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Chronic Kidney Disease (CKD) - Part 1

Duration: 29:42

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Dec 27 2020, 6:08 am

Thank you. I would love to know more about interpreting results in patients with CKD and heart failure.  Particularly urea and urea creatinine ratio. When to diurese and when to look elsewhere for causes of oedema such as lymphoedema   I find this perplexing and would love some insight.  



Dec 26 2020, 6:38 pm

Hello Carla, 

Thank you for the questions. 

1. Determine if the patient had CKD prior to their acute hear failure episode (did the CKD come first, or was it the heart failure or a combination). If the patient has acute worsening of heart failure symptoms (like edema, congestion-- then the patient will likely have venocongestion and/or hypo renal perfusion). So, after figuring out if they had chronic CKD, and their previous stage and albuminuria status, then figure out if the new changes in Cr are related to acute episode or not. 24 hr urea creatinine clearance is good to figure out a pt's gfr.  

use the calculator:

2.Once you have determined the new gfr, you will need to dose all the medications to this new gfr becasue overdosing can cause toxicity and underdosing can cause insufficiency of treatment. 

3.Rule of thumb for diuresis: if patient is volume overloaded (chest xray shows significant volume, pleural effusion; +JVD, + dilated IVC and heart strain noted on TTE or TEE; ascities; lymphedema with  open blisters, etc), then give them a dose of diuretics (or trial of 1-3 days) (ref: Koyner, Jay L., et al. "Furosemide Stress Test and Biomarkers for the Prediction of Aki Severity." Journal of the American Society of Nephrology 26 8 (2015): 2023.). IV works faster than oral. You can always try a loop or thiazide diuretic first. (good reference: The goal is to balance diuresis so that the stain on the heart diminishes and the kidney's do not get overdosed with diuretics. This goal is to help decrease the risk of becoming ventilator dependent or having significant irreversible heart failure. Unfortunately, sometimes the kidney's will get severely injured when you are managing the heart failure and giving diuretics, inwhich case you then have to turn to renal replacement therapy (dialysis) that may be acute or long term (>3 months). 

4. It is always a good idea to get a nephrologist involved in the care of a patient with heart failure/heart disease and CKD or AKI on CKD, if the patient can have access to the specialist. It is understandable if some patients may not have access to nephrologist, in which case their heart specialist or primary care doctor will be quite helpful in managing the right balance of fluid (with longterm diuretics). It is an art to balance the dose of diuretics. Normally, I advise my patients to continue their diuretics (for example lasix 20mg BID) and if they weigh themselves at home and find increased 2lbs with or without shortness of breath/leg edema, then they take an additional lasix 80mg daily until the weight and or symptoms improve (you can also add hydrochlorothiazide 25mg if you do not want to increase the lasix). Spironolactone and ACEI/ARBs are very good medications to control heart failure and CKD. However, please make sure that they do not cause side effects of hyperkalemia, dizziness/low BP, or worsening CKD. If any of these side effects happen, it could be that the dosages of ACEI/ARB/spironolactone are high and need to be stopped temporarily or decreased to the lowest dosage. 

5. Many patients who are really sick can have chronic lymphedema. So, please do check if this is the case becasue giving diuretics or extra diuretics in these patients will worsen kidney function. Lymphedema can be checked using US of LE, a negative TTE or TEE (meaning no heart failure on tests), and hx of LE blisters/poor wound healing.   

Hope this helps!



Nov 23 2020, 6:59 pm

This is the 1st Dr. Been video I've watched and I thought it was well-presented in terms I could grasp.  I really liked some of the graphics used.  Thank you!  I'm looking forward to PartII.



Dr. Anam Tariq presents chronic kidney disease (CKD.) In the part one she discusses the following topics:

  • Definition of CKD
  • Stages of CKD
  • Biomarkers of CKD, their uses and their limitations
  • Albuminuria and cardiovascular disease
  • Prognosis of CKD by GFR and albuminuria (KDIGO 2012)
  • Causes of CKD
  • Predictors of progression
  • Causes of metabolic acidosis in CKD
  • Diabetes and CKD


Learning objectives of this video are the following: 

1. Definition of Chronic Kidney Disease (CKD).

2. Stages of CKD.

3. Causes 

4. Albuminuria - Biomarker use & limitations 

5. Albuminuria & cardiovascular Disease 

6. Prognosis of CKD by GFR & albuminuria categories : KIDGO 2012 

Presented by Dr. Anam Tariq

Following answers are created by ChatGPT. Occasionally the answer may be harmful, incorrect, false, misleading, incomplete, or limited in knowledge of world. Please contact your doctor for all healthcare decisions. Also, double check the answer provided by the AI below.

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Dr. Anam Tariq

Dr. Anam Tariq

Internist, Nephrologist

Dr. Anam Tariq is a nephrologist in Baltimore, Maryland. She received her medical degree from Edward Via Virginia College of Osteopathic Medicine and has been in practice between 11-20 years. Dr. Anam Tariq accepts Blue Cross, United Healthcare. She has also traveled to Honduras and Dominican Republic on medical relief trips, delivering medications to free health clinics, performing first aid, serving as first responder and teaching hygiene practices. Her volunteer work has been recognized nationally and she has been awarded the Presidential award from George W. Bush for the recognition of devoted service through national organizations, such as the Veterans Affairs and the American Osteopathic Association.

Renal System

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