Chronic Kidney Disease. Dr Mohan B. Biyani A. Professor of Medicine University of Ottawa/Ottawa Hospital

Transcription

1 Chronic Kidney Disease Dr Mohan B. Biyani A. Professor of Medicine University of Ottawa/Ottawa Hospital Health Seminar Series Date 12 May 2013

2 Objectives Normal functioning of Kidneys. Risk factors to develop Chronic kidney disease. Early indicators of Chronic kidney disease. Prevention and treatment of Chronic kidney disease.

3 How Do the Kidneys Work?

4 How Do the Kidneys Work? Two kidneys, size of a fist. The kidneys perform job of filtering and returning to the bloodstream about 200 litres of fluid every 24 hours. About two litres are removed from the body in the form of urine, and about 198 litres are recovered.

5 How Do the Kidneys Work? First blood enters the kidneys via the renal arteries. Then, inside the kidneys, millions of mini-filtering systems called nephrons sieve the blood. waste products removed in the form of urine The clean blood returns to the body through the renal veins.

6 Remove medications. Functions of the kidney Produce urine by filtering waste products and excess fluid from your blood. Maintain water balance. Maintain acid-base balance.

7 Functions of the kidney Regulate blood pressure(hormones and volume) Help produce red blood cells.(epo) Maintain healthy bones(vit D, role in Ca and Po4 balance)

8 Kidneys and Aging With Age kidneys sizes become smaller. Kidney function start declining after the age of 40. Kidney function decline is usually by ml/year. The decline in function may vary based on other medical conditions.

9 What is Chronic Kidney Disease The presence of Kidney Damage or an egfr < 60 ml/min/1.73m 2 and Present for 3 months and Not treated with dialysis or transplant The diagnosis of CKD is only present in patients with egfr 60ml/min if other abnormalities (i.e. proteinuria, hematuria, anatomical) are also present. egfr- estimated glomerular filtration rate-test to check kidney function

10 Stages in Progression of Chronic Kidney Disease. Complications Normal Increased risk Damage GFR Kidney failure CKD death Screening for CKD risk factors CKD risk reduction; Screening for CKD Diagnosis & treatment; Treat comorbid conditions; Slow progression Estimate progression; Treat complications; Prepare for replacement Replacement by dialysis & transplant

11 GFR: Glomerular filtration rate-measure of Kidney function Stages of CKD Stage 1*: GFR >= 90 ml/min/1.73 m 2 Normal or elevated GFR/Urine abnormalities. Stage 2*: GFR (mild)/urine abnormalities. Stage 3: GFR (moderate) Stage 4: GFR (severe) Stage 5: GFR < 15 (kidney failure)

12 CKD is common

13 Estimated prevalence of CKD in Canadians 20 years old Stage 1 CKD > 90 ml/min 792,000 Stage 2 CKD ml/min 720,000 Stage 3 CKD 30 59ml/min 1,032,000 Stage 4 CKD ml/min 48,000 Stage 5 CKD < 15 ml/min 24,000 Numbers are estimates based on an extrapolation of US data Stigant, C, et al. CMAJ 2003;168:

14 Detection of CKD Early detection and treatment of chronic kidney disease is the key. Some simple tests can be done to detect early kidney disease. More so important in patients who have risk factors to develop Kidney disease.

15 Chronic kidney disease Majority of CKD does not progress to ESRD. Major risk factor for Cardiovascular disease. Patients with CKD have other health problems. Once you have End stage kidney disease, management is expensive.

16 Cardiovascular Mortality in the General Population and in ESRD Treated by Dialysis Annual mortality (%) 100 Dialysis 10 1 General population Male Female Black White Age (years)

17 Age-Standardized Rates of Death from Any Cause (Panel A) and Cardiovascular Events (Panel B), According to the Estimated GFR among 1,120,295 Ambulatory Adults Go, A, et al. NEJM 351: 1296

18 Life expectancy and CKD

19 How Do We Assess Your Kidney Function? Lab tests: Blood Urine Health assessment

20 Simple test to detect CKD Blood pressure measurement. A test for protein/blood in the urine. A test for blood creatinine. (egfr) Your GFR tells how much kidney function you have.

21 Causes of chronic kidney disease Anyone can get chronic kidney disease at any age. Diabetes Hypertension Glomerulonephritis (Inflammation) Drugs and toxins Blockage Heredity Others

22 Clinical Presentatation Early stages of CKD asymptomatic. Symptoms may be non specific. Only way to find out is by doing lab tests.

23 Symptoms of CKD feel more tired and have less energy have trouble concentrating have a poor appetite have trouble sleeping have swollen feet and ankles/puffyeyes. have dry, itchy skin need to urinate more often, especially at night.

