BMS3020 L20 Pathophysiology and Management of CKD 13/11/18
BMS3020 CHRONIC DISEASE
LECTURE 20 – Pathophysiology and Management of Chronic
Kidney Disease
- Causes of CKD - Preventing Progressive Disease
- Progression of CKD - Treatment of End Stage Renal Disease
- Pathophysiology of Tubulointerstitial (ESRD)
Fibrosis
Epidemiology of CKD in the UK
- Prevalence of CKD
- Very common, affecting up to 4 million people but the cause if often unknown
- Rarer kidney diseases such as lupus have specific tests but for the majority of cases, the cause is
unknown and taking biopsies etc. is not a practical option
o 10.6% of women – 2.6 million women
o 5.8% of males – 1.3 million men
Unknown aetiology
What is the cause of the CKD Diabetes
Data not available
epidemic? Glomerulonephritis
Hypertension
- 4 million patients with stage 3-5 CKD Other
Pyelonephritis
- Vast majority will not have a specific diagnosis Renovascular
Polycystic kidneys
- Majority will never have seen a nephrologist
- The pie chart below shows the causes for patients
starting dialysis – mainly type 2 diabetes and lifestyle issues – 20% of
60
Percentage of pateints with
patients in the UK have this disease due to preventable factors, 50% 50
of patients in the US. 40
CKD 3-5
Male
30
Female
- Diabetes is a huge factor in this – prevalence continues to rise 20
10
1. Ageing Population 0
18-24
45-54
65-74
75-84
25-34
35-44
55-64
85+
- Loss of 0.9 ml/min of GFR per year after the age of 40 years as part Age
of the ageing process
- Exponential increase between age and CKD prevalence
- This can explain the increasing CKD prevalence but does give rise to some controversy and
questioning in the renal world
Is ageing always associated with fall in GFR? (Kasiske KI, 1987)
o Study took kidney post-mortems of people who had died due to non-medical reasons e.g.
suicides, car crashes (non-degenerative disease) – checked for signs
of CKD such as replacement of glomeruli with scar tissue (sclerotic
glomeruli)
o Proportion of sclerotic glomeruli calculated for patients
o Dotted line shows the average proportion of sclerotic glomeruli in
patients who had evidence of atherosclerosis and other line shows
proportion in people with healthy circulation
o Fewer sclerotic glomeruli if no other evidence of vascular disease
such as atherosclerosis
- This introduces the idea of having ‘good’ ageing regarding the kidney –
the average loss shows some people maintain their GFR and others decrease rapidly due to other
lifestyle factors which are amenable
1
BMS3020 CHRONIC DISEASE
LECTURE 20 – Pathophysiology and Management of Chronic
Kidney Disease
- Causes of CKD - Preventing Progressive Disease
- Progression of CKD - Treatment of End Stage Renal Disease
- Pathophysiology of Tubulointerstitial (ESRD)
Fibrosis
Epidemiology of CKD in the UK
- Prevalence of CKD
- Very common, affecting up to 4 million people but the cause if often unknown
- Rarer kidney diseases such as lupus have specific tests but for the majority of cases, the cause is
unknown and taking biopsies etc. is not a practical option
o 10.6% of women – 2.6 million women
o 5.8% of males – 1.3 million men
Unknown aetiology
What is the cause of the CKD Diabetes
Data not available
epidemic? Glomerulonephritis
Hypertension
- 4 million patients with stage 3-5 CKD Other
Pyelonephritis
- Vast majority will not have a specific diagnosis Renovascular
Polycystic kidneys
- Majority will never have seen a nephrologist
- The pie chart below shows the causes for patients
starting dialysis – mainly type 2 diabetes and lifestyle issues – 20% of
60
Percentage of pateints with
patients in the UK have this disease due to preventable factors, 50% 50
of patients in the US. 40
CKD 3-5
Male
30
Female
- Diabetes is a huge factor in this – prevalence continues to rise 20
10
1. Ageing Population 0
18-24
45-54
65-74
75-84
25-34
35-44
55-64
85+
- Loss of 0.9 ml/min of GFR per year after the age of 40 years as part Age
of the ageing process
- Exponential increase between age and CKD prevalence
- This can explain the increasing CKD prevalence but does give rise to some controversy and
questioning in the renal world
Is ageing always associated with fall in GFR? (Kasiske KI, 1987)
o Study took kidney post-mortems of people who had died due to non-medical reasons e.g.
suicides, car crashes (non-degenerative disease) – checked for signs
of CKD such as replacement of glomeruli with scar tissue (sclerotic
glomeruli)
o Proportion of sclerotic glomeruli calculated for patients
o Dotted line shows the average proportion of sclerotic glomeruli in
patients who had evidence of atherosclerosis and other line shows
proportion in people with healthy circulation
o Fewer sclerotic glomeruli if no other evidence of vascular disease
such as atherosclerosis
- This introduces the idea of having ‘good’ ageing regarding the kidney –
the average loss shows some people maintain their GFR and others decrease rapidly due to other
lifestyle factors which are amenable
1
