CHRONIC KIDNEY

DISEASE
 Introduction

 Chronic kidney disease (CKD) is defined as the presence of kidney

damage for 3 months or more, as defined by structural or functional
abnormalities, with or without decreased glomerular filtration rate
(GFR), OR, GFR less than 60 ml/min for more than 3 months with or
without kidney damage.
  kidney damage is defined as pathologic abnormalities or markers of
damage, including abnormalities in blood or urine tests or imaging
studies.
STAGES OF CKD

    Glomerular Filtration
Stage Description Rate (GFR)
mL/min
1T Kidney damage (e.g., 90 or above
protein in the urine)
with normal GFR

2T Kidney damage with 60 to 89

mild decrease in GFR

3T Moderate decrease in 30 to 59
GFR
4T Severe reduction in 15 to 29
GFR
5T Kidney failure Less than 15
 Symptoms
 Nausea
 Vomiting
 Loss of appetite
 Fatigue and weakness
 Sleep problems
 Muscle cramps
 Swelling of feet and ankles
 Persistent itching
 Chest pain, if fluid builds up around the lining of the heart
 Shortness of breath, if pulmonary oedima
 High blood pressure
causes
 Type 1 or type 2 diabetes
 High blood pressure
 Glomerulonephritis , an inflammation of the kidney's filtering units
(glomeruli)
 Interstitial nephritis, an inflammation of the kidney's tubules and
surrounding structures
 Polycystic kidney disease
 Prolonged obstruction of the urinary tract, from conditions such as
enlarged prostate, kidney stones and some cancers
 Vesicoureteral reflux, a condition that causes urine to back up into
kidneys
 Recurrent kidney infection, also called pyelonephritis
 Risk factors
 Diabetes
 High blood pressure
 Heart and blood vessel (cardiovascular) disease
 Smoking
 Obesity
 Family history of kidney disease
 Abnormal kidney structure
 Older age
complications
 Fluid retention, which could lead to swelling of arms and legs, high blood
pressure, or fluid in lungs (pulmonary oedema)
 A sudden rise in potassium levels in blood (hyperkalemia), which could
impair heart's ability to function and may be life-threatening
 Heart and blood vessel (cardiovascular) disease
 Weak bones and an increased risk of bone fractures
 Anemia
 Decreased immune response, which makes more vulnerable
to infection
 Pericarditis, an inflammation of the saclike membrane that
envelops heart (pericardium)
 Irreversible damage to kidneys (end-stage kidney disease),
eventually requiring either dialysis or a kidney transplant
for survival
PREVENTION:

To reduce the risk of developing kidney disease:

 Follow instructions on over-the-counter medications. 
 Maintain a healthy weight. 
 Avoid smoking. 
DIAGNOSIS
Blood tests
 Serum Creatinine, serum sodium, serum pottassium
 Glomerular Filtration Rate(GFR)
 Blood Urea Nitrogen (BUN)
Imaging Tests
 Ultrasound
 CT Scan
Kidney Biopsy
Urine Tests
 Urinalysis
 24 hours Urine Protein
 Microalbuminuria
 Creatinine Clearance
TREATMENT:

 Conservative method
 Dialysis
 Kidney transplant
Energy requirements
NUTRIENT CKD CKD ON HD CKD ON CAPD
Energy
30-35 30-35 30-35
Kcal/kg

Foods that are high in Energy and nil protein are:

• Sago arrow root
• Butter
• Oil
• Sugar
• Potatoes
 Protein.
 The recommended dietary protein level for CKD patients has
changed over time.
 Studies have shown that a reduction of protein intake to as low as
0.8 mg/kg/day may decrease proteinuria without adversely affecting
serum albumin.
 Serum albumin is a marker of inflammation, not protein
malnutrition.
 To allow for optimal protein use, 50% to 60% of the protein should
be from sources of high biologic value (HBV), meaning that the
body is easily able to digest and use the amino acids.
 If The patient on heamo- dialysis the protein requirement should be
1.2 gm /kg body weight.
Protein requirements
NUTRIENT CKD CKD ON HD CKD ON CAPD
Protein
0.6-1.0 1.1-1.4 1.2-1.5
g/kg/day

Foods that are rich in protein –HBV;

•All animal foods like –
• Fish
• Chicken
• Meat
• Egg
•Milk and milk product like –
• Curd
• Paneer
• Cheese
Sodium

 Edema, the most clinically apparent manifestation, indicates

total body sodium overload.
 In addition, because of low oncotic pressure from
hypoalbuminemia, the volume of circulating blood may be
reduced because of migration of fluid to interstitial space.
 Attempts to severely limit sodium intake or to use diuretics
may cause marked hypotension, exacerbation of coagulopathy,
and deterioration of renal function.
 Therefore control of edema in this group of diseases should be
with dietary intake of 1500 mg of sodium daily.
Sodium requirements
NUTRIENT CKD CKD ON HD CKD ON CAPD
Sodium
1000-3000 2000-3000 3000-4000
mg/d

•Salt •Popcorn
•Baking powder •Salted biscuits
•Baking soda •Papads
•Canned foods •Pickles
•Bacon •Sauces
•Ham •Aerated drinks
•Sausages, •Commercial soups
•Meat •Ajinomoto
•Meat extracts •Dried fish
•Salted chips •Dried fruits
•Nuts
Potassium.

 Potassium management is possible through use of

medications such as diuretics, individualized diet
prescription, and rate of progression of CKD.
 Many patients in early-stage CKD take potassium-wasting
diuretics (e.g., furosemide) that require normal potassium
from food.
 When urine output drops below 1 L/day and in CKD stage
4, the kidney can not able execrate potassium so potassium
should be restricted.
Potassium requirements
NUTRIENT CKD CKD ON HD CKD ON CAPD
Potassium
Individualized 40 Individualized
mg/kg

Foods that are rich in Potassium rich food

potassium are all fruits • Tender coconut
except • Water
• Apple • Tea
• Pine apple • Coffee
• Pappaya • Lemon
• Guava • Cocoa
• Pears • Chocolate
• Tamarind
PHOSPHATE

 The diet typically is modified to allow no more than 1000

mg of phosphates daily.
 Because of the decrease in protein intake, the control of
phosphorus is somewhat easier to manage.

 https://www.mayoclinic.org/
 https://www.kidney.org/
Phosphorus requirements
NUTRIENT CKD CKD ON HD CKD ON CAPD
Phosphorus
8-12 <=17 <=17
mg/kg

• Phosphorus can be found naturally in foods (organic

phosphorus) and is naturally found in protein-rich foods such as

• Meats , poultry, fish, nuts, beans and dairy products.

Phosphorus found in animal foods is absorbed more easily than
phosphorus found in plant foods.
Fluid requirements
NUTRIENT CKD CKD ON HD CKD ON CAPD
Fluid 500-750+ urine output
Unrestricted Individualized
ml/d (1000 if anuric)

Fluid should be counted including the following

• Water
• Milk
• Soup
• Gravies
• Curd
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