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Chronic Kidney Disease - Coggle Diagram

- - - - Treatment to Slow progression
        
        Monitor and treat complications
        
        CV risk factor management
        
        Prepare for renal replacement therapy
        
        Inidcatiosn for renal replacement therapy
        
        Preparation for end stage renal disease Education/Access
        
        Options
        
        Kidney transplanatiation, Hemodialysis, Peritoneal dialysis, No treatment
        
        Blood pressure control, ACE inhibitors/Angiotensin receptor antagonists, Protein restriction, Salt restriction, Others
        
        BP Control
        
        Hypertension is a cause of CRF, and a result -> Risk factor for progression of CKD
        
        ACE inhibitors/Angiotensin Receptor blockers
        
        Protein Restriction: Controversial
      - Diabetes, Glomerulonephritis, Renvascular disease, Myeloma, Infections
- - - - Erythropoesis stimulating agents (erythroopoetin, darbepoetin)
      - Iron
      - Transfusion
    - - Fatigue, SOB, Cold, Pallor
  - - - Patients unable to maintain K until high GFR loss due to tubular function and aldosterone
      - Treatment
        
        Diet, minimize meds causing hyperkalemia, binding resins, diuretics
    - - Less phosphate clearance, Less vitamin D production
      - Treatment
        
        Diet, Phosphate binders, active vitamin D
  - - - Increased JVP, Peripheral edema, pulmonary edema (SOB hypoxia, lung crepitations)
    - - Na restriction, water restriction, diuretics
  - - - Malaise, nausea/vomiting, pruritis, encephalopathy (confusion,asterixis), pericaridtis (pericaridal rub), neuropathy
  - - - Kidney converts inactive to active vitamin D
      - Stimulates Ca and phosphate absorption from gut, releases Calcium from bone and suppresses PTH
    - - Regulates normal bone formation
      - Stimulated by low calcium, high PO4
      - Inhibited by active vitamin D
    - - Decreased clearance of PO4
        Decreased production of active Vitamin D
        Hypocalcemia
        Alteration in set point PTH secretion
        
        Overstimulation of PTH
        
        Destruction of bone
    - - PO4 restriction, phosphate binders, Vitamin D analogue, Correction of acidosis, PTH inhibitors/parathyroidectomy
  - - - Manage BP, hyperlipidemia, other modifiable cardiac risk facotrs
        
        Ex: Lifestyle, statin, Diabetic control, BP
  - - - Anorexia, Nausea/vomiting, decreased intestinal absorption, increased protein catabolism, decreased protein syntehsis
    - - Weight loss, decreased markers of nutrition (albumin, prealbumin, and transferrin)
  - - - Limited: Desmopressin, cryoprecipitate, estrogen
- - - - Absolute
        
        Pericarditis/pleuritis
        Ecephalopathy
      - Relative Indications
        
        Volume overload unresponsive to diuretics
        Metabolic disturbances
        Uremic Symptoms (anorexia, nasuea/vomiting, weight loss, sleep disturbance, low energy, poor concentration)
    - - Requirements
        
        Suitable Recipient
        
        Acceptable surgical Risk and acceptable risk for immunomodulation
        
        Evaluation by transplant nephrologist and surgeon, social worker
        
        Suitable Donor
        
        Living or decreased (after brain or cardiac death), acceptable kidney function, acceptable anatomy and acceptable transmission risk
        
        Successful Surgery
        
        Arterial anastomosis to external iliac artery
        
        Venous anastomosis to external ilaic vein
        
        Ureteric anastomosis to bladder
        
        Immune Modulation
        
        Humoral (antibodies) - Compatible blood type and absence of pre-formed antibodies
        
        Cellular: Lifelong immunosuppression
      - Contrainidcations to KT
        
        Surgery too risky (Heart or lung disease)
        
        Infection, cancer, low life expectance, poor adherence to treatment, uncontrolled substance disorder
      - Advantages
        
        Replaces all renal functions, normal lifestyle, pregnancy
      - Disadvantages
        
        Risky/stressful first six months, long term risks of malignancy/infection, risk of unknown
    - - Hemodialysis
        
        Membrane is artificial
        
        Fluid removal down hydrostatic
        
        4 hrs 3 x a week to remove fluid gained and clear toxins
        
        Advantages
        
        Keeps you alive, instantaneous all done for you, social aspect
        
        Diadvantages
        
        6 hrs 3 x a week, hard to travel/work, washed out afterwards, fluid overload before, restrictive diet, venous access
      - Peritoneal Dialysis
        
        Peritoneum is membrane
        
        Fluid removal down osmotic gradient
        
        Advantages
        
        Done at home, constant fluid control
        
        Disadvantages
        
        Cosmetic, weight gain, 2-3 hours a day, all supplies at home, risk of peritonitis
      - Remove toxins, remove fluid, remove potassium, source of bicarbonate
      - Does not replace all of kidney functions (EPO, active vitamin D)