Renal Disease: CKD, Diagnosis, and Dialysis Methods

What are the primary functions of the renal system?

Homeostasis, waste elimination, blood volume and pressure regulation via RAAS, electrolyte balance, energy conservation, acid/base excretion, EPO production, and vitamin D activation.

What defines Chronic Kidney Disease (CKD)?

CKD is defined as long-term damage or reduced kidney function lasting 3 months or more.

What are the consequences of CKD?

Waste buildup, electrolyte imbalance, and various complications.

How is CKD diagnosed?

Diagnosis involves measuring kidney function through Glomerular Filtration Rate (GFR), identifying kidney damage markers (albuminuria, imaging abnormalities), and other lab markers (creatinine, urea).

What is the normal range for Glomerular Filtration Rate (GFR)?

Normal GFR is 90-120 mL/min/1.73m².

What GFR value indicates CKD?

CKD is indicated if GFR is less than 60 mL/min for 3 months or more.

What are major risk factors for CKD?

Diabetes, hypertension, family history, age, obesity, smoking, and cardiovascular disease.

What is uraemia?

Uraemia is the buildup of toxins in the blood due to kidney failure.

What are some metabolic consequences of uraemia?

Increased potassium (↑K⁺), decreased calcium (↓Ca²⁺), increased phosphate (↑PO₄³⁻), metabolic acidosis (↑H⁺), anaemia (↓EPO), bone problems (↓calcitriol), and increased waste products (↑urea, creatinine).

What are the goals of CKD management?

Control blood pressure, control blood sugar, manage electrolytes and fluids, prevent disease progression, and treat complications.

What are the two types of dialysis?

Haemodialysis (HD) and peritoneal dialysis (PD).

What is haemodialysis?

A medical procedure used to remove waste and excess fluid from the blood when kidneys are not functioning properly.

How does peritoneal dialysis work?

The peritoneum is a treatment for kidney failure that uses the lining of the abdomen (peritoneum) as a filter to remove waste and excess fluid from the blood

What are common complications of dialysis?

Infection (peritonitis for PD, access site infection for HD), hypotension during HD, electrolyte imbalances, fatigue, cramps, and nausea.

What is the role of ACE inhibitors in CKD management?

ACE inhibitors help prevent the progression of CKD.

What is the effect of decreased EPO production in CKD?

It leads to fewer red blood cells (RBCs) and results in anaemia.

How does CKD affect bone health?

Decreased calcitriol production leads to weak bones.

What are the effects of metabolic acidosis in CKD?

It results in increased hydrogen ions (↑H⁺) and can lead to various health issues, such as a decrease in blood pH.

What role do electrolytes play in CKD?

In CKD, the kidneys impaired ability to regulate electrolytes can lead to dangerous imbalances. Electrolytes like sodium, potassium, calcium, and phosphate are crucial for various bodily functions, and their dysregulation in CKD can cause serious health problems, including cardiac arrhythmias, bone disease, and muscle weakness. 

What is the significance of protein in urine for CKD diagnosis?

Protein in urine (albuminuria) is a marker of kidney damage.

What symptoms might indicate worsening kidney function?

Fatigue, nausea, and increased levels of urea and creatinine.

what are the 5 stages of CKD

Stage 1: GFR of 90 or greater. Kidneys are working normally, but there may be other signs of kidney disease, like protein in the urine or structural abnormalities.

Stage 2: GFR of 60-89. Mild kidney damage is present.

Stage 3: GFR of 30-59. Moderate kidney damage.

Stage 4: GFR of 15-29. Severe kidney damage.

Stage 5: GFR less than 15. Kidney failure, also known as End-Stage Renal Disease (ESRD).