Download MBBS CRF Lecture PPT

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest CRF Lecture PPT


INTRODUCTION.

? Kidney failure also known as renal failure is

the partial or complete impairment of kidney

function. It result in an inability to excrete

metabolic waste products and water, and it

contributes to disturbances of all body system.

? The term uremic syndrome and renal failure

are used synonymously. The term uremic

syndrome describes a set of manifestations

that result from loss of renal function.
ACUTE KIDNEY INJURY.

? Acute kidney injury is a syndrome

characterized by-

? Sudden decline in GFR(hours to day)
? Retention of nitrogenous wastes product in

blood(Azotemia).

? Disturbance in extracellular fluid volume
? Disturbance in electrolyte and acid base

homeostasis.
CHRONIC RENAL FAILURE.

? CKD is defined as abnormalities of kidney structure

or function , present for > 3 month.

? Markers of kidney damage
? Albuminuria
? Electrolyte and other abnormalitiesdue to tubular disorder.
? GFR < 60mL/min/1.72m2 for > 3 month.
ETIOLOGY.

? Glomerular disease obstruction
? Diabetes Stone
? Autoimmune disease
? Systemic infection
? Drug
? Vascular disease Cystic disease
? polycystic kidney disease.

? Atherosclerosis
? Hypertension
? Ischemia
Leading cause of CKD.

? Diabeticnephropathy
? Glomerulonephritis
? Hypertension
? Autosomaldominantpolycystickidneydisease
? Cysticnephropathy.
Genetically determined abnormalities in

kidney
Immune complex deposition and

inflammation in certain type of

glomerulonephritis.
Toxin exposure
Hyperfilteration and Hypertrophy of remaining

nephrons.
NEPHRON-Functional unit of kidney.

? each nephron contains-
? 1. Glomerulus- tuft of

glomerular capillaries through which large

amount of fluid filtered from the blood.

? 2. Long tubule-
? Filtered fluid is

converted into urine on its way to pelvis of the

kidney.

?
Function of kidney.

? 1.Excretion of metabolic waste product.
? 2.Regulation of water and electrolyte balance.
? 3.Regulation of body fluid osmolality and

electrolyte concentration.

? 4.Regulation of arterial pressure.
? 5.Regulation of acid base balance.
? 6.Secretion, metabolism and excretion of

hormones.

? 7.Gluconeogenesis.
STAGES OF CKD.

? Stage 1--
? GFR> 90ml/min, kidney damage with normal or increase

GFR.

? Stage2--
? mild reduction( GFR 60-89ml/min)
? GFR of 60 may represent 50% loss in function.
? Stage3-
? Moderate reduction(GFR 30-59)
? Stage4-
? severe reduction( GFR 15-29)
? Stage5-
? kidney failure(GFR < 15 ml/min), End stage kidney diseae.
UREMIA

? Those consequent to the accumulation of

toxins that normally undergo renal excretion ,

including product of protein metabolism.

? Those consequent to the loss of other kidney

function , such as fluid and electrolyte

homeostasis and hormone regulation.

? Progressive systemic inflammation and its

vascular and nutritional consequences.


Pathophysiology.

Compensatory

Adaptive

hypertrophy of

hyperfiltration

Loss of excretory

nephrons.

and hypertrophy

function

Decrease

Sclerosis of

ph,k+,nitrogenous

remaining

waste excretion.

nephrons and total

function loss.
? Hundreds of toxins that accumulate in renal

failure have been implicated in the uremic

syndrome.

? These include water soluble, hydrophobic,

protein bound charged and uncharged

compounds.

? Nitrogenous excretory product includes

guanidino compounds, urates, hippurates,

product of nucleic acid metabolism, etc....
Laboratory finding.

? Elevated BUN and creatinin.
? GFR
? Hyperkalemia
? Hyponatremia
? Acidosis
? Hypocalcemia
? Hyperphosphatemia
? Elevated uric acid
? Hypoproteinemia
? Normocytic normochromic anemia
? Hematuria and proteinuria(Glomerulonephritis.)
Classification of KFT.

? 1.To screen for kidney disease.

