(内科学课件）11.Chronic Kidney DiseaseCKD.ppt

Modification of Comorbidity:Cardiovascular Disease ESRD CVD mortality rates 15x higher than general population. CVD is leading cause of death in patients with CKD, regardless of stage. Management of hypertension: antihypertensive therapy :combination 2 or more Calcium channel blockers ACE inhibitors and ARB Alpha-blockers Beta-blockers diuretics Dialysis Management of Patients with Chronic Kidney Disease Preparation for Renal Replacement Therapy(GFR 30ml/min/1.73m2) nephrologist allows: Timely placement of dialysis access Timely initiation of dialysis Timely referral for transplant evaluation with preemptive transplant if possible. Renal Replacement Therapy: Indications -severe metabolic acidosis -intractable volume overload -Uraemic pericarditis -Severe renal bone disease -Peripheral neuropathy or encephalopathy -intractable gastrointestinal symptoms, -Creatinine 707 umol/l or GFR 10 ml/min -hyperkalemia 1) Haemodialysis Use artificial membrane as dialysis membrane, Pumps move blood on either side of membrane in countercurrent directions ,Solutes move across membrane by diffusion ,conduction, dialysis, ultrofiltration . Aim: remove toxin from blood elimination of volume Hemodialysis vascular access obtained by: ＊AVF:Arteriovenous fistula between artery and vein AV fistulas take 4-6 weeks to mature ＊Graft Synthetic Material Biological Material (Bovine Carotid Artery) ＊Vascular catheters in large central veins by jugular or femoral vein AV fistulas Hemodialysis Haemodialysis Peritoneal dialysis Use peritoneum as dialysis membrane , dialysis fluid low in urea and creatinine Dialysis occurs as a result diffusion and Ultrafiltration Tenckoff catheter usually inserted below umbilicus Peritoneal Dialysis Peritoneal Dialysis Kidney transplant Case Analysis A 30-year man ,who always had excellent health before, he had clouded vision and headache for 1 month. He was found to