Human Body Anatomy Vector Images' title='Human Body Anatomy Vector Images' />Vector Free Free Vector Graphics. Vector Free is a vector art gallery of free to use vector images, graphics, symbols, icons, buttons, logos, clip art, cartoons, silhouettes, characters, patterns, brushes and backgrounds. Download the vectors for free in Illustrator vector format and use them for your digital art, graphic design and illustration projects. More about Vector. Chronic Kidney Disease. Cs Chemdraw Drawing Object. Chronic kidney disease CKD is an important source of long term morbidity and mortality. It has been estimated that CKD affects more than 2. United States. Given that most patients are asymptomatic until the disease has significantly progressed, they remain unaware of the condition. EJQJ5-Mc2ZznaG5RXo_XcC9swMBCgrWcxrfhqR1I5M=' alt='Human Body Anatomy Vector' title='Human Body Anatomy Vector' />The brain. The body. The bedroom. How much do you know about sex, love, and the human body Yahoo Lifestyle is your source for style, beauty, and wellness, including health, inspiring stories, and the latest fashion trends. Thus, it is essential to have clinical practice guidelines aimed at early detection, evaluation, diagnosis, and treatment of this condition. This chapter reviews the medical management of patients with CKD, emphasizing measures aimed at slowing disease progression and treatment of its common complications. Methods used for estimating the level of renal function are presented elsewhere in this section Kidney Function Assessment Creatinine Based Estimation Equations. Definition and staging. Im still doing my best to answer everybody. Sometimes I get backlogged, sometimes my Email crashes, and sometimes my literature search software crashes. This information resource of the Maryland State Archives is presented here for fair use in the public domain. When this material is used, in whole or in part, proper. Chronic Kidney Disease Online Medical Reference from definition and diagnosis through risk factors and treatments. Coauthored by Martin E. Lascano, Martin J. CKD is an irreversible, progressive reduction in renal function. The National Kidney Foundations Kidney Disease Outcomes Quality Initiative KDOQI guidelines define CKD as sustained kidney damage indicated by the presence of structural or functional abnormalities e. GFR to less than 6. Lmin1. 7. 3 m. 2 for at least 3 months. Based on GFR estimation, the National Kidney Foundation has classified CKD into five stages Table 1. Table 1 Stages of Chronic Kidney Disease and Clinical Action Plans. Stage. Description. GFR m. Lmin1. 7. Action. Plan. 1Kidney damage with normal or elevated GFR9. Diagnosis, treatment of underlyingcondition and comorbidities, cardiovasculardisease risk reduction. Kidney damage with mildly decreased GFR6. Estimating progression. Moderately decreased GFR3. Evaluating and treating complications. Severely decreased GFR1. Preparation for renal replacement therapy. Kidney failure ESRDlt 1. Replacement therapy dialysis or transplantationESRD, end stage renal disease GFR, glomerular filtration rate. Adapted from the National Kidney Foundation KDOQI Clinical practice guidelines for chronic kidney disease Evaluation, classification, and stratification. Am J Kidney Dis 2. S1 S2. 66. In addition to GFR estimation, the evaluation of all patients with suspected or confirmed CKD should include a urinalysis, with testing for proteinuria. In addition to being a marker of kidney damage, proteinuria is a strong predictor of increased risk of cardiovascular morbidity and mortality in patients with or without CKD. To quantify the level of proteinuria, rather than using a 2. Urinary ratios are also useful for monitoring changes in the degree of proteinuria in CKD patients. Back to Top. Evaluation and treatment. Once the presence of CKD and the disease stage have been established, the KDOQI recommends following a stage specific clinical action plan see Table 1. During stages 1 and 2, the focus should be on treating comorbid conditions, addressing reduction of cardiovascular risk factors. During these early stages, aggressive blood pressure control is the mainstay of therapy. In stage 3, in addition to continuing with the measures described, the focus shifts to evaluating and treating complications of CKD, such as anemia and the effects of abnormal mineral metabolism on bone and overall health. By stage 4, preparations for renal replacement therapy dialysis, transplantation, or both should begin. When stage 5 is reached, or when symptoms of the uremic syndrome ensue, renal replacement therapy is started. Back to Top. Slowing disease progression. Given the progressive nature of most forms of CKD, with a continued decrease in the GFR over time, it is important to address factors known to contribute to loss of renal function. Primary renoprotective strategies for limiting the progression of CKD are presented in Table 2. Table 2 Renoprotective Strategies for Slowing Progression of Chronic Kidney Disease. Parameter. Goal. Intervention. Cyber Surfer Game. Blood pressure control mm Hglt 1. ACE inhibitors, ARBs, sodium, restriction, diuretics. Reduction in proteinurialt 0. ACE inhibitors, ARBs. Glycemic control. Hgb. A1clt 7Dietary counseling, oral hypoglycemic agents, insulin. Dietary protein restriction. Dietary counseling. Lipid lowering. LDL lt 1. LDietary counseling, statins. Lifestyle modifications. Smoking cessation, achieving ideal body weight, regularly exercising. Counseling, exercise program. ACE, angiotensin converting enzyme ARB, angiotensin receptor blocker LDL, low density lipoprotein. Hypertension. The progression of CKD is strongly linked to hypertension control. Descargar Bloques Para Autocad 2006 here. A number of studies have shown that for diabetic and nondiabetic kidney disease, elevated blood pressure is associated with a faster decline in GFR. The Modification of Diet in Renal Disease MDRD study has shown that control of hypertension is even more important in patients with proteinuria higher than 1 gday, because lowering blood pressure to a target of 1. Hg in these patients achieves a greater decrease in the rate of decline of GFR than in patients with less proteinuria. For patients with proteinuria higher than 3 gday, the impact of blood pressure lowering was even greater. The MDRD study also showed that hypertensive African Americans have faster progression of CKD compared with their white counterparts. However, reduction of blood pressure to lower than 1. Hg reduced the rate of decline by 5. The Ramipril Efficacy in Nephropathy REIN trial followed nondiabetic renal disease patients with proteinuria higher than 1 gday. It demonstrated that patients being treated with an angiotensin converting enzyme ACE inhibitor have more effective preservation of renal function at similar levels of blood pressure reduction. This effect was most profound in those patients with the highest levels of baseline proteinuria. In the African American study of kidney disease AASK, metoprolol, amlodipine, and ramipril were compared as first line drugs in patients with nondiabetic nephropathy. Blood pressure control was similar among the three groups. However, only in the patients treated with ramipril were there significant reductions in rates of renal disease progression and in composite end points 2. These combined results support the hypothesis that reduction in systemic hypertension slows or prevents progression of proteinuric and nonproteinuric renal disease. Studies have shown that even treating isolated systolic hypertension in older patients slows the progression of CKD. Most classes of antihypertensive medication can be used to treat patients with CKD because many of these trials required additional drugs to achieve their goals. However, it has also been shown that at similar degrees of blood pressure control, ACE inhibitors are more protective, particularly in proteinuric disease. In patients who cannot tolerate ACE inhibitors, an angiotensin receptor blocker ARB may reasonably be prescribed. In spite of these observations, the therapeutic goal of reducing the blood pressure to target, regardless of agent used, should not be sacrificed. It is worth noting that CKD may alter some of the pharmacologic characteristics of multiple medications, including the antihypertensive medications. However, specific pharmacologic information is beyond the scope of this chapter. Proteinuria. Microalbuminuria and proteinuria are well recognized prognostic factors for the development and progression of CKD. The MDRD study has shown that severe proteinuria 3 gday is associated with a higher rate of decline in GFR. Other studies have shown that this holds true for the glomerular and nonglomerular forms of CKD.