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CKD (Cause (Reflux nephropathy
lead to tubulointerstitioal nephritis
…
CKD
Cause
Reflux nephropathy
- lead to tubulointerstitioal nephritis
- results from VUR + infections
- papillary damage & cortical scarring as well
Diabetic neuropathy
Microalbuminuria
- early marker, appear before low GFR
- ACR > 3mg/mmol
Hypertensive nephrosclerosis
- arteriosclerosis, changes in intrarenal vasculature
- long history of HTN, slow rise of eGFR
Glomerular disease
- Nephrotic - loss of protein >3.5g, cause low serum albumin
- Focal Segmental Glomerular Sclerosis
-
Clinical Features
-
malaise, loss of appetite, itching, nausea
-
Stage 5
- mental slowing
- seizure
- myoclonic twtiching
Managing
Anaemia
- if Hb < 110g
- synthetic human EPO
- monitorblood count
Mineral Bone Disorder
- reduce phosphate lvl
- use gut phosphate binder e.g CaCo3
- Vit D analogues - alfacalcidol
Bp
- <140/90 (CKD)
- <130/80 (diabetic)
- JNC & Guideline <140/90 (both)
- Statins
- HbAlc 53mmol
- salt intake <2g
- Lifestyle
Complications
CKD Mineral Bone Disorder
- phsophate retention
- Decrease vit D
- reduce Ca absorption
- reduce bone mineralization
Cardiovascular Disease
- 16 fold increase
- MI , Hear failure
- HTN, coronary artery calcification
- Pericarditis
Anaemia
- lack erythropoietin
- haematinic deficiencies