kidney 101 - university of babylon · 2019-01-14 · 1. overview of kidney anatomy and functions 2....
TRANSCRIPT
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Kidney 101
Southern Alberta Renal Program Alberta Health Services
Presenter: Janice James RN CNeph ( C )
Nurse Clinician Chronic kidney Disease Clinic
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CONTENTS
1. Overview of Kidney Anatomy and Functions
2. Common causes of declining kidney function
3. Kidney and kidney related diseases
4. Signs to look out for kidney diseases
5. Common tests to assess your kidney health
6. Five Stages of Kidney function
7. Kidney replacement therapy
8. Living well with kidney disease
9. Tips to take control your kidney health
10. Questions and answers
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The Kidneys
Most people have two kidneys, located on either side of the spine.
Each kidney is about the size of your fist.
They are attached to the bladder by ureters.
Urine is stored in the bladder
A Nephron
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The Kidneys Make Urine and Regulate Body Water
The kidneys make one to two liters of urine every day.
Too much water, minerals and waste products get separated from the blood and eliminated as urine.
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What do kidneys do?
Removal of wastes
Maintain fluid balance
Maintain acid-base balance
Balance of minerals and electrolytes
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Kidney produces hormones
These hormones help:
Regulate blood pressure
Make red blood cells
Promote strong bones.
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Common causes of declining kidney function
Diabetes:
Uncontrolled blood sugar
Hypertension (high blood pressure):
Prolonged high blood pressure
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Other Causes
Inherited diseases, such as, polycystic kidney disease .
Immune system disorders : Lupus
Glomerulonephritis: inflammation and damage to the kidney’s filtering units.
Repeated urinary infections.
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Other causes
Obstructions caused by:
- kidney stones
- tumors
- enlarged prostate
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How do we assess kidney health ?
Blood test :
Creatinine : waste product from muscle
breakdown
Urine test:
When kidneys become damaged, protein is
found in the urine.
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Imaging Studies
Ultrasound
(Size and Symmetry of kidneys).
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Estimated Kidney Functions
Estimated glomerular filtration rate (GFR) : a
value that is calculated from creatinine level and
other factors (gender and age) to estimate
remaining kidney function.
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Signs to look out for
High blood pressure
Bloody , cloudy or tea-colored urine.
Protein in urine
Foam in urine
Frequent passing of urine during the night.
Difficulty voiding or passing less urine
Edema (swelling in eyes, hands, legs , feet)
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Five Stages of Kidney Functions
Stage 1: Normal GFR > 90 ml/min
Stage 2: Mild GFR 60-89 ml/Min
Stage 3: Moderate GFR 30-59 ml/min
Stage 4 : Severe GFR 15-29 ml/min
Stage 5 : GFR < 15 ml/min (end stage kidney disease)
Symptoms of Late Stage Kidney Failure
Loss of appetite
Nausea and vomiting
Bad taste in mouth
Chest pain
Fatigue
Cold intolerance
Shortness of breath
Swelling in hands and feet
Persistent
generalised itching
Muscle cramps
Restless legs
Sexual dysfunction
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What Happens Next ? Progressive Renal Insufficiency
(Chronic Kidney Disease stage 1-4)
End stage renal disease ( stage 5) Conservative
Therapy
Renal( kidney) replacement therapy
Hemodialysis
Peritoneal Dialysis
Kidney Transplant (Live or non living donor)
Hemodialysis
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Continuous Ambulatory Peritoneal dialysis
CAPD
Dialysis done every day
Each exchange takes
20-30 min.
4-5 manual exchanges/day of fluid by patient
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Cycler Peritoneal Dialysis
Automatic peritoneal
dialysis (APD) (CCPD)
Automated machine
(cycler) performs
exchanges at night
while patient sleeps
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Kidney Transplantation
Live Donor, a kidney from a donor, often a
blood relative
Paired exchange
Cadaver Donor (
a healthy kidney from
someone who has died,
non living donor)
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Conservative Therapy
Living Well Without Dialysis
Choose not to have dialysis or a transplant
Patient will be managed by a specialized
renal palliative care team
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Tips to keep your kidneys as healthy as possible
1. Keep high blood pressure within target range
2. Control Blood Sugar
3. Cholesterol Management
4. Healthy Food choices
5. Weight Control and exercise
6. Stop smoking
7. Reduce stress
8. Know your medications
9. Know your numbers
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1. Control High Blood Pressure
Target BP
~ < 140/90 for most people
~ < 130/80 for people with kidney disease or diabetes
'chicken and egg' question ?
Sick kidneys cause high BP
Or high BP causes defected kidneys
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Tips to help control high blood pressure
Get it checked !
Measure at home
Cut back on salt and processed food
Control your weight
Limit alcohol
Be active
Be smoke-free
Take time to relax
Take medications as prescribed
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Tips to help control blood sugar level
Get it checked !
