DR Medhat MRCP

Causes of CKD :
Common causes of CKD :
1) DM (diabetic nephropathy)
2) HTN (hypertensive nephrosclerosis)
3) VUR
4) Chronic pyelonephritis
5) Chronic obstructive uropathy.
6) Chronic glomerulonephritis
7) Polycystic kidney disease
Pathophysiology of CKD :
Normal kidney function
1) Clearance of nitrogenous (uraemic)
waste products by excretion in urine
2) Ultrafiltration (excretion) of excess
fluid to maintain fluid balance.
3) Maintain normal Acid-base balance
4) Maintain normal electrolyte balance
5) Endocrine function :
a) 2 nd step of vit D activation (25
OH)[1 st step in liver 1 OH]
b) Secretion of erythropoiten
hormone to ++ BM to produce
RBCs
c) Renin-angiotensin system
Disturbed kidney function in CKD
1) Uraemia (uraemic manifistations)
2) Fluid overload (G.edema)
3) Metabolic acidosis
4) Electrolytes disturbance
a) Hypocalcemia
b) Dilutional hyponatraemia
c) Hyperkalaemia
d) Hyperphosphatemia
5) Insufficient & inactive vit D
6) 2ndry hyperparathyroidism
Osteoporosis
Osteomalacia
Ostitis fibrosa cystica
Adynamic bone disease (i.e
both osteoblastic & osteoclastic
activity with normal PTH.
7) Anemia
8) HTN , salt & water retension.
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