RENAL FAILURE ,Acidisis, Anemia, Blood loss.pptx

Renal failure acute and chronic ewnal failure

1. RENAL FAILURE Dr. E. Muralinath, Dr. K.S.Pragna, Dr. C. Kalyan & Dr. P. Manjari

2. NTRODUCTION Renal failure r is associated with the failure of excretory functions of kidney. It is usually, manifested by a reduction in glomerular filtration rate (GFR). So GFR is considered as the best index regarding renal failure. Whatever it may be , a reduction in GFR is not affected much particularly the initial stages of renal failure. If 50% of the nephrons are affected, GFR reduces only by 20% to 30%. It is due to the compensatory mechanism by the unaffected nephrons. The renal failure may be either acute or chronic. Renal failure is always accompanied by other complications namely : 1. Deficiency of calcitriol (activated vitamin D) leading to reduction of calcium absorption from intestine and hypocalcemia . Deficiency of calcitriol and hypocalcemia may lead to secondary hyperparathyroidism in some patients 2. Deficiency of erythropoietin resulting in anemia 3. Disturbances in acidbase balance.

3. ACUTE RENAL FAILURE Acute renal failure is the abrupt or sudden stoppage of renal functions. It is often reversible especially within few days to few weeks. Acute renal failure may lead to sudden life-threatening reactions in the body with the requirement for emergency treatment.

4. FEATURES 1. Uremia Uremia is the condition manifested by excess accumulation of end products of protein metabolism namely urea, nitrogen and creatinine in blood. There is also storage of some toxic substances like organic acids and phenols. Common features of uremia i. Anorexia (loss of appetite) ii. Lethargy iii. Drowsiness iv. Nausea and vomiting v. Pigmentation of skin vi. Muscular twitching, tetany and convulsion vii. Confusion and mental deterioration viii. Coma.

5. 2. Acidosis Uremia leads to acidosis, which results in coma and death. 3. Edema Failure of kidney to excrete sodium and electrolytes causes an enhancement in extracellular fluid volume leading to development of edema. 4. Blood Loss Gastrointestinal bleeding accompanied by platelet dysfunction results in heavy loss of blood. 5. Anemia Since, erythropoietin is not secreted in the kidney particularly during renal failure, the production of RBC decreases leading to normocytic normochromic anemia. 6. Hyperparathyroidism Secondary hyperparathyroidism is developed because of the deficiency of calcitriol (1,25dihydroxycholecalciferol). It enhances the removal of calcium from bones resulting in osteomalacia.

6. 5. Edema due to enhanced volume of extracellular fluid (ECF) caused by retention of sodium and water 6. Hypertension within few days due to enhanced ECF volume 7. Acidosis takes place because of the retention of metabolic end products 8. Coma due to severe acidosis (if the patient is not treated in time) leading to death within 10 to 14 days.

7. CHRONIC RENAL FAILURE Chronic renal failure is the progressive, long standing and irreversible impairment of renal functions. If some of the nephrons discharge the function, the unaffected nephrons can compensate it. Whatever it may be , if more and more nephrons begin discharging the function over the months or years, the compensatory mechanism fails and chronic renal failure expands . CAUSES 1. Chronic nephritis 2. Polycystic kidney disease 3. Renal calculi (kidney stones) 4. Urethral constriction 5. Hypertension 6. Atherosclerosis 7. Tuberculosis 8. Slow poisoning by drugs or metals.

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