1. Chronic Kidney Disease Darrell Gray, II MD Internal Medicine Tenwek Hospital 2. Definitions CKD = 3 months of glomerular filtration rate GFR +- kidney damage as evidenced by serology, imaging or pathology GFR= 140 age x LBW kg x Constant serum Creat in molL Constant: 1.23 for men 1.04 for women 3. How do we apply GFR? . . . in Staging 4. How does CKD develop? Common pathway Initial Pathologic Insult Reduced Nephron Mass Glomerular Injury Growth Promoters Acting on Intact Glomeruli End-Stage Kidney Glomerular Hypertrophy on intact Glomeruli 5. Ok, but what are the clinical features? General Malaise, nausea, anorexia, pruritis, metallic taste, uremic fetor fishy breath, coma By system Skin: White crystals in and on skin uremic frost, dry scaly skin, easy bruising Neurologic: encephalopathy, neuropathy, seizures Cardiovascular: HTN, HL, CHF, pericarditis, friction rub GI: gastritis, ulcers, AVMs, pancreatitis 6. More clinical features Metabolic: Acidosis, K+, PO4, Ca, PTH Acidosis and hyperkalemia can become profound when GFR 20 Hematologic: Anemia, bleeding Typically when GFR
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