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Chronic kidney disease (CKD) - Coggle Diagram
Chronic kidney disease (CKD)
Definition
The presence of kidney damage or decreased glomerular filtration rate (GFR) for three or more months, irrespective of the cause
Disease classification
Stage G1: GFR ≥90 Normal or high
Stage G2: GFR 60-89 Mildly decreased
Stage G3a: GFR 45-59 Mildly to moderately decreased
Stage G3b: GFR 30-44 Moderately to severely decreased
Stage G4: GFR 15-29 Severely decreased
Stage G5: GFR <15 Kidney failure
Common causes
Vascular diseases (hypertension, atherosclerosis, ischemia, vasculitis, thrombotic microangiopathy
Glomerular diseases (diabetes, autoimmune diseases, systemic infections, drugs, neoplasia)
Tubulointerstitial diseases (urinary tract infections, stones, obstruction, drug toxicity)
Cystic disease (polycystic kidney disease)
Pathophysiology examples
Hyperglycemia causes diabetic nephropathy via three main mechanism: glomerular hyperfiltration, production of advanced glycosylation end products (AGE) and reactive oxygen species, and elevations in cytokines. These lead to alterations in glomerular hemodynamics, inflammation, and fibrosis and ultimately kidney tissue damage.
Elevated blood pressure causes a hypertrophic/thickened vasculature, leading to glomerular damage and Interstitial nephritis, and ultimately resulting in nephron loss.
Clinical manifestations
Patients with stages 1-3 of CKD are generally asymptomatic
Patients with stages 4-5 of CKD may experience the following signs/symptoms:
Edema
Shortness of breath
Nausea/vomiting
Fatigue/weakness
Weight loss/anorexia
Itchy skin
Changes in urination (e.g. frequency, amount, color)
Multi-system alterations
Volume overload
Hyperkalemia
Metabolic acidosis
Mineral and bone disorders (MBD)
Hypertension
Anemia
Dyslipidemia
Sexual dysfunction
Treatment
Lifestyle modifications (e.g. dietary changes, quitting smoking, weight loss)
Maintaining blood pressure and blood sugar in normal range
Avoiding NSAIDs
ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs)
Kidney transplant
Hemodialysis / peritoneal dialysis