Crf ppt with explanation and details ppt

Crf ppt with explanation and details

1. Management : ARF
•Reversal of cause
•Prevention & Rx compli
vol. overload
hyponatremia
hyperkalemia
Metabolic acidosis
Hyperphosphatemia
Hypocalcemia
Hypermagnesemia
Hyperuricemia
Nutrition
Prescription -medication
•Dialysis
HD
PD
CRRT
CAVHD
CVVHD
CAVH
CVVH

2. Principles of dialysis

4. Acute Vascular access : HD

5. HD : technical aspects

6. Hemodialysis
•

7. CAVH CVVH

8. CAVHD / CVVHD

9. Acute PD
•A STIFF CATHETER
•BLIND PROCEDURE
•36 HRS
•Peritoneal membrane

11. Scope for conservative management in CKD

12. Normal Kidneys : Light Microscopy

13. CKD : Light Microscopy

14. CKD : Aetiology
Glomerulonephritis
MPGN/FSGS
MN/PICN/RPGN

Pyelonephritis
Including
reflux
nephropathy
Vasculitis
WG/PAN/micro
polyangiitis/SLE
Structural
Aplasia/
dysplasia/
obstruction/
SC injury
Diabetes Analgesic
Nephropathy
Dysprotenemias
Amyloid/MM/
cryoglobinemia/
LCD/
Interstitial
nephritis
Cystic Diseases
ADPKD/ARPKD/JN
Vascular
RAS/
scleroderma/
HUS/cholesterol
emboli
Hereditary
Alport
syn/TS/SCD
Unknown
Hypertension Metabolic
Cystinosis/
oxalosis/
nephrocalcinosis/
cystinuria/UA
Malignancy
Hypernephroma/
lymphoma
Miscellaneous
AIDS
nephropathy/GVH
D

15. CKD : common etiology
•CGN
•DM
•PN : with obstruction
•HBP
•Cystic diseases

16. Pathophysiology : CRF
•Underlying etiology progressive mechanism
irrespective of etiology
Reduction in adaptive hyperfiltration
nephron mass
vasoactive molecules
cytokines , GF
[ RAS]
compensatory hypertrophy

progressive sclerosis

ESRD

17. inter relation between structure & function

18. Functions of kidney & its pathophysiology
Function
•Salt, water , acid balance
water balance
sodium balance
potassium balance
bicarbonate balance
magnesium balance
phosphate balance
Dysfunction
•Salt, water , acid balance
fluid reten , hyponatremia
edema, CCF, HBP
hyperkalemia
met acidosis , osteodystrophy
hypermagnesemia
hyperphosphatemia, osteodystrophy

19. Functions of kidney & its pathophysiology
Function
•Excre. of nitroge. end products
urea , creatinine, uric
acids, amines, guanidine
derivatives
•Endocrine & metabolic
1 hydroxylatoin of Vit. D
Renin
Erythropoietin
Dysfunction
•Excre. of nitroge. end products
anorexia, nausea,
pruritis,pericarditis,
encephalopathy, polyneuropathy,
thrombocytopathy
cardiomyopathy
•Endocrine & metabolic
osteomalacia, osteodystrophy
hypertension
anemia

20. CRF : manifestations
Dysfunction
• Endo - Metabolic
CHO intolerance
Hyperuricemia
hyperlipidemia
accelerated atherosclerosis
PEM
impaired growth/deve
Infertility / sexual dysfunction
amenorrhea
hypothermia

•Dermatologic
• CVS /RS
•CNS
•GIT
•Hematological /
immunologic

21. ARF Vs CRF
•Prior DM / HBP / VUR / Urolithiasis / abn urine
analysis
•Nocturia / polyuria
•Uremic osteodystrophy
•Uremic polyneuropathy
•Broad casts on urine analysis
•Carbamylated Hb
•Kidney size
•Reversibility with time

22. CKD : Management
Prevention
Control acute factors
Control primary cause
Metabolic consequences
Renoprotective therapy
Establish LIFE LINE : permanent access
Dialysis HD PD
error on early dialysis than late
Kidney Transplantation : Live Cadaveric

23. CRF : Prevention
is
it
possible???

24. CRF : Conservative Therapy
Renoprotective Therapy
• GFR Rx metabolic consequences
primary Anemia Rx
cause glycemic control
BP control
lipid control proteinuria control
diet
ACEI / ARB / combination / CCB
somatostatin analogues
GH receptor antagonists
CO MORBID CONDITIONS
• ESRD

25. ESRD : Rx options
•HD home centre
•CAPD CCPD
•Kidney transplantation

26. Vascular access ; AVF : primary failure 30 to 40 %
3 Yr survival 80 %

27. Vascular access ; graft
half life > 1 yr 3 yr 47 %

28. Vascular access ; perm cath
Compli. of various vascular access : leading cause of hospitalization

29. Hemodialysis
•

31. Complications of Hemodialysis
Fever : bacteremia, water borne pyrogens , overheated dialysate
Hypotension : excess UF, cardiac arrythmias, pericardial
tamponade, air embolus,
hemmorhage, anaphylactiod reactions
Hemolysis : chloramine , formaline,overheating of dialysate
Dementia : aluminium
Seizure : DDD, inadequate delivary of dialysate to the system
Bleeding : heparin, other anticoagulant
Muscle cramps : excessive UF

33. •

34. CAPD :
When : severe cadiac dysfuction
Difficult vascular access
as 1
st
mode

35. CCPD

36. CCPD
• cycler
• free morning

37. CAPD : adv. Over HD
 free from machine
At home
Rapid training
Less cardiovascular stress
Avoidance of heparin
No biomaterials

38. CAPD : Disadvantages
•Peritonitis
•Hyperinsulinemia
•Hyperglycemia
•Hyperlipidemia
•If blind : dependent
•Higher mortality than
HD
•Non compliance
•Expensive
•Twice hospitali.
Compared to non DM
•Malnutrion

39. DM ESRD : inferior survival on RRT
LKT , Cadaveric , Dialysis

40. Kidney Transplantation