This insightful on-demand session provides a detailed overview of Chronic Kidney Disease (CKD), renal failure, and dialysis. The attending medical professionals will delve into the core functions of the kidney under normal and disease conditions. The session covers essential topics such as regulation of electrolytes, acid-base balance, the kidney's role in endocrine functions, excretion, and glucose metabolism. The speaker also provides comprehensive knowledge about hyperkalemia, hyponatremia, hyperphosphatemia, and acidosis, which are common in renal failure. Further, the session discusses CKD and Acute Kidney Injury (AKI), the differences in their onset, and the potential causes. The session will also focus on the initial management of CKD including fluid balance assessment, the effects of hypovolemia and hypervolemia, amongst other things. This provides an excellent learning opportunity for medical professionals involved in neurology and patient care.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Hi, everyone. Um Are you guys able to hear me now? So? All right. Ok. Um So now I'm gonna um start my presentation which is essentially uh on CKD renal failure and dialysis. So, yeah, sorry, just give me one moment. Um Yeah. Ok. So these are the, the main topics uh we're gonna be covering. So let's just start off with the kidney function um in a normal circumstance and when it's um diseased. So essentially the kidney has four main functions, which is basically going to be involved in homeostasis. Um endocrine functions, it has excretion, uh functions and is involved in glucose metabolism anomaly. So, in, in a normal kidney, it will be involved in regulating electrolytes. And the main ones that we need to be focusing on would be sodium and potassium where the kidneys would normally retain uh retain potassium and excrete. Um sorry, retain sodium and excrete potassium and under the acid base balance, the the kidneys will also be excreting um hydrogen ions. And also it's um the kidneys are also involved in volume to either um make um to increase the production of urine when there's too uh when there's too much of uh water in, in the circulator system or to reduce the production of urine when there's too little water. Um, in the psychiatry systems. And this essentially, it is essentially just gonna be the opposite in the diseased um, kidney where there's a disruption to the kidney's functions. And because of that, uh the kidney is not able to do its normal, um, it's not able to essentially do its normal function. And what happens then is you'll have a hyperkalemia, which is essentially in excess potassium in the bloodstream and hyponatremia, which is essentially, which is a low um low sodium in the bloodstream. And there's also a hyper uh phosphatemia as well. And in terms of um the acid base balance, uh there is essentially going to be acidosis, um acidosis in uh in the ki uh kidney just because um the kidneys are no longer able to excrete uh uh hydrogen ions. And therefore that will, that will cause a drop in the ph since also bicarbonate uh production by the kidneys is going to be decreased. And the acidosis can also further contribute to hyperkalemia, which we'll talk about uh in the, in the future slide. And again, in, in kidney diseases, that can be either hypovolemia or hypervolemia. And we'll also touch upon this later on in the, in the presentation in terms of the endocrine function, the normal kidneys involved in Vitamin D hydroxylation. And that is done by, by the enzyme one alpha hydroxylase um um in that is produced in the kidney and, and at the same time, there's there is gonna be a production of epo uh within uh the kidneys. And what does is to stimulate the red blood cell production in response to hypoxia. And again, as you can see, um in disease, these functions won't be fulfilled. And because there's gonna be um less of Vitamin D hydroxylation um in the kidneys, you're not gonna have the same effects of uh Vitamin D And that essentially means that there will be reduced calcium absorption uh from the and naturally, when this reduced um calcium levels, there will be an increase in the production of parathyroid hormone to in to in order to increase the calcium levels uh within uh the bloodstream. Um and that can be done via calcium resorption from the bone to compensate for this. And secondly, with, because of the E epo, uh because of the lack of uh epo production, there is gonna be anemia and disease because uh without epo, you're not gonna be able to produce enough red blood cells. And thirdly, we have um under the con um the category of excretion, there will be a removal of waste products by the kidney like urea and the creatinine. And again, in the diseased kidney, that's not be the kidney is not gonna be able to do this uh same function. And therefore, that's gonna be an increase in urea and creatinine uh levels in the blood stream. And finally, um the kidneys are also involved in glucose metabolism in terms of, in terms of uh gluconeogenesis and also insulin clearance clearance. And when this fails to happen, there is automatically gonna be hyperglycemia because the kidney is no longer able to uh produce uh glucose as well. And at the same time, we ina uh insulin clearance there, um there's just not gonna be, there will be an excess of effect of insulin and that can contribute to hypoglycemia. So we'll now look at uh both CKD and AK. So, naturally CKD is just um so not AKI essentially is a more um rapid onset because AKI is or the term the AK is essential uh a kidney injury. And what happens there is essentially there's a transient um uh some transient damage uh to the kidney and usually uh caused by certain things like hypovolemia or uh infections. And whereas CKD, which is known as chronic kidney disease, that's uh something that happens over years. Um and that will be accumulated damage to the kidneys because of uh multiple uh factors. And that's why it's a slower onset. And when you look at imaging in kidney, that will be shrunken kidneys because the kidney has sustained a lot of damage over over many years. And because of that, there'll be a progressive um loss of nephrons and there will also be fibrosis to replace function, kidney tissues and over time, it just shrinks the um the kidneys, whereas for AKI the kids are actually just gonna be normal because it is a trans attack on the kid function. So it can be easily reversed. And that is why the kidney size is unaffected. But in CKD, that's just gonna be a chronic, that will just be a chronic uh compensate uh compensation by the body or just sustained damage that causes the kidneys to shrink over time. Um Yeah. So in terms of um initial uh management, there are multiple things that we need to consider when it uh when it comes to um uh chronic kidney disease or a. So the first thing that you should be thinking about for a patient who comes in with any um like uh kidney disease would be fluid balance to see if they are hypo hypovolemic or hypervolemic or sometimes they might also just be uem and uem. It just means that there's um normal fluid, um there's a normal amount of fluid within the person itself. So, in terms of, well, let's look at hypovalaemia. So hypovolemia just means that there's less of fluid within um the circulatory system and within the body. And there are certain signs that you can, that you can see cause of um uh because of reduced uh fluid in the body. And 1st, 1st and foremost, I just that it is gonna be a low BP and just because there's less of fluid circulating within the circulator system. And because of that, because of uh less of fluid and less of blood, what happens would be that, that would be vasoconstriction. That would be um that would just be cold hands and uh vasoconstriction as a result of it. Um And because of the vasoconstriction, there is gonna be pa with the skin because not enough blood is be um uh going to your skin and there's also gonna be poor skin type because water is required and you need water in order to maintain um the firmness of the skin. And whereas in hypervolemia, that's essentially just uh gonna be excess fluid within uh within the body. And naturally, that just increases the amount of blood flow through the circulation system. And because of that, it might be a high BP. And also there, there will be signs of edema within.
