renal failure mary rose g. tantoco. how do we assess renal function? what markers can we use to...
TRANSCRIPT
![Page 1: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/1.jpg)
Renal FailureMary Rose G. Tantoco
![Page 2: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/2.jpg)
How do we assess renal function?
What markers can we use to assess renal function Inulin (Gold standard)
Iothalmate
Iohexol
Urea
Cystatin C**
CREATININE***
![Page 3: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/3.jpg)
What is creatinine
Function of muscle breakdown i.e. it is a function of muscle mass
Can be affected by factors that can affect muscle mass Age
Gender
Race
Used in calculating estimated Glomerular filtration rate Cockcroft-Gault equation
MDRD**
CKD-EPI**
![Page 4: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/4.jpg)
How reliable is using creatinine and eGFR?
![Page 5: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/5.jpg)
How do we ensure accuracy?
Cystatin C: expensive, not universally available 24 hour urine: calculate measure clearance Can we use these markers in Acute Kidney Injury?
![Page 6: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/6.jpg)
Acute Kidney Injury
Abrupt decline in the functioning of the kidneys
Assess severity: different criteria e.g. RIFLE etc.
Different causes: Pre/Renal/Post
Pre-renal: disrupt effective circulating volume to the kidney e.g. hypotension, profound anemia, dehydration, heart failure.
Renal: ATN, AIN, GN
Post: obstruction from stones, BPH, strictures etc.
![Page 7: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/7.jpg)
Acute Kidney Injury
ATN: Ischemic or Nephrotoxic
AIN: Drug-induced, infectious
GN: IgA, HSP, Good Pasture’s, ANCA vasculitis, Cryoglobulinemia-related GN, post-infectious, FSGS, MGN, MPGN
![Page 8: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/8.jpg)
How to treat AKI? Remove offending agents and other potential nephrotoxins:
ACE Inhibitors/ARB/NSAIDs/Phosphasoda enemas/certain antibiotics, anti-viral and anti-fungals agents/certain chemotherapeutic agents/CT IV contrast etc.
Optimize effective circulating volume.
Treat electrolyte abnormalities medically or through dialysis.
When to consider biopsy?
Call nephrology consult.
![Page 9: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/9.jpg)
![Page 10: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/10.jpg)
Chronic Kidney Disease (KDOKI website)
![Page 11: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/11.jpg)
Causes for CKD
Diabetes Mellitus Hypertension Other chronic disease Drug therapy Toxin exposure Recurrent infections/ATN GN
![Page 12: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/12.jpg)
Management of CKD Dependent on stage ALL stages:
Management of co-morbid chronic diseases/underlying pathology***
Minimization of nephrotoxic exposure ( including CT IV contrast +/- MRI contrast)
Managing proteinuria (DM)
Stage 3 and up Electrolytes: dietary modification Anemia Bone/Mineral health
Stage 4 and up Start preparation for renal replacement therapy
![Page 13: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/13.jpg)
Why is proteinuria important?
Prognostic factor: associated with progression of renal disease
RENAAL trial (In patient with diabetic nephropathy, Losartan decreased risk of development to ESRD compared to placebo)
Might point to other underlying pathology FSGS, malignancy etc.
Treatment: ACE Inhibitors/ARB’s**
![Page 14: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/14.jpg)
Renal diet: Why low Potassium?
Potassium has a narrow therapeutic window High levels linked to bradycardia and heart block High K + EKG changes = indications for renal
replacement therapy particularly in the setting of impaired renal functions without response to medical therapy.
Medical therapy: Kayexalate/Sodium Bicarbonate/Insulin and D50/IV Calcium***
![Page 15: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/15.jpg)
Foods High in Potassium
![Page 16: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/16.jpg)
Renal Diet: why low Phosphorus
Generalized itching Can cause abnormal mineralization with dire
consequences e.g. Calciphylaxis
![Page 17: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/17.jpg)
Foods High in Phosphorus**
![Page 18: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/18.jpg)
Other considerations:
![Page 19: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/19.jpg)
Other considerations
Anemia of Chronic Disease Iron stores Need for Epogen
CKD related mineral bone disease Vitamin stores Parathyroid activity
![Page 20: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/20.jpg)
Getting ready for dialysis
Education, education, education!!! Is the patient a candidate? Big lifestyle change What about transplant?
Dialysis access: AVF/AVG/ PC/ PD***
![Page 21: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/21.jpg)
Hemodialysis
![Page 22: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/22.jpg)
Hemodialysis
Access management: avoid needle sticks in same arm with AVF/AVG, weight lifting limit, no restrictive/binding clothing, monitoring for function/infections/aneurysm
Fistula first 2 types: In-center and Home hemodialysis.
![Page 23: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/23.jpg)
Peritoneal Dialysis
Access management: drainage/placement/infection 2 types: Automated or Manual
![Page 24: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/24.jpg)
You can live a relatively normal life on dialysis
It is not a “death sentence” People can travel on both HD and PD Kidney Transplant
![Page 25: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/25.jpg)
A Few words on Kidney Transplant
Not an immediate solution to renal failure Extensive work-up required to ensure that patients will
be safe for procedure and that they don’t have any factors that might be impediments to having a kidney transplant (heart disease, lung disease, malignancy, non-compliance***)
Living Donor vs Deceased Donor Kidney Transplant: for the latter once listed wait time can be on average 3 to 5 yrs
New allograft allocation criteria since December 2014 Also need to consider the chronic financial
repercussions
![Page 26: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/26.jpg)
![Page 27: Renal Failure Mary Rose G. Tantoco. How do we assess renal function? What markers can we use to assess renal function Inulin (Gold standard) Iothalmate](https://reader036.vdocuments.net/reader036/viewer/2022062423/5697c0281a28abf838cd694f/html5/thumbnails/27.jpg)