Done by : Fatima, Nadia,

Dairawan, Zainab, Muskaan.

Objectives

★ Discuss the importance of World Kidney Day.

★ Describe the structure function relationship of kidneys.
★ List the common risk factors of kidney diseases.
★ Define chronic kidney disease. State its prevelance,
symptoms, diagnosis and prognosis.
★ Explain the steps in prevention of kidney disease and its
management.
 What is WKD?
● World Kidney Day is a global awareness campaign
which takes place every year, on the 8th of March.

● It aims to incite attention about the importance of our

kidneys to our overall health and to reduce the
frequency and impact of kidney disease and its
associated health problems worldwide.

● All across the globe many hundred events take place

from public screenings in Argentina to Zumba
marathons in Malaysia.
Preventive
Risk Factors
Behaviors

AWARENES
S
Kidney
Treatments
importance
LET US
Structure-Function
relationship of the
kidneys
● The kidney consists of a huge
number of functional units
called nephrons.

● Each nephron has multiple

sub-structures within it that
relate to the kidney's overall
function.
● Each nephron is made up two parts:

- the renal corpuscle

-the renal tubule

● The renal corpuscle has two parts as well. The glomerulus is a network of
capillaries that blood is forced through at a higher blood pressure than your normal
blood pressure. This increased blood pressure helps wastes, excess water and
other materials be forced out of the blood and into the Bowman's Capsule.

● The Bowman's Capsule (also known as the Glomerular Capsule) a double walled
cuplike sac. Its walls are actually filtration membranes, which enables water and
other materials to pass through while keeping blood and proteins out.
● The other part of the nephron is the renal tubule. After the excess water
and waste passes through the Bowman's capsule, it goes to the renal
tubule.

● There, some of the materials that are filtered from the blood end up being
reabsorbed back into the blood, which aids in regulating electrolyte levels.
It is here that urine is produced and collected. Afterwards, it is then sent to
the collection tubule.
● All of the tubules from the many nephrons in each kidney pool together
go into one collection tubule or collection duct.

● Inside the collection duct system, even more material is reabsorbed back
into the blood circulations, helping to regulate electrolytes.

● There are several parts of collection ducts, beginning with the initial
collection tubules, followed by the cortical collection ducts and the
medullary collection ducts. The last portion of collection ducts are the
papillary ducts, which then drain into ureter.
● Proximal convoluted tubule - The main site of reabsorption.
Most glucose, water, salts and small amino acids are absorbed
here back into the blood via villi (with a high surface area) in a
similar way to the way the gut absorbs them through villi.

● The loop of Henle - Facilitates water reabsorption back into

the blood by pumping out NaCl into the medulla. Water then
follows by osmosis.
● Collecting duct - The final stage of the nephron. The collecting duct responds to
hormones such as ADH and helps with osmoregulation of the blood. When ADH
is secreted from the pituitary gland in response to low water in the blood,
aquaporins open up in the collecting duct, allowing more water to re-enter the
blood via osmosis and re-raise blood water levels.

● The kidneys are a major part of the urinary system, responsible taking the
waste and excess water from your blood and making urine. Once that urine is
ready to leave a kidney, it travels through the ureter, a muscular duct, to the
bladder. There the urine collects until the bladder is full and the urine can be
excreted from the body.
Risk Factors
Smoking

● Causes arteriosclerosis
● Increases BP and heart rate
● Increases production of angiotensin
II

Reduced blood flow to kidneys

Diabetes Mellitus

Damages kidneys by:

● Hyperfiltration injury
● Advanced glycation end products (AGEs)
● Reactive oxygen species
Obesity
● Risk factor for diabetes and
hypertension
● Hyperfiltration
Genetic Predisposition

● Polycystic kidney disease

● Alport syndrome
● Mutation to APOL1 gene
Old Age
● Decrease in the amount of kidney tissue
● 30-50% decrease in glomerular number
by 70 yrs
● Glomerulosclerosis
 Other Risk Factors

● Hypertension
● CV disease
● People of African descent
● Abnormal kidney structure
● Use of nephrotoxins, excessive alcohol, analgesic medications
● Proteinuria, hyperlipidemia and hyperphosphatemia
Chronic Kidney
Disease
DEFINITION

● also called chronic kidney failure

● gradual loss of kidney function
● dangerous levels of fluid, electrolytes
and wastes build up in the body
● associated with age-related renal
function decline
● accelerated in hypertension, diabetes,
obesity and primary renal disorders
● not apparent until kidney function is
significantly impaired
● CVD causes CKD, and vice versa
SYMPTOMS

• Nausea

• Vomiting

• Loss of appetite

• Fatigue and weakness

• Sleep problems

• Changes in how much you urinate

• Decreased mental sharpness

• Muscle twitches and cramps

• Swelling of feet and ankles

• Persistent itching

• Chest pain, if fluid builds up around the lining of the heart

• Shortness of breath, if fluid builds up in the lungs

• High blood pressure (hypertension) that's difficult to control

PREVALENCE
ALL 5 STAGES 13·4%(11·7–15·1%)

STAGES 3-5 10·6%(9·2–12·2%).

STAGE 1 3·5%

STAGE 2 3·9%

STAGE 3 7·6%

STAGE 4 0·4%

STAGE 5 0·1%
● Between 1999 to 2004, the prevalence of CKD stages 1 to 4 increased significantly when
compared to the survey period 1988 to 1994 (13·1 versus 10·0%).
● In the UK prevalence estimates reports a declined over time.
● Prevalence - due to the aging population
● Also associated with increases in hypertension and diabetes mellitus
DIAGNOSIS

● Chronic kidney disease (CKD) can be diagnosed

with blood and urine tests.
● Who should be tested?
○ People with persistent symptoms
○ People with higher risks
○ People with certain diseases, like CVD,
diabetes, high BP
○ People with a family history of advanced
CKD/inherited kidney disease
○ People taking long term meds for kidneys
TESTS FOR CKD

● BLOOD TEST
● measures the levels of creatinine in the
blood.
● Using the result, calculations are done to
determine eGFR.
● Healthy kidneys - more than 90 ml/min.
● Less than this value - kidney disease
● URINE TESTS
● checks the levels albumin and creatinine in your urine – known as the albumin:creatinine
ratio, or ACR
● checks for blood or protein
● Alongside your eGFR measurement, these tests give a more accurate picture of how well
the kidneys are working.
OTHER TESTS

● Ultrasound scan
● Magnetic resonance imaging (MRI) scan
● Computerised tomography (CT) scan
● kidney biopsy
TEST RESULTS
eGFR result is given as a stage from one to five:

• Stage 1 (G1) – a normal eGFR (above 90ml/min), but other tests have detected signs of kidney
damage

• Stage 2 (G2) – a slightly reduced eGFR (60-89ml/min), with other signs of kidney damage

• Stage 3a (G3a) – an eGFR of 45-59ml/min

• Stage 3b (G3b) – an eGFR of 30-44ml/min

• Stage 4 (G4) – an eGFR of 15-29ml/min

• Stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function
ACR result is given as a stage from one to three:

• A1 – an ACR of less than 3mg/mmol

• A2 – an ACR of 3-30mg/mmol

• A3 – an ACR of more than 30mg/mmol

For both eGFR and ACR, a higher stage indicates more severe kidney disease.
PROGNOSIS

● CKD patients experience progressive loss of kidney

function
● risk for end-stage renal disease (ESRD)
● Progression depends on
○ Age
○ The underlying diagnosis
○ The success of implementation of secondary preventive
measures
○ The individual patient
○ lower estimated glomerular filtration rate (GFR)
○ Higher albuminuria
○ Younger age
○ Gender (males)
● Risk of ESRD and death increased progressively from stages 3 to 5
● ESRD was more frequent than death in stage 4 and 5 CKD
● the opposite was true in stage 3 CKD
● Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD
● Older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and
anemia predicted death
DIALYSIS
● Dialysis patients -2 hospital admissions per
year
● Patients who have a renal transplant - 1
hospital admission per year
● Patients who undergo renal transplant -
survive longer
● 6 days a week dialysis - increases risk for
complications (48/125 patients)
● 3 days a week dialysis - better (29/120
patients)
● Overall risk - 76% higher with daily dialysis
MORTALITY

● Mortality rate - 56% greater than that in patients

without CKD
● Stages 4-5 - 76% greater
● Mortality rate - higher for men
● Highest during first 6 months of dialysis
● Improves over next 6 months
● increases over next 4 years
● 5 year survival rate
○ 35%
○ 25% for patients with diabetes
STAGES OF CKD
STAGE 1

● Kidney damage present

● GFR - normal or high level greater than 90 ml/min
● Usually no symptoms to indicate the kidneys are damaged
● Kidneys can still work well
● Thus, most people will not know they have stage 1 CKD
● Found when tested for another condition (diabetes or high blood pressure)
STAGE 2

● Kidney damage with

● Mild decrease in their GFR of 60-89 ml/min
● usually no symptoms to indicate the kidneys are damaged
● Very similar to Stage 1
STAGE 3

Stage 3A 45-59 mL/min

Stage 3B 30-44 mL/min

● Moderate kidney damage

● Build up of waste products
● Complications of kidney disease can arise
○ High BP
○ Anemia
○ Early bone disease
STAGE 4

● Advanced kidney damage

● Severe decrease in GFR to 15-30 ml/min
● Dialysis required
● Complications can arise
● Including CVD and other heart diseases
STAGE 5

● Has end stage renal disease (ESRD)

● GFR of 15 ml/min or less
● kidneys have lost nearly all their ability to do their job effectively
● dialysis or a kidney transplant is needed
● Build up of toxins, leading to overall ill feeling
● Kidneys won’t be able to perform other functions
● regulating blood pressure, producing the hormone that helps make red blood cells and activating
vitamin D for healthy bones
Management and
Prevention
 Management

There is no cure for chronic kidney disease (CKD),

but can be managed to help relieve the symptoms and stop it from getting worse.

