RENAL FAILURE.pptx

Renal failure is a medical condition at which the kidneys are functioning at less than 15% of the normal.
Two main classifications
Acute renal failure or Acute kidney injury (AKI)
Chronic renal failure or Chronic kidney disease (CKD)

1. RENAL FAILURE PRESENTERS DR. WANYAMA RONALD STEPHEN

2. Definition ; Renal failure is a medical condition at which the kidneys are functioning at less than 15% of the normal. Two main classifications Acute renal failure or Acute kidney injury (AKI) Chronic renal failure or Chronic kidney disease (CKD)

3. ACUTE RENAL FAILURE (ARF OR AKI) AKI aka Acute renal failure (ARF) is an abrupt deterioration in parenchymal renal function resulting in the inability to excrete metabolic wastes and maintain proper fluid & electrolyte balance It is usually associated with oliguria. although urine output may be normal or increased BUN & creatinine values are elevated Reversible over a period of days or weeks

4. ARF may occur in 3 clinical settings: There are many causes of AKI and its frequently multi factorial often classified into 3 subtypes As an adaptive response to severe volume depletion and hypotension, with structurally and functionally intact nephrons (Prerenal) In response to cytotoxic or ischemic insults to the kidney, with structural and functional damage (Intrinsic or Intrarenal) Obstruction to the passage of urine (Postrenal) Pathophysiology

5. Clinical Presentation : may also have none of these signs Oliguria (<400ml/m 2 BSA) Oedema Pulmonary oedema Uremic encephalopathy Hypertension Arrhythmias Seizures, ALC, coma Signs of underlying cause

6. Investigations Urinalysis CBC BUN and creatinine Electrolytes Abdominal UUS etc. Management Supportive Specific

7. Chronic Renal Failure Also known as End-Stage Renal Failure (ESRF), is a longstanding (more than 3 months) progressive deterioration in renal function in which the body’s ability to maintain metabolic and fluid and electrolyte balance fails , resulting in uremia (retention of urea and other nitrogenous wastes in the blood). decreased kidney glomerular filtration rate (GFR) of <60 mL/min/1.73 m2 for 3 or more months

8. As renal function declines, the end products of protein metabolism (which are normally excreted in the urine), accumulate in the blood. Uremia develops and adversely effects every system in the body. The greater the buildup of waste products, the more severe the symptoms. Approximately 1 million nephrons are present in each kidney, each contributing to the total GFR. Regardless of the etiology of renal injury, with progressive destruction of nephrons, the kidney has an innate ability to maintain GFR by hyperfiltration and compensatory hypertrophy of the remaining healthy nephrons. This nephron adaptability allows for continued normal clearance of plasma solutes such that substances such as urea and creatinine start to show significant increases in plasma levels only after total GFR has decreased to 50%, when the renal reserve has been exhausted. The plasma creatinine value will double with a 50% reduction in GFR. Pathophysiology

9. Stages of Chronic Renal Disease Stage 1 : Reduced Renal Reserve Characterized by a 40%-75% loss of nephron funtion. The patient is usually asymptomatic because the remaining nephrons are able to carry out normal function of the kidney Stage 2 : Renal Insufficiency Occurs when 75%-90% of nephron function is lost. At this point, the serum creatinine and BUN rise, the kidney loses its ability to concentrate urine and anemia develops. The patient may report polyuria and nocturia Stage 3 : End-Stage Renal Disease The final stage, occurs when there is less than 10% of nephron function remaining. All normal regulatory, excretory, and hormonal functions of the kidneys are severely impaired. ESRD is evidenced by elevated creatinine and BUN levels as well as electrolyte imbalances. Dialysis is usually indicated at this point.

10. Hypertension Diabetes Renal artery stenosis Glomerular diseases Systemic inflammatory diseases e.g SLE Interstitial diseases Congenital and inherited e.g polycystic kidney disease HIV Drug intoxication Progression of AKI Common causes Increased blood pressure Smoking Increased proteinuria Decreased HDL Alcohol intake Poorly managed DM Obesity Chronic use of NSAIDS Old age etc. Risk factors

11. Increased blood urea and creatinine Hypertension Proteinuria Edema Easy fatigability Vomiting Loss of appetite Confusion Clinical assessment

12. Staging of CKD according to estimated GFR Urea and creatinine Urinalysis and quantification of proteinuria CBC Electrolytes- for K+ and acidosis Calcium, phosphate & parathyroid hormone - to asses renal osteodystrophy Renal ultrasound Hepatitis and HIV serology Investigations

13. Management of stages 1-3 of CKD Pts will not develop ESRD in these stages But those with proteinuria, microalbuminemia & GFR <50ml/min are at increased cardiovascular risk. Therefore Do; Blood pressure control Use ACEi & ARB in those with proteinuria Lipid management and give lifestyle advice Management of progressive and stage 4+ CKD Identify the underlying renal disease where possible Identify reversible factors and correct them Prevent further renal damage Address any associated cardiovascular risk diseases Institute renal replacement therapy- dialysis, transplantation.

14. Anemia - reduced production of Erythropoietin Hyperkalemia Hyperphosphatemia Hypocalcemia Metabolic acidosis Low vit D 1,25 Edema Uremia Complications of CKD Questions? Thank you for listening.