RENAL FAILURE. reduction in the renal function.

RENAL FAILURE.

1. . Renal failure Renal failure 23-Sep-24 PRESENTED BY MUTEGEKI ADOLF KSHS

2. DEFINITION Renal Failure refers to the condition in which the kidneys lose their ability to adequately filter waste products from the blood, regulate fluid and electrolyte balance, and maintain blood pressure. It can be classified into two main types: acute renal failure (ARF) and chronic renal failure (CRF) .

3. Acute Renal Failure (ARF) occurs suddenly and is usually reversible. Chronic Renal Failure (CRF) develops gradually over months or years and is often irreversible.

4. 1.Acute Renal Failure ARF is an acute and potentially reversible irritability of the kidneys to perform their normal functions to maintain homeostasis.

5. ACUTE RENAL FAILURE (ARF) CAUSES : Prerenal causes : Reduced blood flow to the kidneys due to dehydration, heart failure, shock, or severe blood loss. Intrinsic (renal) causes : Direct damage to the kidneys from conditions such as acute tubular necrosis, glomerulonephritis, toxins, or drugs (e.g., NSAIDs, antibiotics). Postrenal causes : Obstruction of the urinary tract (e.g., kidney stones, tumors, prostate enlargement) that prevents urine flow.

6. PHASES Initial -Renal damage is occurring, the patient may be -Asymptomatic 2. Oliguric -<1ml/kg/hr of urine -Impaired glomerular filtration -Waste cannot be remove -Uremia develops -Neurotoxicity -CCF, HTN, anemia

7. 3. Diuretic - lasts 2 weeks - cellular regeneration and healing - gradual return to normal - dehydration and electrolyte imbalance due to excess urination 4. Recovery - it takes months - if left untreated it result in fluid overload, electrolyte imbalance, uremia, coma

8. PATHOPHYSIOLOGY In renal failure, the kidneys fail to filter blood effectively, leading to: Accumulation of waste products like urea and creatinine. Imbalance of electrolytes, such as sodium, potassium, and calcium. Dysregulation of fluid volume, leading to fluid overload, edema, and hypertension. Inadequate production of hormones (e.g., erythropoietin), leading to anemia.

9. PATHOPHYSILOGY

10. CLINICAL PRESENTATIONS OF ARF Sudden reduction in urine output (oliguria) or no urine output (anuria). Fluid overload: swelling (edema) in the legs, ankles, or face. Shortness of breath. Fatigue and weakness. Nausea and vomiting. Confusion, lethargy, or seizures in severe cases.

11. DIFFERENTIAL DIAGNOSIS Other renal disorders Biventricular heart failure

12. INVESTIGATIONS Blood tests : Elevated levels of urea (BUN) and creatinine (indicative of impaired kidney function). Electrolyte imbalances (e.g., high potassium, low calcium). Complete blood count (CBC) to check for anemia. Urine tests : Urinalysis for protein, blood, or casts in urine. Urine output measurement.

13. Imaging : Ultrasound : To detect kidney size, structural abnormalities, or obstruction. CT scan/MRI : For detailed imaging of renal vasculature, masses, or stones. Biopsy : Renal biopsy may be required to determine the underlying cause, especially in glomerulonephritis. Glomerular Filtration Rate (GFR) : Estimates kidney function and helps stage chronic kidney disease.

14. MANAGEMENT Treat underlying conditions e.g. dehydration Monitor fluid input and output Daily fluid requirements = 10 ml/kg + total of losses through urine, vomitus and diarrhoea Monitor BP twice daily Daily weighing Restrict salt intake (<2 g or half teaspoonful daily )

15. Restrict potassium intake e.g. oranges, bananas, vegetables, meat, fizzy drinks Moderate protein intake Ensure adequate calories in diet, Check urine and electrolytes frequently Treat any complications (e.g. infections, hypertension, convulsions), adjusting drug dosages according to the clinical response where appropriate

16. If oliguria, furosemide IV according to response (high doses may be necessary) If no response to above general measures, worsening kidney function or anuria (urine output less than 100 ml/24 hours) Refer for specialist management including possible dialysis as soon as possible and before the patient’s ondition becomes critical

17. NOTE: Do not give any drugs which may make kidney damage worse e.g. use gentamicin with caution

18. PROGNOSIS Mortality rate of ARF is about 20 to 40% which is influenced by the cause and duration of renal failure with severity of pathological changes. Poor prognosis is related to associated sepsis, prolonged anemia, cardiac failure, hepatic failure and respiratory failure with delayed initiation of treatment.