? Complete urine analysis
? Plasma urea and creatinine
? Plasma electrolyte

? 2.To asses renal function

? A.To assess glomerular function-
? Glomerular filteration rate- clearance test
? Glomerular permeability- proteinurea
?
? B.To assess tubular function
?
? specific gravity

? Reabsorption and secretion

? Concentration and dilution tests

? Renal acidification.
Blood Biochemistery.

? Two biochemical parameters are commonly

used to assess renal function.

? 1.blood urea nitrogen.
? 2.serum creatinine.
? Insensitive marker of glomerular function.


? 1.Pre- renal azotemia-
? shock, CHF, salt and water

depletion.

? 2.Renal azotemia--
? impairment of renal function.
? 3.Post- renal azotemia-
? obstruction of urinary tract.
? 4. Increaed rate of production of urea-
? High protein diet.
? Increased protein catabolism.
?
Serum creatinine.

? Creatinine is a nitrogenous waste product

formed in muscle from creatine phosphate.

? Serum creatinine is a more specific and more

sensitive indicator of renal function as

compared to BUN.


? Urea = BUN x (60/28). Urea = BUN x 2.14
? Normal BUN is 10-18 mg/dl.
? Increased BUN or Urea ---Azotemia.
? Azotemia--
? Retention of nitrogenous waste products

excreted by kidney. It is either due to increased protein
catabolism or impaired kidney function.
Test to assess Glomerular injury/ integrity.

? Endothelial cell-- impermeable to RBC.
? Glomerular BM ? impermeable to Albumin.

? normal urinary protein excretion--

? Less than 150 mg/24 hours. Made up of mostly albumin,

Tamm Horsfall glycoprotein and alpha-1-microglobulin.

? Albuminurea - always pathological.
? Proteinurea in urine is an indicator of leaky glomeruli.
? The glomerulus act as a selective filter of the

blood passing through capallaries.

? Urea, glucose, creatinine, electrolyte are freely

filtered.

? Urinary concentration of proteins depend on

the permeability of glomerular membrane and

the reabsorptive capacity of PCT.

? 90 % of the filtered protein are reabsorbed by

healthy kidney.
PROTEINUREA.

? First sign of glomerular injury, before in GFR.
? Glomerular permeability- smaller molecule of

albumin pass through damaged glomeruli more

readly than the heavier globulins--NEPHROTIC

SYNDROME.

? Tubular reabsorption- Retinal binding

protein(RBP) and alpha-1- microglobulins in urine

increased.

? Oveflow proteinurea- SMW protein are increase

in bloods, they overflow into urine.

? Bens-jones protein--Multiple myeloma.
PROTEINUREA.

? Nephron loss proteinurea--
? occurs when

functional nephrons are reduced GFR is

increased and remaining nephrons are

overworking.

? Urogenic proteinurea--
? Due to inflammation

of lower urinary tract, when proteins are

secreted into tracts.
Microalbuminurea/minimal

albuminurea/paucialbuminurea.

? Small amount of Albumin is excreted 30-

300/day.

? Early indicator of nephroppathy.
? Is an indicator of future renal failure.
? It ia expressed as albumin-creatinine ratio.
? Simplest test.
? Index of concentrating ability of tubules.
? Increased sp.gravity----dehydration, DM.
? Decreased sp.gravity----renal failure.
? Fixed sp.gravity--1.010-ISOSTHENURIA--CRF.
? OSMOLALITY--
? Plasma osmolality 285-300

mosm/kg.

? Osmolality is measured by osmometer and based

on the depression of Freezing point.
PRESENTING MANISFESTATION.

? symptom and sign--
? Decreased or no urine output.
? Flank pain
? Edema
? Hypertension
? Discolored urine-Hematuria, pus in urine.
? Anemia.
? Weakness, Anorexia, Nausea and vomiting.
Clinical manifestation.

? Failure of kidneys to remove excess fluid may cause?
? Edema of leg, ankle, feet, face or hand.
? Shortness of breath due to extra fluid on the lung.
? METABOLIC CHANGES--
? An increase in serum creatinine or

BUN.

? High level of urea in the blood , which can result in
? Vomiting or diarrhoea leads to dehydration.
? