CKD management
1-anti-HT
Target blood pressure ≤ 130/80 mmHg for uncomplicated CKD, and ≤ 125/75 mmHg for CKD complicated by significant proteinuria of ≥ 1 g/day
(PCR >100 mg/mmol or ACR > 70 mg/mmol).
Which cause reduction in proteinuria
blood pressure specialy in patients with proteinuria (PCR >50 mg/mmol or ACR >30 mg/mmol) , diabetic nephropathy
Treatment with ACEi and ARBs ( if GFR become less than 20% stop 🚫)
2-lipid lowering ( GDR less than 60 , statin is recommended)
3-treat anemia ( target level 10-12g/dL
If ferritin <100 µg/l, consider trial of IV iron alone, 200–500 mg
If ferritin >100 µg/l or no response to IV iron, start EPO, 4000–6000
IU/wk or darbepoetin alfa 20–30 g/wk
Side effect of erythropoietin
1-hypertension crisis
2-encephalopathy
3-hyperkalemia
4-anaphylaxix
5-rise in platelets count
كل ما نصلح الانيميا يقل احتياج القلب وتتحسن كل مشاكل القلب
بس ما يتحسن الsurvival ⚠️
-maintaining fluid & electrolytes
Salt restriction
Diuretic ➡️ fluid overload
If hyperkalemia ➡️ stop k sparing diuretic
Correction acidosis ➡️ sodium bicarbonate
plasma bicarbonate should maintained above 22 mmol/L by giving sodium bicarbonat
supplements (starting dose of 1 g 3 times daily)
calcium carbonate (up to 3 g daily) may be used as an
alternative, since this has the advantage of also binding dietary phosphate.
بشكل عام دائما نراقب p , vitD , PTH level
CKD stage 3
Dietary phosphate restrictions ( حليب ، جبن ، بيض )
levels of 25-hydroxyvitamin D
should be measured and corrected if <30 ng/ml.
hyperparathyroidism persists, calcium-based or other phosphate binders may be initiated
CKD stages 4 and 5,
larger amounts of phosphate binders may In patients on dialysis, calcitriol therapy
calcimimetic cinacalcet which bind to the calcium sensing receptor
and reduce PTH secretion provides additional effective control of HPTH
🔹 protein(diet consisting of
0.8 g protein/kg ideal
بس مو اكثر من هلكد لان اصلا هو ضعفان
🔹 ensuring
adequate calorific intake( 30kcal/kg ideal body weight/day) & limiting
potassium and phosphate intake.
Parathyroidectomy indicated in Severe hyperparathyroidism
1.With persistent hyperphosphatemia
2.Unresponsive to calcitriol and calcium
3.With hypercalcemia
4.With intolerance or unresponsiveness to calcimimetics
5.In renal transplantation candidate
6.With evidence of metastatic calcification
Adynamic Bone Disease
هم نراقب vit D , phosphate, PTH
ونحاول نصصحهم دائما
Renal Replacement Therapy(RRT) ➡️ only for the excretory function of kidney
haemodialysis
haemofiltration➡️ rapid effect
haemodiafiltration (HDF),
peritoneal dialysis(PD)
and renal transplantation.
contraindications for renal transplantation
absolute/ active malignancy, active vasculitis, severe heart disease,
relative/ age extreme, risk of recurrence lower UTI
#nephrology_1