Eat a healthy diet
Control your weight
Limit alcohol
Be active
Take medications as prescribed
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2. Control Your Blood Sugar level
Meter readings:
4 - 7mmols – fasting + before a meal
5 – 11 mmols – 2 hours after meal/snack
Hemoglobin A1C
A hemoglobin A1C (also known as glycated
hemoglobin or HbA1c) test gives you a
picture of your average blood sugar
(glucose) for the past two to three months
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Dangers of High Cholesterol
High cholesterol is one of the
risk factors for atherosclerosis
( hardening of the arteries)
Atherosclerosis, like corrosion in pipes, builds
inside the wall of arteries (not veins)
decreasing blood flow through the arteries
4.2-5.2mmol/L
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3. Cholesterol Management
Cholesterol is a soft waxy substance found
among the fats in the blood
Important for development of:
– Cell membranes
– Nerve tissues
– Certain hormones
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Diagnosing High Cholesterol
A lipoprotein profile measures:
Total cholesterol
Low density lipoprotein
(LDL or “bad”) cholesterol
High density lipoprotein
(HDL or “good”) cholesterol
Triglycerides
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Cholesterol Lowering Medications
Atorvastatin (Lipitor), Simvastatin (Zocor),
Rosuvastatin (Crestor), Fenofibrate (Lipidil)
Statins for the prevention of cardiovascular events in patients with chronic kidney disease
Latest research results
Age < 50 Age ≥ 50
GFR ≥ 60 GFR < 60
CAD
DM
Stroke
CV risk
Statin
or
Statin/Ezetimibe
Statin Statin
CKD
Dialysis Patient
Don’t STOP
Don’t START
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5. Weight Control and Exercise
Maintain healthy body weight
Body Mass Index : ratio of weight-to-height.
( BMI 18.5 -24.9 Kg/M2)
underweight (BMI less than 18.5);
normal weight (BMI 18.5 to 24.9);
overweight (BMI 25 to 29.9), and
obese (BMI 30 and over).
Waist circumference
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Abdominal obesity
Waist circumference of:
Men> 102 cm (40”)
Women >88 cm (35”)
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Exercise
Exercise
30-60 minutes of moderate intensity exercise (walking, jogging, cycling or swimming) ,4-7 days a week.
Benefits:
Combat chronic diseases eg. High BP, Type 2 diabetes
Boosts good cholesterol and decreases build up of plaque in arteries
Improve your mood & reduce stress
Helps to manage /maintain healthy weight
Strengthen your heart and lungs
Promote better sleep
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6. Stress Reduction
Identify sources of stress
Stress relief techniques: Deep breathing exercises or positive thinking.
Avoid unnecessary stress.
Alter stressful situations.
Accept things that you cannot
change.
Allow time for fun
and relaxation.
Emotional Well Being
Stages of acceptance
Denial
Anger
Bargaining
Depression
Acceptance
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7. Smoking Cessation
Why should I stop smoking?
1.To reduce the risk of developing chronic
kidney disease and kidney failure.
2.To reduce the risk of heart attack or stroke.
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Smoking Cessation Resources
Family physician
Tom Baker Cancer Centre- group classes
The Alberta Lung Association
AADAC
Web sites
Nicotine anonymous
www.nicotineanonymous.org
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8. Know Your Medications
Diabetes medication : to reduce blood sugar
Insulin : to supplement what our body makes
Oral pills: to help body make more insulin or help the body use insulin more effectively.
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8. Know Your Medications
Blood pressure medications:
ACEI/ARB (Altace/Avapro)
Beta blocker (atenolol, metoprolol)
Calcium channel blockers (eg Norvasc):
reduce BP by dilating blood vessels
Diuretics (eg Hctz, Lasix) : lower blood pressure by reducing excess fluid
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Users Beware!
Long term use of prescription or non
prescription pain relievers and arthritis
medications (Nsaids)
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Pharmacy Tips
Your Pharmacist
Know your medications and carry a current list with you
include any over-the-counter (OTC) and herbal remedies.
Take your meds as directed.
Check with your pharmacist or health care provider before starting any new meds, OTC, or herbal remedies.
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9. Know Your Lab Results
Creatinine
– Waste product of exercising muscle
– Creatinine in your blood increases as your kidney
function decreases
< 120 umoL/L (Men)
< 100 umoL(Women)
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UREA
– Waste product from the protein that you eat
– Urea increases as kidney function decreases
– 2.5-8 mmol/L
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POTASSIUM
– Mineral found in food
– Essential for nerve conduction and muscle
function
– 3.5-5.1 mmol/L
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Calcium
– Mineral required for nerve, muscle and bone
production
2.10-2.55 mmol/L
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Phosphorus
– Mineral found in food
– Elevated levels will leech calcium from the bones
– Foods high in phosphorus will be restricted
– Phosphate binders may be started
– 0.8–1.5 mmol/L
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Self management Toolbox Kidney Care Record
Physical Lifestyle Optimal Values My Records
Weight (every visit) BMI -18.5 -24.9 Kg/M2
Blood Pressure (every visit) 130/80 or less
Foot exam (once a year) -
Eye exam (once a year) -
Dental Exam (once a year) -
Pneumococcal vaccine (once) -
Influenza Vaccine (once a year) -
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Chronic Kidney Disease Toolbox
Supports:
Canadian Hypertension Society
www.hypertension.ca
Kidney Foundation of Canada
(www.kidney.ca)
Canadian Diabetes Association
(www.diabetes.ca)
Living Well with a Chronic Condition
(www.albertahealthservices.ca/livingwellcalgary.asp)
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Living Well Program
Disease Specific Education :
Diabetes Essentials, Pre-Diabetes, Gestational Diabetes,
Hypertension, Cholesterol, Chronic Lung Disease, Chronic Pain,
Falls Prevention, Food & Mood, Congestive Heart Failure.
Supervised Exercise Classes :
Easy Going, Get Going, Keep Going
Better Choices Better Health
Goal Setting, Managing Emotions, Fear & Frustration, Relaxation,
Communication, Coping with Pain/Fatigue.
Call 403- 943-2584 (9-HEALTH) to register
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In Summary: Kidney Health Self Management
Toolbox Blood Pressure Control
Blood Glucose Control
Cholesterol Management
Healthy food Choices
Weight Control and exercise
Smoking Cessation
Stress Management
Know your medication
Know your numbers
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Questions and Answers