This depends on the stage of your CKD.

● lifestyle changes – to ensure you remain as healthy as possible
● medication – to control associated problems, such as high blood pressure and high cholesterol
● dialysis – treatment to replicate some of the kidneys functions, which may be necessary in
advanced (stage 5) CKD
● kidney transplant – this may also be necessary in advanced (stage 5) CKD
Lifestyle changes
● eat a healthy, balanced diet.
● restrict salt intake to less than 6g (0.2oz) a day.
● do regular exercise – aim to do at least 150
minutes a week.

High blood pressure

● Good control of blood pressure is vital to protect

the kidneys.
● Aim to get blood pressure down to below
140/90mmHg, but you should aim to get it down
to below 130/80mmHg if you also have diabetes
Water retention

● Experience swelling in the ankles, feet and hands.

● This is because your kidneys aren't effective at removing fluid
from your blood, causing it to build up in the body tissues
(edema).
● It is advised to reduce daily salt and fluid intake (soups and
yogurts).

Bone problems

● Kidneys are severely damaged - build-up of phosphate in your

body
● Along with calcium, phosphate is important for maintaining
healthy bones. But if your phosphate level rises too much, it can
upset the balance of calcium in your body and lead to thinning
of the bones.
● You may be advised to limit the amount of high-phosphate food
in your diet, such as red meat, dairy products, eggs and fish.
 ● Some people with kidney disease also have low
levels of vitamin D, which is necessary for
healthy bones, too - supplement called
cholecalciferol or ergocalciferol

Anemia

● Many people with later-stage kidney disease

develop anemia.
● you may be given injections of a medication
called erythropoietin..
● If you have an iron deficiency as well, iron
supplements may also be recommended.
 Prevention
1. Watch your weight and Eat healthy

Healthy eating plays an important role in reducing the risk of getting chronic kidney disease (CKD).
Consuming the right amount of calories (energy) helps you achieve a healthy body weight. Maintaining a
Body Mass Index (BMI) of 18.5-22.9kg/m 2 can reduce your risk of getting obesity-related chronic diseases
including kidney failure.

Healthy eating includes a diet that is/has:

● Low in sodium (salt)
● Low in fat especially saturated fat
● Low in dietary cholesterol
● Minimise trans fat
● High in dietary fibre (fruits and vegetables) and whole grains
2. Hypertension and CKD
If u have high blood pressure try to keep it below
130/80. High blood pressure damages kidneys over
time. Keeping your blood pressure under control can
protect your kidneys and prevent kidney failure.

3. Diabetes and CKD

It is important for diabetic patients to maintain normal
blood sugar level by controlling carbohydrate intake.
Having well-controlled blood sugar levels help to slow
down the progression of Diabetes Nephropathy
(kidney failure caused by diabetes).
4. Kidney stones and CKD
Kidney stones can increase the risk of chronic kidney
disease and cause permanent damage to kidneys.

To prevent this drink plenty of water. It helps to dilute

the urine and prevent chemicals in the urine to form
crystals. It also helps to excrete chemicals from the
body and prevent stone formation. It is recommended
to drink 2-3L of water a day.

5. Gout and CKD

Gout (Hyperuricemia) occurs when uric acid, a normal

waste product, builds up in the blood and forms
crystals in the joints and/or kidneys.

It can lead to chronic kidney disease and even kidney

failure. You need to follow a low purine diet if you have
a gout problem.
References
● https://www.nhs.uk/conditions/kidney-disease/treatment/
● https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/anemia
● https://www.healthdirect.gov.au/kidney-disease-prevention
● https://www.google.ae/search?
q=NEPHRON+GIF&safe=strict&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjlj4XnjcTZAhXBvhQKHQ5JDdIQ_
AUICigB&biw=1366&bih=662#imgrc=ue2K2wrZajlS1M:
● https://www.ultracleanseguide.com/healthy-kidneys.html
● https://www.google.ae/search?q=NEPHRON+GIF&safe=strict&dcr=0&source=lnms&tbm=isch&sa=X&
ved=0ahUKEwjlj4XnjcTZAhXBvhQKHQ5JDdIQ_AUICigB&biw=1366&bih=662#imgrc=Dpukj3Qh2YUGs
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