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what are the most common etiology for CKD ?

diabetic nephropathy

hypertensive nephropathy

chronic GN

polycystic kidney disease


what is the pathophysiology of hypertensive nephrosclerosis ?

: chronic hypertension → narrowing of afferent arterioles and efferent arterioles → reduction of glomerular blood flow → glomerular and tubular ischemia

arteriolonephrosclerosis and fibrosis (focal segmental glomerulosclerosis)


diagnosis of hypertensive nephroslerosis ?

Initially microalbuminuria and microhematuria
With disease progression, nephrosclerosis with macroalbuminuria (usually < 1 g/day) and

Biopsy: sclerosis in capillary tufts, arterial hyalinosis

typical findings in diabetic nephropathy include a thick basement membrane, an increased mesangial matrix, fibrosis, and round nodules within the glomeruli (Kimmelstiel-Wilson nodules.)

but hypertensive predominantly affect the afferent arterioles


what are the clinical featured of CKD?

often asymptomatic until later stages.

Peripheral edema
Pulmonary edema (usually interstitial pulmonary edema)

Clinical features of uremia
Fatigue, weakness, loss of appetite, headaches
Uremic fetor



Uremic pericarditis
Friction rub on auscultation


Encephalopathy: seizures, somnolence, coma

Peripheral neuropathy: paresthesias

Gastrointestinal symptoms: nausea, vomiting

↑ Risk of infection: leukocyte dysfunction

↑ Bleeding tendency secondary to platelet dysfunction - abnormal aggregation and adhesion

Chronic kidney disease-mineral and bone disorder (CKD-MBD):
Etiology: mostly due to secondary
short supply of active vitamin D
hen the blood phosphorus level goes up and blood vitamin D level goes down, your body makes too much parathyroid hormone (PTH). High PTH levels cause calcium

Clinical features: weakness, fractures, bone pain, avascular necrosis


diagnostics ?

↑ Creatinine and BUN
Electrolytes: hyperkalemia, hyperphosphatemia, hypocalcemia
Monitor blood pH for metabolic acidosis
↓ Calcitriol levels
↑ Parathyroid hormone (PTH

↑ bleeding time caused by uremic coagulopathy
Anemia of chronic kidney disease: ↓

ultrasound - shrunk kidneys
renal biopsy


stages based on GFR ?

Glomerular filtration rate (GFR) (mL/min/1.73 m2)

1 > 90 Normal or high
2 60 to 89
3 30 to 59 Moderately decreased
4 15 to 29 Severely decreased
5 < 15 = kidney failure


based on albuminuria
A1 < 30 Normal

A2 30 to 300 Mildly increased (microalbuminuria)

A3 > 300 Severely increased (macroalbuminuria)


treatment for CKD ?

Salt restriction in patients with edema or hypertension

hyperkalemia = Discontinue drugs that increase serum potassium
Avoid high-potassium foods
insulin administration
calcium gluconate
sodium bicarbonate
ion exchange resin - sorbisterit

acid-base disorders- metabolic acidosis correction - sodium bicarbonate for compensated

decompnesated - intravenous alkalisation with sodium bicarbonate

hyperphosphatemia is used calcium carbonate and calcium citrate, which actively binds phosphorus in the intestine and prevents its absorption.
if acute

or vitamin D analogs (calcitriol, paricalcitol) and calcimimets to improve mineral exchange and treat secondary hyperparathyroidism

Nephrotoxic substances avoidance
aminoglycosides, vancomycin

Strict blood pressure control

All patients with CKD
Pneumococcal vaccine every 5 years
Influenza vaccine annually

End-stage renal disease
Dialysis until a renal transplant is available

Anemia of chronic kidney disease
Administer human recombiant synthetic EPO, possibly in conjunction with iron replacement depending on serum ferritin and transferrin values.

Metabolic diseases
Hyperlipidemia: statins

Actively bleeding or about to undergo a surgical procedure
Desmopressin (DDAVP): first-line therapy

Conjugated estrogens: for chronic control of bleeding
Correction of anemia