CHRONIC KIDNEY DISEASE

CAESAR AYUDI
dr. WIDODO Sp.PD KGH, FINASIM
SMF ILMU PENYAKIT DALAM
 TOPICS

Background

Definition

Causes

Clinical Findings
Labs and Imaging
Complications

Treatment
Prognosis
 BACKGROUND

Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic

processes associated with abnormal kidney function and a progressive decline in glomerular
filtration rate (GFR).

The term end-stage renal disease represents a stage of CKD where the accumulation of
toxins, fluid, and electrolytes normally excreted by the kidneys results in the uremic
syndrome.
More than 10% of U.S. adults may have CKD
More than 20 million, aged 20 years or older

REFERENCE: HTTP://WWW.CDC.GOV/DIABETES/PUBS/FACTSHEETS/KIDNEY.HTM (CDC, 2010)

 Prevalence of CKD in the world continues to increase. Its related with
CVD, DM and aging with comorbid disease.

The general Medicare population with recognized CKD was 9.8% in

2007 and the general Medicare expenditures on CKD were 27.6% of total
cost in 2007.(Reference: http://www.usrds.org/2009/pdf/V1_09_09.PDF)

The most frequent cause of CKD in North America and Europe is diabetic
nephropathy,most often secondary to type 2 diabetes mellitus
 DEFINITION
According NKF-K/DOQI

Kidney damage >= 3 months

GFR <60ml/min/1,73 m2 >= 3 months with or without kidney damage

STAGE OF CKD
CAUSES OF CKD ACCORDING NFK-K/DOQI

Diabetic Kidney Non-Diaetic Kidney Transplantation

Disease Disease Disease

Glomerular Chronic
Disease Rejection
DM I
Tubulointerstitial Drug Toxicity
DM II Disease Glomerulopathy
Cystic Disease Transplant
HT,
microangiopathy
 PATHOPHYSIOLOGY OF CKD

Underlying Progressive- Decrease

agent Chronic kidney mass

Tubulus damage
Hyperfiltration
Nephrosclerosis Interstitial
Hypertrophy
inflammation
CLINICAL FINDINGS
Basicly, symptoms of CKD related to decline of renal functions

Failure of secretion function, decline GFR,

reabsorbtion disorder.

Failure of hormonal function.

LABS AND IMAGING

LABS
Elevation of BUN and creatinine serum

Urine sediment abnormalities

Fluid, electrolyte and acid-base disorder

Hematologic abnormalities

Hemostasis abnormalities
IMAGING

Finding of small echogenic kidneys

Radiological evidence of renal osteodystrophy

COMPLICATIONS

HYPERKALEMIA

ACID-BASE DISORDER

CARDIOVASCULAR

HEMATOLOGIC
NEUROLOGIC

DISORDERS OF MINERAL METABOLISM

ENDOCRINE DISORDERS
TREATMENT

Treatment for Control the balance

initiations factors of water-sodium

Control the balance

of electrolyte and Diet low protein
acid base high calorie
disorders
 Prevention and
Management of treatment of
Hipertension metabolic bone
disease

Detection and
Management of
treatment of
Anemia
infection
Pay attention to the
treatment and
patient safety Dialysis
(medicine)

Transplantation
CKD-PROGNOSIS

Mortality higher for patients on dialysis

Most common cause of death is cardiac disfunction

For those who require dialysis to sustain life, but decide

against it, death ensues within days to weeks
THANK YOU