- •Acute kidney injury.
- •Relationships between AKI, AKD and CKD
- •Incidence of kidney pathology
- •Acute kidney injury
- •AKI criteria
- •AKI stages (KDIGO)
- •Classification of AKI
- •Common causes of AKI
- •Clinical Presentation of AKI
- •Diagnostic Approach in AKI
- •Prerenal AKI
- •Diagnosing pre-renal AKI
- •Renal AKI
- •Further lab evaluation for renal AKI
- •Postrenal AKI
- •Urine Output and AKI
- •Principles of AKI Management
- •Principles of AKI Management
- •Acute kidney disease
- •Chronic kidney disease (CKD)
- •Acute kidney injury and chronic kidney disease
- •Conceptual model of CKD
- •Key questions in CKD
- •Assessment of renal function: estimation of GFR
- •Why CKD-EPI is the most appropriate estimation of GFR?
- •www.kidney.org
- •Assessment of renal function: GFR measurement
- •How to assess albuminuria?
- •GFR categories in CKD
- •Albuminuria categories in CKD
- •CKD causes
- •Risk factors of CKD
- •Каковы факторы прогрессирования ХБП
- •Prognosis of CKD by GFR and albuminuria categories
- •GFR and albuminuria grid to reflect the risk of progression by intensity of
- •How to formulate diagnosis in CKD?
- •Clinical case
- •Stratification by cardiovascular and renal risks
- •Clinical diagnosis
- •Treatment of CKD
- •Renal replacement therapy
- •Clinical examples
- •73-year old female
- •Physical examination
- •Blood chemistry:
- •Индексация ХБП по уровню альбуминурии
- •Сstratification by cardiovascular and renal risks
- •Recommended frequency of monitoring
- •Направление к нефрологу в зависимости от категории СКФ и альбуминурии
- •Diagnosis:
- •69-year old male
- •no abnormalities in physical examination at admission BP 167/80 mmHg
- •Blood chemistry
- •Diagnosis
Diagnosis:
Main: Arterial hypertension stage 3, risk 4. Left ventricular hypertrophy. CAD. Stable angina 2-3 FC. Previous MI.
Concomitant: Obesity. Dyslipidemia. Type 2 DM, target. HbA1c < 8%. Diabetic and hypertensive kidney disease. CKD G3b А3.
Previous stroke
69-year old male
2007
HTN |
150/100 |
|
Chest pain
Creatinine,
мкмоль/л
|
|
Клопидогрель 75 мг |
|
2011г |
21.03.2016 |
Аспирин 125 мг |
|
|
|
Метопролол 25 мг |
|
|
|
Ривароксабан 2,5 мгх 2 р/д |
|
200/110 |
167/80 |
Розувастатин 20 мг |
|
|
|
||
|
ECG: ритм |
|
Coronary |
|
синусовый, ↑ ST |
||
|
angiography |
||
|
II, III, aVF. |
|
Hospitalization
107 325 137
03/10/2021
no abnormalities in physical examination at admission BP 167/80 mmHg
03/10/2021
CBC
Показатель |
21.03 |
29.03 |
норма |
Ед.измерения |
WBC |
9,9 |
9,6 |
4-9 |
10*9/л |
RBC |
5,43 |
4,83 |
4-5 |
10*12/л |
HGB |
164 |
135 |
130-160 |
г/л |
Neutrophils |
78 |
74,2 |
47-78 |
% |
ESR |
15 |
|
0-15 |
мм/ч |
03/10/2021
Blood chemistry
Показатель |
21.03 |
25.03 |
29.03 |
Норма |
CK-MB, Е/л |
40 |
|
|
0-24 |
CK, Е/л |
267 |
|
|
0-171 |
Troponin, нг/мл |
34,54 |
|
|
0-0,02 |
ALT Е/л |
24,4 |
74 |
|
0-50 |
AST Е,л |
19,5 |
57 |
|
0-50 |
Total cholesterol, ммоль/л |
7,65 |
|
|
0-5,2 |
Triglycerides, ммоль/л |
1,93 |
|
|
0-1,7 |
HDL, ммоль/л |
1,08 |
|
|
0-1,3 |
LDL, ммоль/л |
2,82 |
|
|
0-2,6 |
Creatinine, мкмоль/л |
107 |
325 |
137 |
59-104 |
GFR, CKD-EPI |
61 |
16 |
45 |
>90 |
Urea, ммоль/л |
5,5 |
27,9 |
|
2,8-7,2 |
К+, ммоль/л |
4,5 |
4,6 |
5,29 |
3,5-5,1 |
03/10/2021
Diagnosis
•Main: CAD. Acute inferior MI. CAG (21.03.2016): stenting of the right CA.
•Arterial hypertension stage 3, risk 4. Dyslipidemia.
•Complications. Contrast-induced AKI, stage 3
03/10/2021