19. CHRONIC KIDNEY DISEASE Chronic renal failure End stage renal failure

20. 2. Chronic Renal Failure It is a permanent irreversible destruction of nephron leading to severe deterioration of renal function, finally resulting to end stage renal disease.

21. ETIOLOGY Cause below 5 years of age is mostly congenital anomalies After 5 that is acquired glomerular disease, hereditary disease Glomerular disease Congenital anomalies Obstructive uropathy Miscellaneous

22. Diabetes mellitus : Leading cause due to diabetic nephropathy. Hypertension : Causes damage to blood vessels in the kidneys. Glomerulonephritis : Chronic inflammation of the kidney's filtering units (glomeruli). Polycystic kidney disease : Genetic condition causing cysts to develop in the kidneys. Prolonged use of nephrotoxic drugs (e.g., analgesics, chemotherapy agents). Obstructive uropathy : Chronic obstruction of urine flow due to stones, tumors, or prostate issues.

23. CLINICAL PRESENTATIONS OF CRF Fatigue and weakness. Loss of appetite, nausea, and vomiting. Swelling (edema) in the legs, face, or hands. High blood pressure (hypertension). Persistent itching (pruritus). Decreased urine output or frequent urination. Muscle cramps and bone pain due to calcium imbalances. Anemia leading to paleness, shortness of breath, and lethargy. Uremic symptoms in late stages, such as confusion, lethargy, and pericarditis

24. PATHOPHYSIOLOGY In the early stage of disease child remains asymptomatic. Advance renal damage will occur only in late stages. Increased numbers of nephrons are destructed at various degrees and a few remain intact but hypertrophied and functional . This leads to insufficient adjustments in fluid and electrolyte balance . As the disease progress to end stage severe reduction in number of nephrons occur and the kidney will not b able to maintain fliud and electrolyte balance . The accumulation of various substances in blood result in complications

25. Stages of Chronic Renal Failure Diminished Renal Reserve Normal BUN ( Blood Urea Nitrogen), and serum creatinine absence of symptoms 2. Renal Insufficiency GFR is about 25% of normal, BUN Creatinine levels increased 3. Renal Failure GFR <25% of normal increasing symptoms 4. ESRD (End stage Renal Disease) or Uremia GFR < 5-10% normal, creatinine clearance <5-10ml/min resulting in a cumulative effect

26. COMPLICATIONS Azotemia (Uremia) Metabolic acidosis Electrolyte imbalance CCF HTN Severe anemia Growth retardation Delayed or absent sexual maturation

27. Differential diagnosis Other causes of chronic anaemia Heart failure Protein-energy malnutrition Chronic liver disease

28. MANAGEMENT Conservative management Correction of reversible component of renal dysfunction Preservation of renal function Treatment of metabolic and psycho-social problems Optimization of growth Preparation for treatment of ESRD Treat for infection, accelerated hypertension, CCF, obstruction of urine flow - to improve renal function

29. Dietary therapy Low protein diet Severe protein restriction may produce protein calorie malnutrition Diet should consist of 100 percent RDA (Recommended Dietary Allowance) for calories Protein should be of high biological value and should comprise 6 – 10 % of all calories

30. Avoid nephrotoxic medicines, e.g. NSAIDs, celecoxibs , aminoglycosides, contrast agents Prevention of complications Anaemia : due to multiple causes. Consider iron and folic supplements. Target Hb 11-12 gr/ dL Bone mineral disease: consider adding calcium Treatment of symptoms

31. Blood pressure control: Target 130/80 mmHg ( lower in children). Use ACE inhibitors as first line antihypertensives for diabetics and patients with proteinuria, plus low salt diet In diabetics: BP control is paramount Optimal blood sugar control (HbA1C <7%) Proteinuria : Reduce using ACE inhibitors and/or ARBs ; target < 1 g/day

32. Salt restriction in patients with hypertension and fluid overload Patients with salt losing nephropathy should take a liberal amount of salt and water If the GFR falls <10ml/min/1.73m 2 , potassium intake should be restricted.(hyperkalemia may develop) Vit D is essential to raise the serum calcium and suppress parathormone secretion.

33. If fluid retention/oliguria, furosemide tablet according to response (high doses may be necessary ) Dialysis for end stage cases

34. Dialysis

35. Renal transplatation

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