Kidney Disorders: Overview and Management

Kidney Disorders Overview

• Kidney Function: Essential for eliminating metabolic wastes, regulating fluids and electrolytes, and maintaining homeostasis. Dysfunction leads to fluid, electrolyte, and acid-base disturbances.

Chronic Kidney Disease (CKD)

• Definition: Enduring kidney damage or decreased glomerular filtration rate (GFR) for ≥3 months.
• Stages:
  • Stage 1: GFR > 90 (kidney damage, normal)
  • Stage 2: GFR 60-89 (mild decrease)
  • Stage 3: GFR 30-59 (moderate decrease)
  • Stage 4: GFR 15-29 (severe decrease)
  • Stage 5: ESKD (GFR < 15)
• Risk Factors: Diabetes, hypertension, cardiovascular disease, obesity, and certain kidney diseases.
• Complications: Cardiovascular disease is the leading cause of morbidity/mortality.

Acute Kidney Injury (AKI)

• Definition: Rapid loss of renal function, often reversible, but can lead to CKD.
• Classification: RIFLE criteria (Risk, Injury, Failure, Loss, and ESKD).
  • Types:
  • Prerenal: Blood flow issues (e.g., dehydration).
  • Intrarenal: Damage to kidney tissue (e.g., acute tubular necrosis).
  • Postrenal: Obstruction of urine flow.

Nephrotic Syndrome

• Characteristics: Increased glomerular permeability resulting in proteinuria, edema, and hyperlipidemia.
• Typical Symptoms: Massive proteinuria (>3.5g/day), hypoalbuminemia, diffuse edema.
• Complications: Increased risk for infections and thromboembolic events.

Treatment & Management

• CKD: Control hypertension, hyperglycemia, and proteinuria; engage patients in self-management.
• AKI: Fluid management, electrolyte monitoring, and possible renal replacement therapy (RRT) if necessary.
• Diuretics and dietary adjustments: For fluid overload and electrolyte imbalances.
• Nutritional Support: High-quality protein, caloric intake, and vitamin supplementation.

Renal Replacement Therapy (RRT)

• Choices: Hemodialysis (HD), Peritoneal Dialysis (PD), and kidney transplantation.
• HD: Removes toxins, fluids; performed thrice weekly.
• PD: Uses peritoneal membrane; suitable for patients intolerant to HD.

Kidney Transplantation

• Indications: Choice for patients with ESKD, offering improved quality of life.
• Post-Transplant Care: Monitor for rejection (e.g., oliguria, edema, weight gain); educate on immunosuppressive therapy.
• Complications: Infections, malignancies, cardiovascular issues.