Renal failure Renal failure is defined as a significant loss of renal function in both kid to the point of about 1020 of the GFR Renal failure may occure as an acute and rapidly progressing process or may present as chronic form in which there is a progressive loss of renal function ov ID: 929442
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Slide1
Renal failure
Dr.Hussein lafta
Slide2Renal failure
Renal failure is defined as a significant loss of renal function in both kid.
to
the point of about 10-20% of the GFR.
Renal failure may
occure
as an acute and rapidly progressing process or may present as chronic form in which there is a progressive loss of renal function over a many yrs.
Acute renal failure has an abrupt onset and it is potentially reversible.
Chronic renal failure progresses slowly over at least three months and can lead to permanent renal failure.
HUSSEIN LAFTA
Slide3Pathophysiology of renal failure
In renal failure there is either glomerular or tubular dysfunction
.
Glomerular dysfunction : as main function of glomeruli is
filrtration,glomerular
dysfunction lead to fall in GFR with retention of those substances usually cleared by
filteration,including
water
.
Tubular dysfunction: as the main function of tubules is reabsorption, tubular failure result in the voiding large volume of dilute urine {polyuria} of low specific gravity ,along with electrolytes and nutrients.
HUSSEIN LAFTA
Slide4Acute renal failure
Sudden decrease in renal function.
ARF may be pre-renal ,intra-renal or post-renal in nature . ARF is often reversible so long as permanent injury to the kid. has not occurred.
Clincal
features
-oliguria{ reduced urine output}.
-
possilble
odema
and fluid retention.
-elevated blood urea and serum creatinine.
-alteration in serum
eletrolytes
.
-poor appetite.
-
heamaturea
HUSSEIN LAFTA
Slide5Causes of ARF.
Pre-renal failure
-result from impaired or reduced blood flow to the kidney.
e.g. shock ,sever
hypotention,anaphylaxis
,sever heart ischemia (extensive MI).
Intra-renal failure
-result from acute damage to renal structures.
-possible causes:
Acute
GN,PN.,acute
tubular necrosis{ATN},or damage of the kid. From exposure to
toxins,solvents,drugs
and heavy
meatals
.
ATN is the most common cause of acute renal failure.
HUSSEIN LAFTA
Slide6Acute renal failure
Post renal failure
- result from condition block of urine outflow
e.g
stone,
tumours,prostatic
hypertrophy.
Dx
-
Hx
,
-Ex,
Lab
investigationwhich
include :
-Blood
urea,serum
creatinine,Hb
.
U.Sof
the
kid.help
to determine whether the kid. Problem is acute or chronic.
Renal biopsy.
C.T scan
HUSSEIN LAFTA
Slide7Treatment of acute renal failure
Try to correct the cause .
e.g
volume
correction,stop
nephrotoxic agents or relief the obstruction.
Correction of fluid and electrolyte imbalances.
Dialysis which may employed while the kid. In recovery phase .
Low
prottien
,high carbohydrate diet to minimize the formation of nitrogenous wastes products.
HUSSEIN LAFTA
Slide8Chronic renal failure
CRF result of progressive kid. Damage and loss of function. CRF is often classified into four stages according to the degree GFR loss.
- diminished renal reserve ( GFR------35-50% OF normal).
-renal insufficiency-------GFR -----20-35%.
-renal failure -----------GFR less than 20%.
-end stage renal disease ---- GFR less than 5%.
HUSSEIN LAFTA
Slide9Cuases of CRF.
Chronic G.N.
Chronic P.N.
Prolong obstruction.
Exposure to toxic
chemical,toxins
or drugs.
D.M
Hypertention
.
Nephrosclerosis
.
Alport
syndrome {
inherted
disorder include
deafness,progressive
kid. Damage and eye defect.}
HUSSEIN LAFTA
Slide10Clinical feature of CRF
Aneamia,increase
level of phosphate in blood .
Malaise .
Dry skin.
Poor appetite
Vomiting.
Bone pain
Metallic taste in mouth.
HUSSEIN LAFTA
Slide11Treatment of CRF
Correction of fluid and electrolytes.
Prodent
use diuretics.
Careful
dietery
mangment
(restriction of protein intake).
Correction of anemia by periodic use of synthetic
erythropoitin
.
Renal dialysis (
heamodialysis
or peritoneal dialysis).
Renal transplant.
HUSSEIN LAFTA
Slide12heamoldialysis
It is medical procedure to
remve
fluids and waste products from
blood and to correct electrolytes imbalance.
Done using
heamodialysis
machineand
dialyzer also called artificial kid.
Hussein
lafta
Slide13Indication for HD
Acidosis------ PH < 7.1
Electrolytes imbalance -----k>6.5mg/ dl
GFR < 10 ml/min.
Overload of fluids (pulmonary
oedema
)
uramic
symptoms(increase level of nitrogenous waste products)
Hussein
lafta
Slide14Basics for renal transplant
kid,.
Tranplant
is the most effective therapy for end stage renal disease.
The transplanted organ can come from either a live donor or
deseased
donor.
Most
deseased
donor organs come from brain dead donor.
Non –standard criteria donor:
-expanded criteria donors.
-donation after cardiac death.
Hussein
lafta