What causes chronic kidney disease.PPT

* * Outcomes: living donor transplantsFigure 7.18 (Volume 2) Patients age 18 older receiving a first-time, kidney-only transplant. Adj (survival): age/gender/race/primary diagnosis. USRDS 2011 Renal transplant vs chronic dialysis Longer survival Better quality of life There are concerns: immunosuppressive medications, infections (virus), cancer The future Therapies for chronic kidney disease improve every year Perhaps we can develop specific therapies for WAGR kidney disease * * * * * * * * * * * * * * * * * * * * * * * * * * * * The kidney,chronic kidney disease and WAGR kidney disease  Jeffrey Kopp, MD CAPT, US Public Health Service Kidney Disease Section jbkopp@nih.gov Kidneys on computerized tomography (CT) scan Kidneys and what they do (1) Product Waste Cars Smoke Homeostasis Urine Kidneys came early in animal evolution 1 million nephrons in each kidney: each is glomerulus + tubule Glomerular filtration: filtering small molecules from the circulation Renal blood flow ~1000 mL/min Renal plasma flow ~600 mL/min Glomerular filtration rate (GFR) ~100 mL/min = ~150 L/day One kidney, one million nephrons Tubular reabsorption: reclaiming what we need before it heads down the tubule to the ureter, bladder, and out THE GOOD (unless excess) Sodium Potassium Chloride Bicarbonate Calcium Magnesium Glucose Amino acids Vitamins B, C etc THE BAD Urea Uric acid Creatinine Toxins etc Why does the kidney filter everything, and then reclaim what is needed and discard the rest? Keeping the baby, throwing out the bathwater Creatinine physiology Small molecule, released from muscle turnover Production depends on muscle mass Freely filtered through the the glomerulus Serum levels depend upon muscle mass (higher when muscle mass is higher) and kidney function (higher when kidney function is poor) When kidney function is impaired GFR declines linearlyserum creatinine rises geometrically Estimating kidney function from serum tests Population Nam