Chronic Kidney Disease

Lecture given:


List the most common causes of chronic kidney disease

All eGFR done with MDRD formula


  1. presence of kidney damage or eGFR <60mL/min1.73m2 AND
  2. Present for >= 3 months AND
  3. Not treated with dialysis or transplant (if treated, then automatically ESRD)

Diagnosis of significant CKD is only present in patients with GFR >= 60 if other abnormalities (proteinuria, hematuria, anatomical) are also present

Stage 1: > 90 (Kidney damage with normal or high GFR - hyperfiltration)
Stage 2: 60-89 (Kidney damage with mild decr in GFR)
Stage 3: 30-59 (Moderately decr in GFR)
Stage 4: 15-29 (Severely decr GFR)
Stage 5: <15 Kidney failure
Stage 3-5 are at risk for progression to ESRD

Even when asymptomatic, decline in kidney function is associated with death of any cause. Could be a marker of vascular disease for somewhere else in the body

  • CV Disease
  • Heart failure
  • Peripheral artery disease
  • stroke

Progression in Renal disease:

  • once GFR falls <25% of normal, renal function declines even if the original insult has been removed
    • Dimunition of renal reserve
    • Renal insufficiency
    • Overt renal failure
    • Uremia with ESRD

When giving ACEi, there will be a very drastic drop in GFR if patient also takes NSAIDs, or have 100% renal artery stenosis, or is volume contracted

Risk factors for progression:

  • Renal injury
  • Reduction in nephron mass
  • Glomerular capillary hypertension
  • Increased glomerular permeability to macromolecules
  • Increased filtration of plasma proteins
  • Excessive tubular protein reabsorption
  • Renal scarring
  • Hypertension
  • Fluid depletion
  • Malignant hypertension
  • UTI
  • Obstruction
  • Drug toxicity (NSAIDs, aminoglycosides, sulfas, diuretics, over exercise, contract)
  • Pregnancy

Most common cause = diabetes nephropathy; second most common = hypertension
Also glomerulonephritis, cystic kidney

List the clinical manifestations of chronic kidney disease

Signs and symptoms of chronic renal failure

  • General/constitutional symptoms - weakness, fatingue
  • Cardio - HTN, pericarditis
  • GI - N/V/D
  • CNS - Lethargy, confusion, coma
  • Muscles - Twitching, weakness
  • Bones - osteodystrophy
  • Metabolic - acidosis, incr PO4, incr K, incr BUN, incr Cr
  • Endocrine - incr PTH

Complications of CRF (Uremia)

  • Hyponatremia (can't pee out water)
  • CHF and pulmonary edema (increase total body sodium)
  • HyperK
  • Metabolic acidosis
  • GI inflammation, PUD
  • Anemia (EPO, iron folate B12 deficiency, osteitis fibrosa cystica)
  • Hemostasis problems from impaired platelets
  • neurological system

Outline a management plan for optimizing the care of patients with chronic kidney disease

Goals of treatment:

  • stop or slow the rate of GFR decline
  • Prevent additional kidney damage caused by superimposed events
  • Maintain nutritional status
  • Prevent or limit the complications of uremia


  • ACEi/ARB
  • Strick BP control
  • Dietary protein restriction if needed (make sure will not result in malnutrition)
  • Manage hyperlipidemia
  • Glycemic control
  • Phosphate restriction + binders
  • Activated vit D


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