Chronic Kidney Injury Overview

Study Notes

Definition of Chronic Kidney Injury (CKI)

Chronic Kidney Disease (CKD) involves irreversible renal function deterioration over months to years.
Initial manifestation is biochemical abnormalities like azotemia; advanced stages show clinical signs of uraemia.
Chronic renal failure describes a significant, irreversible nephron reduction, corresponding to CKD stages 3-5.
End-stage renal disease (ESRD) is the final stage where toxin accumulation leads to uremic syndrome.
Normal GFR declines around 1 mL/min/year post-peak value (~120 mL/min per 1.73 m²) by age 30, averaging 70 mL/min by age 70.

Classification of Chronic Kidney Disease (CKD)

Stage 0: No kidney damage, risk factors present; GFR ≥ 90.
Stage 1: Kidney damage with normal/high GFR; GFR > 90.
Stage 2: Kidney damage with slightly low GFR; GFR 60–89.
Stage 3: Moderately low GFR; GFR 30–59.
Stage 4: Severe low GFR; GFR 15–29.
Stage 5: Kidney failure (ESRD); GFR < 15.

General Considerations in Management

Blood pressure target: 130/80 mmHg; reduce to 125/75 mmHg for diabetes or elevated protein-creatinine ratios.
ACE inhibitors/ARBs recommended for patients with proteinuria to reduce progressive CKD risk.
Aggressive lipid management and lifestyle modifications (smoking cessation, exercise, dietary changes) are crucial.
Dietary protein restriction can slow chronic renal failure progression.

Complications of CKI

Sodium Homeostasis: Hyponatremia is rare; managed with water restriction. Loop diuretics are preferred in advanced stages.
Potassium Homeostasis: Hyperkalemia can result from increased dietary potassium or metabolic acidosis, indicating potential dialysis need.
Dialysis Frequency: Hemodialysis typically requires three sessions per week; peritoneal dialysis involves daily exchanges.

Dialysis Methods

Peritoneal Dialysis:
- Less efficient but can be done at home.
- Requires multiple daily exchanges; risks include peritonitis and infection.
Hemodialysis:
- More efficient, usually takes place thrice weekly in a clinical setting.
- Risks include hypotension during treatment and associated complications such as muscle cramps and arrhythmias.

Complications during Hemodialysis

Hypotension due to excessive fluid removal or inadequate filling.
Muscle cramps from low-sodium dialysate.
Headache and anaphylactoid reactions related to dialyzers.
Risk of hemorrhage due to anticoagulation needs.

Complications during Peritoneal Dialysis

Infection is the primary complication (peritonitis).
Hypoproteinemia resulting from increased protein permeability of peritoneum.
Potential for hyperglycemia and weight gain.

Renal Transplantation

Best long-term survival option for patients with ESRD, restoring normal kidney function and addressing metabolic issues.
Consideration for transplantation required unless contraindicated.
Kidney grafts may come from deceased or living donors.
Blood type and HLA-DR matching between donor and recipient are critical to reduce rejection incidence.

Contraindications to Renal Transplantation

High risk of disease recurrence in transplanted organ.
Existing active health issues that could significantly compromise transplant success.

Description

This quiz focuses on Chronic Kidney Injury (CKI), exploring its definition, pathophysiology, causes, and clinical presentation. It also discusses complications, treatment options, and preventive measures. Enhance your understanding of CKI and its impact on renal function.