CRE

1
Kidney 101
Southern Alberta Renal Program
Alberta Health Services
Presenter: Janice James RN CNeph ( C )
Nurse Clinician
Chronic kidney Disease Clinic
2
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
3
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
5
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.
6
What do kidneys do?
Removal of wastes
Maintain fluid balance
Maintain acid-base balance
Balance of minerals and electrolytes
7
Kidney produces hormones
These hormones help:
? Regulate blood pressure
? Make red blood cells
? Promote strong bones.
8
Common causes of declining kidney
function
? Diabetes:
? Uncontrolled blood sugar
? Hypertension (high blood pressure):
Prolonged high blood pressure
9
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.
10
Other causes
?Obstructions caused by:
? - kidney stones
? - tumors
? - enlarged prostate
11
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.
12
Imaging Studies
? Ultrasound
(Size and Symmetry of kidneys).
13
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.
14
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)
15
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
17
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
19
Continuous Ambulatory Peritoneal dialysis
CAPD
? Dialysis done every
day
? Each exchange takes
20-30 min.
? 4-5 manual
exchanges/day of
fluid by patient
20
Cycler Peritoneal Dialysis
? Automatic peritoneal
dialysis (APD) (CCPD)
? Automated machine
(cycler) performs
exchanges at night
while patient sleeps
21
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)
22
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
23
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
24
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
25
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
26
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
27
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
29
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
30
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
31
Diagnosing High Cholesterol
A lipoprotein profile measures:
? Total cholesterol
? Low density lipoprotein
(LDL or “bad”) cholesterol
? High density lipoprotein
(HDL or “good”) cholesterol
? Triglycerides
32
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
36
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
37
Abdominal obesity
Waist circumference of:
? Men> 102 cm (40”)
? Women >88 cm (35”)
38
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
39
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
41
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.
42
Smoking Cessation Resources
? Family physician
? Tom Baker Cancer Centre- group classes
? The Alberta Lung Association
? AADAC
? Web sites
Nicotine anonymous
www.nicotineanonymous.org
43
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.

44
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

45
Users Beware!
?Long term use of prescription or non
prescription pain relievers and arthritis
medications (Nsaids)
46
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.
47
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)
48
UREA
– Waste product from the protein that you eat
– Urea increases as kidney function decreases
– 2.5-8 mmol/L
49
POTASSIUM
– Mineral found in food
– Essential for nerve conduction and muscle
function
– 3.5-5.1 mmol/L
50
Calcium
– Mineral required for nerve, muscle and bone
production
2.10-2.55 mmol/L
51
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
52
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) -
53
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)
? NutritionResources@albertahealthservices.ca
54
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
55
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
56
Questions and Answers