Kidney Disease Part I - Chronic Kidney Disease (CKD)...

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Chronic Kidney Disease (CKD) Learning Objectives Know the risk factors for CKD Identify the central functions of the kidney and describe the consequences of kidney failure Describe the role of the kidney/nephron in filtering blood Recognize the mechanisms by which hyperglycemia can contribute to kidney dysfunction Identify indicators of kidney damage Describe the stages of kidney disease
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Disease in which progressive loss of kidney function occurs Prevalence has doubled in the past 10 years Primary causes include DM (40% of cases) and HTN (28% of cases; damage to the renal blood vessels) Approximately 40% of patients with T1DM and 10% of patients with T2DM develop renal failure CVD is the main cause of mortality in patients with CKD CKD increases CVD risk by ~ 20 times More likely to die from CVD than progress to end stage disease People with treated (dialysis) end stage renal disease (Stage 5) have a 22% annual mortality rate http://www.kidney.org/Professionals/kdoqi/ guidelines_bp/guide_1.htm N Am = Native American Chronic Kidney Disease Kidney diseases affect ~20 million Americans per year (11% of US population)
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CKD Risk Factors Can be modified/treated Cannot be modified Hypertension Hyperfiltration, TGF β , Direct damage to small blood vessels Age over 60y Diabetes (Hyperglycemia) AGEs, ROS, ATII, transforming growth factor ‐β Ethnicity: highest in African American males Dyslipidemia Increased Renal Lipid Accumulation and Glomerulosclerosis Gender: highest in males Albuminuria Excess proteins in renal tubule triggers inflammatory and immune events leading to progressive tubule injury CVD Income: highest in low income Obesity Hyperfiltration by glomeruli; Glomerular and Tubular Hypertrophy Family History NEJM 2006;354:2473 2483 J Am Soc Nephrol 17: 1501 1502, 2006
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Filtration of waste products and maintenance of homeostasis in blood/tissues Acid/base balance Production of renin, a key player in RAAS Regulation of Blood Pressure Production of the active form of vitamin D Production of erythropoietin (EPO) which stimulates erythropoiesis (production of RBC) in the bone marrow. Glucose Metabolism
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Kidney Disease Part I - Chronic Kidney Disease (CKD)...

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