.
5. Leading causes of ESRD
• Diabetes
• Hypertension
• Last stage of kidney failure
End-stage renal disease (ESRD) occurs when GFR <15
ml/min
6. 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
7. Uremia
• Syndrome that incorporates all signs and symptoms seen in various
systems throughout the body
9. Urinary system
Polyuria
• Results from inability of kidneys to
concentrate urine
• Occurs most often at night
• Specific gravity fixed around 1.010
Oliguria
• Occurs as CKD worsens
Anuria
• Urine output <40 ml per 24 hours
10. Metabolic disturbances
Waste product accumulation
• As GFR ↓, BUN ↑ and serum creatinine levels ↑
BUN ↑
Not only by kidney failure but by protein intake, fever,
corticosteroids, and catabolism
N/V, lethargy, fatigue, impaired thought processes, and
headaches occur
11. Electrolyte/acid–base imbalances
Sodium
• May be normal or low
• Because of impaired excretion, sodium is retained
Water is retained
Edema
Hypertension
CHF
Potassium
• Hyperkalemia
Most serious electrolyte disorder in kidney disease
Fatal dysrhythmias
12. Electrolyte/acid–base imbalances
Calcium and phosphate alterations
Magnesium alterations
Metabolic acidosis
• Results from
Inability of kidneys to excrete acid load (primary ammonia)
13. Hematologic system
Anemia
• Due to ↓ production of erythropoietin
From ↓ of functioning renal tubular cells
Bleeding tendencies
• Defect in platelet function
Infection
• Changes in leukocyte function
• Altered immune response and function
• Diminished inflammatory response
16. Gastrointestinal system
Every part of GI is affected
• Due to excessive urea
Mucosal ulcerations
Stomatitis
Uremic fetor (urinous odor of the breath)
GI bleeding
Anorexia
N/V
17. Neurologic system
Expected as renal failure progresses
• Attributed to
Increased nitrogenous waste products
Electrolyte imbalances
Metabolic acidosis
Demyelination of nerve fibers
Altered mental ability
Seizures and Coma
Dialysis encephalopathy
Peripheral neuropathy
18. Neurologic system
Restless leg syndrome
Muscle twitching
Irritability
Decreased ability to concentrate
Reproductive system
Infertility
• Experienced by both sexes
Decreased libido
Low sperm counts
Sexual dysfunction
19. Musculoskeletal system
Renal osteodystrophy
• Syndrome of skeletal changes
• Result of alterations in calcium and phosphate
metabolism
Weaken bones, increase fracture risk
• Two types associated with ESRD:
Osteomalacia
Osteitis fibrosa
20.
21. Integumentary system
Most noticeable change
• Yellow-gray discoloration of the skin
Due to absorption/retention of urinary pigments
Pruritus
Uremic frost
Dry, pale skin
Dry, brittle hair
Thin nails
Petechiae
Ecchymoses
23. Drug therapy
• Hyperkalemia
IV insulin and glucose
• IV 10% calcium gluconate
Raises threshold for excitation
Sodium bicarbonate
Shift potassium into cells
Correct acidosis
Sodium polystyrene sulfonate (Kayexalate)
Cation-exchange resin
Resin in bowel exchanges potassium for sodium
Evacuates potassium-rich stool from body
Educate patient that diarrhea may occur due to
laxative in preparation
25. Drug therapy
Renal osteodystrophy
• Phosphate intake restricted to
<1000 mg/day
• Phosphate binders
Calcium carbonate (Tums)
Bind phosphate in bowel and excreted
Sevelamer hydrochloride (Renagel)
Lowers cholesterol and LDLs
26. Drug therapy
Renal osteodystrophy (cont’d)
• Phosphate binders (cont’d)
Should be administered with each meal
Side effect: Constipation
• Supplementing vitamin D
Calcitriol (Rocaltrol)
Serum phosphate level must be lowered
before administering calcium or vitamin D
27. Drug therapy
Renal osteodystrophy (cont’d)
• Controlling secondary hyperparathyroidism
Calcimimetic agents
Cinacalcet (Sensipar)
↑ Sensitivity of calcium receptors in parathyroid
glands
Subtotal parathyroidectomy
28. Drug therapy
Anemia
• Erythropoietin
Epoetin alfa (Epogen, Procrit)
Administered IV or subcutaneously
Increased hemoglobin and hematocrit in
2 to 3 weeks
Side effect: Hypertension
29. Drug therapy
Anemia (cont’d)
• Iron supplements
If plasma ferritin <100 ng/ml
Side effect: Gastric irritation, constipation
May make stool dark in color
• Folic acid supplements
Needed for RBC formation
Removed by dialysis
• Avoid blood transfusions
32. Nutritional therapy
Sodium restriction
• Diets vary from 2 to 4 g depending on
degree of edema and hypertension
• Sodium and salt should not be equated
• Patient should be instructed to avoid
high-sodium foods
• Salt substitutes should not be used because
they contain potassium chloride