Im - Chronic Kidney Disease - Dr. Lorna Wong - March 20 2021

Dr.
Maria Lorna Yap Wong, MD,FPCP, FPSN, MHA March 20, 2021
Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones
Dr. Maria Lorna Yap Wong, MD,FPCP, FPSN, MHA March 20, 2021



NOTES:
Kidney Size: AKI – normal,
CKD – smaller
CBC: CKD pts usually have
anemia and bone problems →
renal osteodystrophy
*AKI may also present with

anemia esp. if there is bleeding


NOTES:
CKD – incidental finding esp. in
the early stages as it is usually
asymptomatic

NOTES:
Uremia – clinical syndrome
marked by elevated
concentrations of toxins (urea)
in the blood

NOTES:
• HPN can cause CKD, CKD can
cause HPN
• Azotemia – elevated
BUN/crea
• Uremia – elevated BUN/crea
with clinical manifestations
(s/sx)




NOTES:
No need to do biopsy in
advanced stages of kidney
disease, whatever the cause is,
the kidney will be sclerosed


NOTES:
Serum Crea and GFR are
inversely related.
↓GFR ↑Serum Crea


NOTES
If the patient has uremic syndrome
→ renal replacement therapy must
be initiated





NOTES:
If a patient presents to you with a
CC of azotemia (↑BUN/Crea)
- Request for U/A and Renal US
(to r/o hydronephrosis)
- Hydronephrosis (dilation of the
renal pelvis) may be due to
obstruction (stone)
- Refer to urologists for evaluation
and relief of obstruction



First thing to do:

Place an indwelling catheter




NOTES:
Positive kidney punch – possible
infection → pyelonephritis
Pyelonephritis – usually (+) fever


NOTES:
Bladder stone common
presentation:
- When lying down, feels the urge
to pee; upon urination, no or
little urine comes out
- By virtue of gravity, stone floats
when lying down, and may block
the bladder upon standing

NOTES:
BPH – may also cause urinary
symptoms
Whole abdomen US – should be
requested to include evaluation of
prostate

NOTES:
Not all can be subjected to this
therapy especially if the stone is
large

NOTES:
Usually performed in small stones

NOTES:
A nephrostomy is an artificial
opening created between the
kidney and the skin which allows
for the urinary diversion directly
from the upper part of the urinary
system.

NOTES:
• Once you ruled out
hydronephrosis, look for the
size of the kidney
• SMALL sized kidneys - may
suggest CKD
• NORMAL sized kidneys- can
suggest AKI; take note of
the result of the urinalysis
of the patient


NOTES:
• Normal size of kidney: 9-10
• Not all patients with CKD
have small kidneys, some may
have normal size
• REMEMBER: PARDS
• RPGN: Rapid Progressive
Glomerulonephritis
• Adult Polycystic Disease:
sometimes increased in size;
hereditary in nature





NOTES:
• “Butterfly rash”-
most prominent
• Multi-organ disease


NOTES:
• Usually has “triad”

NOTES:
• Diabetes- lots of complications
• #1 cause of kidney failure

NOTES:
• HYPERTENSION- #2 cause of
kidney failure
• #3 - Glomerulonephritis




NOTES:
• Give colchicine
• Start with pain relievers
• Makikita mo yan when
you get older

NOTES:
• Uric acid stones- natutunaw yan
• If you give sodium bicarbonate,
you alkalinized the uric acid,
then matutunaw sya


NOTES:
• Glomerulus: located in the
cortical area

NOTES:
• Hallmark: proteinuria + hematuria

NOTES:
• Do kidney biopsy to determine the
particular histopathologic
abnormality of the patient
• Do Ultrasound guided kidney biopsy
because if you do it blindly you
might hit the other organs such as
the spleen (at the left side)

NOTES:
• Mesangial cells- hold the
glomeruli
• If dumami ang mesangial cells,
nagiging narrow ang capillaries,
naapektuhan ang filtration
• Sclerosis- with “scars” na

NOTES:
• With other manifestations such
as difficulty of breathing
• Plasmapheresis – improve the
kidney function

NOTES:
• IgA nephropathy- complain is
hematuria; allergic component
• Diagnosis of IgA: kidney biopsy

NOTES:
• Nephrotic syndrome – podocytes
are affected, edema, proteinuria (if
heavy we can consider Minimal
change nephropathy, FSGS or
Membranous Nephropathy)
• Nephritic syndrome – more on
nagkaroon ng throat infection; mas
madami ang hematuria compared to
proteinuria



NOTES:
• Pitting edema

NOTES:
• Periorbital edema- most common
in post strep glomerulonephritis;
nephritic
• Anasarca- generalized edema; most
probably nephrotic

NOTES:
• Take note the color of
the urine, if mabula ba
• Hiccups: check the
creatinine





NOTES:
• Replaces the function of
the kidneys


NOTES:
• UF volume- tubig na gusto mong
alisin sa pasyente
• UF goal- ung total volume na gusto
mong tanggalin sa pasyente

NOTES:
• Dialyzer – acts as the
artificial kidney

NOTES:
• Countercurrent mechanism –
blood comes in contact with the
dialysate solution in an opposite
direction. Toxins will transfer
from the blood to the dialysate
solution through the
semipermeable membrane
between the 2 medium.


NOTES:
The fistula connects the artery to the
vein for an easier access to arterial
blood during dialysis.

NOTES:
• The arm with an AV fistula cannot
be used to extract blood or
determine blood pressure.



NOTES:
• PD also undergoes diffusion
• It is usually done 3x a day

NOTES:
• Kidney transplant is a more
effective and better option than
long term dialysis.








NOTES:
• Strep throat can lead to
streptococcal glomerulonephritis
if left untreated.

NOTES:
• High-oxalate foods (like
chocolates, instant coffee, tofu,
sweet potatoes) can lead to
kidney stones.
• Drink plenty of water after eating
food with high-oxalate content.







NOTES:
• Excessive exercise can cause
rhabdomyolysis which can lead to
kidney injury.












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Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

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*AKI may also present with

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Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

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First thing to do:

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