Chronic kidney disease (CKD) is classified into five stages (CKD stages): Stage GFR (ml/min per 1.73 m²) Positive protein detection in urine Neg. protein detection in urine 1 ≥ 90 Renal disease with normal GFR Normal findings 2 60-89 Renal disease with mildly impaired GFR (mild renal function impairment). Mild renal function impairment but no … Chronic Kidney Insufficiency: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes [possible symptom stage 5: yellowish skin color]. Oral cavity [possible symptom stage 5: stomatitis (inflammation of the oral mucosa)] Throat [possible symptom stage 5: parotitis … Chronic Kidney Insufficiency: Examination
1st-order laboratory parameters-obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Electrolytes (blood salts) Calcium ↓ Sodium ↓ Potassium ↑ (initially normal potassium concentration despite impaired renal function due to compensatory increase in renal and intestinal potassium secretion; later hyperkalemia due to metabolic acidosis triggering potassium leakage … Chronic Kidney Insufficiency: Test and Diagnosis
Therapeutic Targets Prevent progression (progression) of chronic renal failure (nephroprotection/protection of kidneys) [review current medications: see “Renal function-dependent and -independent drugs” list below]. Normalization of blood pressure; in chronic kidney disease, optimal blood pressure appears to be 130-159/70-89 mmHg. Therapy recommendations The KDIGO (Kidney Disease: Improving Global Outcomes) international therapy guidelines recommend RAAS blockade by. … Chronic Kidney Insufficiency: Drug Therapy
Mandatory medical device diagnostics. Renal ultrasonography (ultrasound examination of the kidneys) – primarily to determine the size/shape of the kidneys. Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification. Duplex sonography (ultrasound examination: combination of a sonographic cross-sectional … Chronic Kidney Insufficiency: Diagnostic Tests
A risk group indicates the possibility that the disease may be associated with the risk of vital nutrient deficiency. The complaint chronic renal failure indicates a vital nutrient deficiency for: Vitamin B6 Folic acid Vitamin D Calcium Potassium Iron Zinc Scientific studies support the benefits of dietary intake of omega-3 fatty acids (eicosapentaenoic acid, EPA; … Chronic Kidney Insufficiency: Micronutrient Therapy
1st order Kidney transplantation (NTx, NTPL) – performed in late-stage chronic renal failure; involves either a living donor or a cadaveric donor
To prevent chronic renal insufficiency (chronic kidney failure), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Excessive consumption of fructose through soft drinks (two or more glasses of soda daily) [possible risk factor] – leads to kidney damage early on associated with albuminuria (abnormal excretion of albumin in urine; evidence … Chronic Kidney Insufficiency: Prevention
In stages 1 and 2, there are usually no symptoms of chronic renal failure (chronic renal insufficiency) or chronic kidney disease. Then, from stage 3, the following symptoms and complaints become more prominent: Anemia (anemia) Anorexia (loss of appetite) Energy loss Fractures (broken bones) Hyperkalemia (excess potassium) Hypernatremia (excess sodium) Hypertension (high blood pressure) Hypocalcemia … Chronic Kidney Insufficiency: Symptoms, Complaints, Signs
Pathogenesis (disease development) Progressive (progressive) impairment of renal function results in the need to build up increased pressure in the glomeruli (renal corpuscles; part of the blood-urine barrier) to maintain residual function. To do this, an increase in angiotensin II (tissue hormone that occupies a key position in the renin-angiotensin-aldosterone system (RAAS), which is responsible … Chronic Kidney Insufficiency: Causes
Medical history (history of illness) is an important component in the diagnosis of chronic renal failure (chronic kidney disease) or chronic kidney disease. Family history What is the general health status of your relatives? Are there any kidney/urinary tract diseases in your family that are common? Social history What is your profession? Are you exposed … Chronic Kidney Insufficiency: Medical History
Genitourinary system (kidneys, urinary tract-genital organs) (N00-N99). Acute renal failure (ANV).
