 Alternative Names:

 Chronic Renal Failure

 Chronic Renal Insufficiency
 Chronic Renal Disease
 Chronic Kidney Insufficiency
 Chronic Kidney Failure
  CKD implies longstanding (>3 Months),
and usually progressive impairment in renal
function.
 GGFR <60 mL/min per 1.73 m2 or
 Diabetes Mellitus  Family history of CKD
 Hypertension  Kidney Stones
 Cardiovascular  Infections like Hep B,
Disease C and HIV
 Age and Race  Autoimmune diseases
 Acute Kidney Injury  Nephrotoxic drugs like
NSAIDS
 Diabetes
 Non Diabetic
 Glomerular

 Tubulointerstitial: Analgesic, Reflux, Ch. Obs

 Vascular: Vasculitis, HTN, RAS

 Cystic: ADPKD

 CKD in transplantation
 100%
90% Other
80%
70% Interstit N
60% Cystic KD
% 50% GN
40%
30% BP
20% Diabetes
10%
0%
l te n
Al hi ac
k is a ian
W Bl A Ind
e r
Am
USRDS Annual Data Report
 History
 Duration of symptoms
 Drug ingestion
 Previous Medical & Surgical History
 Previous Occasions of Investigations
 Family History of Renal Disease
amlaise, loss of energy, loss of appetite,
insomnia,
Nocturia & polyuria due to impaired concentrating ability,
Itching,
Nausea, vomiting and diarrhoea,
Paraesthesiae due to polyneuropathy
 ‘Restless legs’ syndrome (overwhelming need
to frequently alter position of lower limbs)
 Bone pain due to metabolic bone disease
 Paraesthesiae and tetany due to hypocalcaemia
 Symptoms due to salt and water retention –
peripheral or pulmonary oedema
 Symptoms due to anaemia
Mental slowing, clouding of consciousness and Seizures

Myoclonic twitching.
 SPallor (due to anemia)
 Increased photosensitive pigmentation Brown
discoloration of the nails
 Scratch marks due to uraemic pruritus
 Ccutaneous vasculitic lesions in systemic
vasculitides
 Retinopathy in diabetes and hypertensive
retinopathy in hypertension
 Evidence of peripheral vascular disease and
associated renal artery stenosis
 Hematuria:
 Proteinuria:
 Urine Culture:
 White Cells: UTI, GN, Papillary Necrosis or TB

Eosinophilia: Allergic Tubulointerstitial Nephritis or

Cholesterol Embolization
Casts

Granular cast: Active renal tubular disease

RBC Cast: GN

 Red Cells
 Urinary Electrolytes
 Urine Osmolality
 Urine Electrophoresis & Immunofixation
 Urea & Creatinine
 Calculation of eGFR
 Electrophoresis & Immunofixation for
myeloma
 Elevation of creatinine kinase:
Rhabdomyolysis
 Eosinophilia: vasculitis, allergic Tubulointerstitial
nephritis or cholesterol embolism
 Markedly raised viscosity or ESR: Myeloma or
Vasculitis
 Fragmented RBC &/or Thrombocytopenia:
Accelerated HTN, HUS or TTP
 Complement Components
 Autoantibody Screening
 Cryoglobulins
 Antibodies to Streptococcal Antigens
 Antibodies to Hep B & C
 Antibodies to HIV
 Ultrasound
 CT Scan
 MR Angiography in Renovascular
Disease
 Should be performed in every patient
with unexplained CKD & normal-sized
kidneys
 Erythropoietin Deficiency
 Bone marrow toxins
 Bone marrow Fibrosis
 Hematinic Deficiency
 Increased RBC destruction
 Abnormal RBC membranes
 Increased Blood Loss
 ACE inhibitors
 Hypeparathyroid Bone Disease
 Osteomalacia
 Osteoporosis
 Osteosclerosis
 Adynamic Bone Disease
 Pruritis
 Eczematous
 Porphyria Cutanea Tarda
 Pseudoporphyria
 Decreased gastric Emptying
 Reflux Esophagitis
 Peptic Ulceration
 Acute Pancreatitis
 Constipation
 Gout
 Insulin
 Lipid Metabolism Abnormalities
 Hyperprolactinemia
 Increased LH
 Decreased Testosterone
 Oligomenorrhea or Amenorrhea
 GH Abnormalities (Low)
 Thyroid Hormone Abnormalities
(Hypothyroid)
 Uremia cause Muscle dysfunction
 Decreased Physical Fitness
 Central Nervous System
 Depressed Cerebral Function

 Dialysis Dementia

 Psychiatric Problems; psychosis, depression,

Phobias
 Peripheral Nervous System
 Restless leg Syndrome

 Median nerve Compression

 Polyneuropathy

 Autonomic Nervous System

 Lymphomas
 Primary Liver cancer
 Thyroid cancer
DDiet:
low protein diet 0.6 – 0.8 gm/kg
Low K diet, Low phosphate diet, Salt restriction
Fluid chart
GIT
Hiccup and vomiting; domperidone
Gastritis; H2 blockers, proton pump inhibitors
CCVS
Hypertension control (CCB, BB, (ACEI and ARBs
with careful monitoring of kidney function and
potassium)
Volume overload: Loop diuretics
pericarditis is an indication of dialysis
Bone
Ca carbonate 1500 – 2000 mg/day (hold if there is
hypercalcemia)
Vit D analog (Calcitriol)
PO4 chelators Oral Ca carbonate, Sevelamer
AAnemia:
Iron therapy better IV
Erythropoetoin
Target Hb 11 – 12 gm/dl
Avoid blood transfusion as possible as it may
cause sensitization to HLA which may affect
renal transplantation
PPruritis:
C o n t r o l C a / P O 4 p r o d u c t a n d
hyperparathyroidism
Antihistaminics
Oral charcoal
Ultraviolet photo therapy (narrow band)
Hyperkalemia:
(dietary restriction, cation exchange resins
t o r e m ove K i n G I T, G l u c o s e i n s u l i n
infusion, if no response dialysis is
indicated

Acidosis:
oral sodium/calcium bicarbonate
If no response dialysis
RRenal replacement therapy

Dialysis (H D , P D)
Transplantation
Indication of dialysis
 Uremic symptoms (encephalopathy, coma ,
pericarditis)
 Volume overload not responding to diuretics
 Hyperkalemia > 6.5 mmol/L not responding
to medical treatment or if there is ECG
changes
 Acidosis not responding to medical treatment
 High urea. 200 mg/dl (BUN>100), Cr >10