24 Warning signs of CKD High blood pressure. Blood and/or protein in the urine/frothy urine. Serum creatinine and Blood Urea) blood test, outside the normal range. A glomerular filtration rate (GFR) less than 60.

25 Prevention of CKD Eat healthy-diet. Physical Activity. Control of High blood pressure. Avoiding pain meds /other nephrotoxins.

26 Chronic kidney disease

27 Who should be tested for CKD? Patients with following medical problems Diabetes mellitus. Hypertension. Heart failure. Atherosclerotic heart disease. Cerebrovascular or peripheral vascular disease. Unexplained anemia. Family history of ESRD. First nations peoples.

28 Diet in CKD In order to help maintain healthy kidneys it is important to eat properly. Keep track of daily calories Limit total fat Watch high fructose corn syrup Control salt intake. Watch fluid intake.

29 Sources of Sodium

30 Sodium Sodium causes thirst Sodium holds water in the body

31 What about medications and the Kidney Some meds can cause kidney problems. Some meds can worsen the kidney function. Some meds are very safe with the kidneys. Some meds are used to help your kidney function.

32 Natural Products Generally NOT recommended. Natural product does not mean safe product. Talk to your doctor or pharmacist before taking any new medication

33 Smoking and Kidneys Cigarette smoking induces blood vessel stiffness which may persist for a decade after smoking cessation. Shown to be a risk factor for development of Chronic kidney disease.

34 Exercise and Kidney Exercise can help you improve physical functioning and emotional well-being, increase physical stamina. Improve blood pressure and reduce the risk of heart disease, lower cholesterol, help you sleep better and control body weight. Incorporating consistent aerobic exercise, even taking a 20-minute walk, can help especially if your CKD is a result of hypertension or diabetes.

35 Benefits of early education Delay or prevent the worsening of cardiovascular disease, hypertension and diabetes. Delay or prevent the progression to chronic kidney disease. Improve outcomes if kidney replacement therapy ever becomes necessary. Psychologically prepare one for kidney disease. Reduce health care costs

36 Common tests used in CKD Blood urea. Serum Creatinine. egfr. Urine exam. Ultrasound of kidneys. Electrolytes.

37 Treatment of CKD Treat the underlying disease. Treat associated problems. Slowing the loss of kidney function. Prevent heart disease. Avoidance of Nephrotoxins. Controlling protein leak by medications. Preparation for dialysis/transplantation Kidney transplant or dialysis

38 Stages in Progression of Chronic Kidney Disease and Therapeutic Strategies Complications Normal Increased risk Damage GFR Kidney failure CKD death Screening for CKD risk factors CKD risk reduction; Screening for CKD Diagnosis & treatment; Treat comorbid conditions; Slow progression Estimate progression; Treat complications; Prepare for replacement Replacement by dialysis & transplant

39 Diabetic Nephropathy Have your urine, blood and blood pressure checked regularly by your doctor. Maintain good control of your blood sugar. Control high blood pressure (less than 130/80* on most readings) Stop smoking, Exercise regularly, Make the proper food choices, Avoid excess alcohol

40 CKD ESRD

41 Dialysis Dialysis is process for removing waste and excess water from the blood. Artificial replacement of kidney function. 2 main kinds of dialysis -Hemodialysis -Peritoneal dialysis It can be done at home or in hospital setting.

42 Hemodialysis Typically 4 hours 3/week. Can be done more often or at night. Can replace 10-15% of native renal function only.

43 1. Peritoneal Dialysis Home dialysis Therapies There are 2 types of home dialysis: 2. Home Hemodialysis

44 What Is A Kidney Transplant? A surgery in which a healthy kidney from one person is placed into another person

45 What Is A Living Kidney? Donor? Living person (usually family or friend) who chooses to give you one kidney. Age 18 to 70 s. In good health. Blood compatibility /Paired Exchange Program. What is A Deceased Kidney Donor? Deceased person, previously in good health, who had consented to donate kidneys. An option for people who don t have living donors (usually once dialysis started).

46 Renal stones Affects 11% of males and 9% of females by age of 70 years. Kidney stone can be formed when substances like Ca, Oxalate, Uric acid are high( or if urine volume is low). Diet with high levels of animal protein, high levels of sugars, High sodium, high spinach consumption.

47 Renal stones Pain, blood in urine, gravel or asymptomatic. US or CT scan. Management: Pain control Lithotripsy. Uretroscopy Diet/Fluid/Medications

48 Conclusions Chronic kidney disease is increasingly recognized as a health concern. Early recognition and management is the key in management of CKD patients. Prevention is better then cure.

49 Resources National Kidney foundation. Kidney foundation of Canada.