Chronic renal failure

Physiology

1. CHRONIC RENAL FAILURE NUR IZZATUL NAJWA BINTI SHARUPUDDIN 082015100036

2. LEARNING OBJECTIVE AT THE END OF THIS SEMINAR, STUDENTS SHOULD BE ABLE TO : DEFINE CHRONIC RENAL FAILURE EXPLAIN THE STAGES OF CHRONIC RENAL FAILURE EXPLAIN THE VICIOUS CYCLE AND ETIOLOGY OF CHRONIC RENAL FAILURE DESCRIBE PATHOPHYSIOLOGY and CLINICAL MANIFESTATION OF CHRONIC RENAL FAILURE LIST THE DIAGNOSIS and TREATMENT OF CHRONIC RENAL FAILURE

3. DEFINITION Progressive and irreversible loss of large numbers of functioning nephrons Decline of kidney function for 3 months or more Serious clinical symptom < 70 – 75 % End- stage renal disease Chronic Kidney Disease stage 6 ( CKD 6 ) A state where renal replacement is needed

4. HIGH RISK FOR DEATH!

5. DEFINITION

6. STAGES

7. VICIOUS CYCLE

8. ETIOLOGY Diabetes Mellitus Hypertension Glomerulonephritis Polycystic kidney disease Obstruction due to tumour Unknown

9. CLINICAL MANIFESTATION May disrupt all the kidney functions: Alterations in fluids and electrolyte Metabolic acidosis Anaemia Complication of uremia

10. PATHOPHYSIOLOGY SODIUM & WATER RETENTION SHORTNESS OF BREATH GENRALIZED EDEMA SWELLING PULMONARY EDEMA AND LOSS OF AIR SPACE VENTILATION – PERFUSION MISMATCH FLUID ACCUMULATION LOSS OF GFR

11. INABILITY TO SECRETE POTASSIUM IN THE URINE HYPERKALEMIA PALPITATION, ARRYHTMIAS ALTERATION OF FLUID AND ELECTROLYTE

12. LEAN OF BODY MASS IMPAIRED HYDROGEN SECRETION FROM BODY PROTEIN – ENERGY MALNUTRITION LOSS WEIGHT FATIGUE, PALLOR ANAEMIA LOSS OF ERYTHROPIOETIN RELEASE METABOLIC ACIDOSIS ANAEMIA

13. COMPLICATIONS OF UREMIA HIGH CONCENTRATION OF NONPROTEIN NITROGENS - UREA, CREATININE, URIC ACID UREMIA- INDUCES PLATELET DYSFUNCTION CHEST PAIN, MALAISE INCREASE TENDENCY G I BLEED AND ECCHYMOSIS UREMIC ENCEPHALOPATHY UREMIC PERICARDITIS HEADACHES, CONFUSION, COMA

14. DIAGNOSIS Blood test Creatinine , urea Urine test Dipstick, 24 hours urinary protein Microscopic examination, RBC/ Pus cell/ cast Microalbuminemia , morning sample, use strip Imaging test Structure and size of kidney Kidney biopsy

15. TREATMENT Treatment options vary, depending on the cause . High blood pressure medications.   angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers Medications to lower cholesterol levels . Statins ; atrovastatin , lovastatin, rosuvastatin Medications to treat anemia .   supplements of the hormone erythropoietin, sometimes with added iron. Lower protein diet Dialysis Kidney transplant

16. SUMMARY

17. REFERENCE GUYTON & HALL TEXTBOOK OF MEDICAL PHYSIOLOGY, 12 TH EDITION ; CHAPTER 84, Applied Physiology Of The Renal System