 Chronic kidney disease is the result of repeated beatings sustained by the kidneys over the years. Hypertension and diabetes mellitus are the two most common contributors. The kidneys shrink as their functional nephrons die off one after another. CKD eventually manifests as insufficiency of all the major functions of the kidney. Fluid balance, waste excretion, acid base homeostasis, and its endocrine role. To diagnose CKD, we want to get an idea of how the kidney's million glomeruli are fairing. To do this, we measure serum creatinine, which is a waste product the kidneys are supposed to get rid of, and put it into a calculator with the patient's height and gender. We then get a value called the Estimated Glomerular Filtration Rate, or EGFR, and the units for that are mills per minute per 1.73 metres squared. This allows us to stage the disease, on our GFR-O meter here. GFR from 120 to 60 can be normal, but is classed as CKD stage 1 or 2 if any of the following is present. Albuminuria, hematuria, pathological abnormality of the kidneys, or structural abnormality of the kidneys. EGFR 60 to 45 is stage 3A, 45 to 30 is stage 3B, 30 to 15 is stage 4, and below 15 is classified as stage 5, which is also known as end stage kidney disease. The rate that your glomeruli can filter, your GFR decreases as you age. They say over the age of 40, your GFR decreases at a rate of 1 ml per minute per year. So imagine you're a 52 year old single mother of 4, you get tested, and your EGFR comes back at 50. You take repeat measurements over 3 months, and if they're all in the same ballpark you know you've got CKD stage 3A. Why? Well, you're a smoker, you're a bit overweight, and it becomes apparent with some testing that you've had undiagnosed hypertension and type 2 diabetes attacking your kidneys for the last several years. And next step is to treat those underlying causes and reduce as best we can for the progression of your CKD. Now let's think about the complications of CKD you may be in for. These include cardiovascular disease, hyperkalemia, mineral bone disease, metabolic acidosis, and anemia. If we can detect these early we can treat them before they become a huge issue. So we'll check your blood regularly, so make sure the relevant levels are stable. We'll check your blood pressure, check your potassium, check your phosphate, or check your pH, your hemoglobin, and so on. As our case is displayed, kidney disease is closely linked to cardiovascular disease. Treating one, you treat the other, so the intertwined management of both will be crucial to maximizing the benefits of our treatment. And lastly, let's switch you from ibuprofen to paracetamol for your attention headaches. We don't want any nephrotoxic drugs or nephrotoxins causing your kidneys any more trouble than they're already in. And what really strikes you as strange after all this is that for all these years you didn't realize your kidneys were being damaged and that's typical of this disease. GFR can get as low as 15 ml per minute without you noticing any symptoms of CKD. So in summary, CKD may go unnoticed and undiagnosed for many years. CKD is common and its etiology multifactorial. We need to first identify CKD and then look for causes that we can reverse. Staging helps us determine the patient's prognosis. And lastly, CKD increases cardiovascular disease risk. So the management of both is tightly linked. Thanks for watching and we will see you next time.