Normal gfr = 120ml/min

Serum Creatinine is 68 micromol/L

GFR depends on number of nephrons and renal blood flow – donors lose one kidney, slight
compensation, so gfr is 70-80% of normal

Creatinine hardly changes if a kidney is lost???

Creatinine is variable based on muscle mass, age, protein intake,

Loss of GFR causes exponential increase in serum creatinine. Mild GFR loss doesn’t affect creatinine,
but in the low levels of GFR a small GFR decrease produces a huge serum creatinine increase. This is
why “GFR of >60” is listed instead of exact numbers.

CKD: decrease of kidney function for >3 months, or if eGFR is <60ml/min

Dialysis is only given when eGFR is less than 15, so stage 5 CKD. You need 10% of kidney function to
stay alive.

Causes: diabetes, chronic GN, renovascular disease, chronic TIN/pyelonephritis, APKD, obstructive
uropathy, hypertension (more severe in black population due to gene conferring resistance to
triptomoriasis?/sleeping disease that has other effect of increasing risk of hypertensive damage)

Symptoms of CKD:

Tiredness, fatigue due to anaemia, pruritis, nocturia (in early), oedema, restless leg syndrome,
cramp, anorexia, nausea, proteinuria, signs of anaemia, late stages (dyspnoea, oedema, confusion),

Signs of CKD:

Increased respiratory rate (due to oedema, anaemia, metabolic acidosis) – Kussmaul breathing,
pallor, scratch makrs, fluid overload, pericardial rub (indication for dialysis).

Most of the time, no symptoms and no signs.

Anaemia is due to lower production of EPO. EPO rescues precursor cells from bone marrow. EPO
level is normally regulated by kidney by monitoring oxygen levels. I.e. smokers have higher levels of
EPO, so higher Hb (polycythemic), so do Tibetans.

Give recombinant EPO to fix this.

Vitamin D is from plant (ergocalciferol) or animal (cholecalciferol). These both enter liver,
hydroxylated, then again in the kidney to form 1,25-dihydroxy vitamin D – short half life, but active.
Increases Ca uptake in gut, Increases PTH-mediated bone resorption, decreases Ca excretion in the
urine.

I.e. no vitamin D mean low serum Ca.

Symptoms of low Ca:

Paraesthesia, tingling around the mouth, ear, nose.

Signs of low Ca:

Trousseau’s and chvostek’s sign. Body reacts by releasing PTH, which increases osteoclast activity
(secondary hyperparathyroidism). However, the PTH levels remains high, which leads to
tertiary hyperparathyroidism, which is bad – bone thins, hyper Ca. Leads to calciphylaxis –
they all die.