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Definition :
CKD is a group of kidney disease with specification :
chronic (more than 3 month)
progressive: become worst time to time
persistent : can not become to completely
remission
Criteria :
1. Kidney damage for 3 month
structural and functional abnormality
with or without decreased Glomerular Filration
Rate (GFR)
manifest by either abnormality of :
pathology
blood composition
urine composition
imaging test
2. GFR < 60 ml/min for 3 month, with or without kidney
damage
Explanation :
Structural abnormality e.g. single kidney,
kidney/ureter stone, cystic kidney,
proteinuria
Prostate hypertrophy, etc
GFR : calculated by Kockroft Gault Formula
Blood composition e.g. ureum, creatinin
Urine composition e.g. proteinuria, haematuria
Imaging e.g. BNO (plain photo abdomen), USG etc
< 60 ml/mnt/1.73 m2
- CKD
60 ml/mnt/1.73 m2
CASE 1.
Man, 60 years old, Bw, 70 kg, Serum Creatinine 1.3 mg/dl
for 4 month
He doesnt have any kidney damage
DOES HE HAVE CKD ?
CASE 2.
Woman, 44 years old, Bw. 50 kg, creatinine serum 1.5 mg/dl
She doesnt have any kidney abnormality
DOES SHE HAVE CKD ?
STAGES OF CKD
Stage
Description
GFR
(mL/min/1.73 m2)
90
II
60-89
III
Moderate GFR
30-59
IV
Severe GFR
15-29
Kidney failure
< 15 or dialysis
ETIOLOGY OF CKD
Etiology of CKD are :
1.
Diabetes Mellitus
2.
Chronic Glomerulonephritis
3.
Chronic Pyelonephritis
4.
Hypertension
5.
6.
7.
8.
9.
Malignancy
10. Others :
pregnancy
chronic liver disease
CLINICAL MANIFESTATION :
Symptom :
Not specific : - lethargic, weakness. nausea, vomiting, headache,
- edema, dyspneu on effort
Physical examination :
Hypertension, anemic, edema
Sign of complications e.g. heart hypertrophy, ascites
Angiotensinogen
(produced by liver)
Renin
(produced by kidney
Angiotensin I
Angiotensin
Converting Enzyme
(ACE)
Suprarenal cortex
Angiotensin II
Aldosteron
Renin Angiotensin Aldosterone System
COMPLICATION OF CKD
1. Cardiac diseases
- coronary artery disease
- congestive heart disease
- acute left heart failure
2. Metabolic acidosis
3. Electrolyte imbalance
- hyper / hypokalemia
- hyper / hyponatremia
4. Renal osteodystrophy (renal bone disease)
What should be
done
How often
Blood pressure
Every 12 months
Diabetes
Smoking
Urine dipstick
(mircoalbuminuria if
diabetes present)
Obesity
eGFR
Family history of
kidney disease
Glomerular haematuria
(particularly if proteinuria present)
Description
GFR
Actions*
(mL/min/1.73 m2)
90
60-89
Estimating progression
normal or GFR
II
III
Moderate GFR
30-59
IV
Severe GFR
15-29
Kidney failure
< 15 or dialysis
Chronic Kidney Disease is defined as either kidney damage or GFR < 60 mL/min/1.73 m2 for 3
months. Kidney damage is defined as pathologic abnormalities or markers of damage, including
abnormalities in blood or urine test or imaging studies
* Includes actions from proceeding stages
Case
Man 44 yrs, came with chief complain lethargic,
anorexia, edema in both of extremity. The complain up
and down since around 4 month. He had an operation
of kidney stone one year ago.
The patient look pale, blood pressure 180/110 mmHg,
edema in both extremity.
Hb. 5.6 mg/dl, BUN 48 mg/dl, serum creatinine 4,2
mg/dl. Hematuria 20 30 /hpf, leukosuria full,
proteinuria +
What is the assessment of that case ?
What other examination do we need ?
Imaging test :
Plain photo abdomen :
opaque stone in left kidney
USG
stone in pielum of left kidney, 4X3 Cm
contracted the right kidney