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Chronic Kidney Disease - Coggle Diagram
Chronic Kidney Disease
Altered Physiology Leading to the Development of CKD
Nephron loss
Glomerulosclerosis
Tubulointerstial fibrosis
Proteinuria
Increased glomerular capillary permeability
Glomerular hyperfiltration
Loss of negative charge
Accumulates In the Interstitial space of the nephron tubules
Activates compliment proteins and mast cells
Progressive fibrosis
Inflammation
Increased Tubular protein reabsoprtion
Angiotensin II
Activation of RAAS promotes
Glomerular hypertension
Hyperfiltration
Systemic hypertension
Renal scarring
Clinical Manifestations
Uremia
Elevated Blood Urea &Elevated Blood Creatinine
Accompanied by
Neurologic changes
Azotemia
Increased Serum Creatinine & Increased Serum Blood Urea Nitrogen
Fluid and electrolyte balance
Sodium
Decreases with osmotic water loss
Increased dietary Intake of sodium
Prevents
Sodium defecits
Volume depletion
Continued progression of CKD
Inability to
Regulate sodium and water balance
Leads to
Edema
Potassium
Early CKD
Potassium excretion maintained
Later CKD
Oliguria
Potassium excretion decreased
Leads to
Hyperkalemia
Decreased GFR (<25% or normal)
Leads to
Metabolic acidosis
Due to
Decreased hydrogen Ion elimination
Decreased bicarb reabsorption
Treatment
Alkali therapy
Leads to
Hypocalcemia
Stimulate parathyroid hormone
Leads to
Hyperparathyroidism
Results in
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Decreased phosphate excretion
Leads to
Increased serum phosphate
Binds to calcium
Leads to
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Protein, Carbohydrate, and Fat Metabolism
Decrease In serum proteins
Includes
Albumin, complement, and transferrin
Leads to
Loss of muscle mass
Insulin resistence
Glucose Intolerance
Due to
Proinflammatory cytokines
Alterations in adipokines
High leptin levels
Low adiponectin levels
Dyslipidemia
Low HDL
High LDL
Leads to
High triglycerides
Physiologic Alteration which causes Multisystem Alterations
Skeletal
Osteodystrophies
Osteomalacia
Osteoporosis
Osteofibrosa
Manifestations
Bone pain
Deformities of long bones
Spontaneous fractures
Cardiopulmonary
Pulmonary Edema
Manifestations
Pulmonary Edema
Metabolic acidosis
Manifestations
Kussmaul respirations
Cardiovascular
Toxins precipitate into pericardium
Anemia Increases cardiac workload
Hyperlipidemia
Manifestations
Left ventricular hypertrophy
Cardiomyopathy and Ischemic heart dieases
Hypertension
Dysrhythmias
Accelerated atherosclerosis
Pericarditis with fever
Chest pain
Pericardial friction rub
Extracellular volume expansion and hypersecretion of Renin
Neurologic
Progressive accumulation of uremic toxins associated with end-stage renal disease
Stroke or intracerebral hemorrhage associated with chronic dialysis
Manifestations
Encephalopathy
Fatigue
Reduced attention span
Difficulty with problem solving
Peripheral neuropathy
Loss of vibration sense and deep tendon reflexes
Pain and burning in legs and feet
Loss of motor coordination
Coma with advanced uremia
Fasciculations
Twitching
Loss of motor coordination
Hematologic
Reduced erythropoietin and RBC production
Uremic toxins shorten RBC survival and alter platelet function
Manifestations
Anemia
Lethargy
Dizziness
Platelet disorders
Prolonged bleeding time
Hypercoagulobility
Increased risk of clots
Gastrointestinal
Retention of metabolic wastes and other metabolic waste products
Manifestations
Anorexia
Nausea
Vomiting
Mouth ulcers
Stomatitis
Urine odor of breath (Uremic fetor)
Hiccups
Peptic Ulcers
GI bleeding
Pancreatitis associated with end stage renal failure
Integumentary
Retention of urochromes
Manifestations
Abnormal pigmentation (sallow yellow color)
High Plasma calcium levels and neuropathy
Manifestations
Pruritis
Immunologic
Suppression of cell-mediated immunity
Reduction In number and function of lymphocytes
Diminished phagocytes
Manifesations
Increased risk of infection that can cause death
Increased risk of carcinoma
Endocrine and Reproductive
Dysfunction of ovaries and testes
Presence of neuropathies
Manifesations
Sexual dysfunction
Amenorrhea
Infertility
Menorrhagia
Decreased libido in women
Decreased Testosterone
Decreased libido In men
Treatment
Early screening evaluation of CKD
Based on
Risk factors
History
Presenting signs and symptoms
Diagnostic testing
Renal biopsy
Confirms diagnosis of CKD
Laboratory testing
Markers of kidney damage
Urine protein level measurement
Albumin
Examination of urine sediment
Imaging studies
Xray
Will show
Small kidney size
CT scan
Ulatrasound
Management
Dietary
Restriction
Potassium
Protein
Sodium
Phosphate
Supplementation
Vitamin D
Vitamin D receptor activators
Promotion of adequate caloric Intake
Maintenance of sodium and fluid blance
Management of dyslipidemias
Use of erythropoietin as needed
Systemic hypertension control
ACE Inhibitor
Prevent progressive renal damage
Angiotensin Receptor Blocker
End stage renal disease
Conservative and supportive care
CRRT
Renal Transplant