PPT-Spectrum of Metabolic Bone Diseases in CKD:

Pathogenesis Clinical Significance and Diagnosis Tiffani R Garrett Renal Grand Rounds March 6 th 2012 Learning ObjectivesRelevant Questions Function of bone Review normal bone remodeling. Josh Exley. Learning Objectives. Acute Kidney Injury. Drugs and the Kidney. Chronic Kidney Disease. Normal Kidney function. Kidney Functions. Excretory function. Filter metabolites, toxins, drugs. Homeostatic function. Metformin must be considered the cornerstone of treatment when not contraindicated (eGFR <30). In patients not at goal on metformin monotherapy, adding an SGLT. 2. inhibitor like empagliflozin is warranted when not contraindicated (eGFR <45). ( ) CVD benefit ?Class effect?. the. OPG/RANKL system on . bone. . strength. . in. . growing. . rats. . with. . experimental. . chronic. . renal. . failure. Znorko. B.1, Oksztulska-Kolanek E.1, Domaniewski T.1, . Roszczenko. 1 Table 1.1 Distribution of NHANES participants with diabetes, self-reported cardiovascular disease, & single sample markers of CKD, 2007-2012. Data Source: National Health and Nutrition Examination Survey (NHANES), 1988–1994, 1999-2004 & 2005–2012 participants age 20 & older. Note: Cardiovascular disease designation is based on self-report of any CVD condition (see CKD Analytical Methods chapter for detail); CKD is defined as eGFR <60 or ACR ≥30. Abbreviations: ACR, urine albumin/creatinine ratio; CKD, chronic kidney disease; SR CVD, self-reported cardiovascular disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; . not applicable.. Learning Objectives. Utilize appropriate screening tools, such as GFR and ACR, in order to diagnose and monitor CKD patients.. Classify CKD, based on GFR and albuminuria categories, in order to guide appropriate treatment. . Data Source: National Health and Nutrition Examination Survey (NHANES), 1988–1994, 1999-2004 & 2007–2012 participants aged 20 & older. Whisker lines indicate 95% confidence intervals. Abbreviations: CKD, chronic kidney disease. This graphic also appears as Figure 1.2. Chapter 1: CKD in the General Population 2017 Annual Data Report Volume 1: Chronic Kidney Disease 2 Table A Kidney Disease Outcomes and Quality Improvement (KDOQI) CKD Staging Guidelines CKD Stage Description Classification of bone diseases. . It is not easy to classify bone diseases, since many of them are of unknown etiology or . their nature . is poorly understood. .. . Hereditary. 1. . Cheurbism. (fibro-osseous lesion).. KDIGO Guideline Co-Chairs:. Alfred K. Cheung, MD. Johannes F.E. Mann, MD. Guideline: . Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3S):S1–S87. In general , metabolic bone disease affects the skeleton in one of two ways : there is either too much or too little calcified bone .The latter change , which comprises the majority of metabolic bone disease , is due either to decrease in the amount of bone formed , or to excessive resorption of bone. In turn this may be due to a variety of causes but most commonly to abnormalities of vitamin D and calcium metabolism , which in turn arise from abnormality of diet or renal function , endocrine abnormalities ( particularly of the parathyroid gland) , drug therapy or poisoning .. In CKD and HD patients dysfunction of . immu. ne . sy. stem . a. lterations. . belonge. to . . involv. ing. . i. nnate. and . a. daptive. . i. mmunity. in T and B lymphocytes (. Reduced . T regulatory cells and memory cells and increased innate cells). . Narender Goel et al.. Middletown Medical PC,. Montefiore Medical Center & Albert Einstein College of . Medicine, New York. 4th International Conference on Nephrology & Therapeutics. September . A 2023 Presidential Advisory From the AHA. Definition of . Cardiovascular-Kidney-Metabolic Syndrome (CKM). A systemic disorder characterized by pathophysiologic interactions among metabolic risk factors, chronic kidney disease, and the cardiovascular system, leading to multi-organ dysfunction and a high rate of adverse cardiovascular outcomes.. Kidney Specialists, Inc.. National Kidney Foundation of Central Ohio. Board of Advisors. Medical Advisory Board. Goals of this talk:. Teach providers how to evaluate CKD patients in their office, to start the diagnostic and treatment plan.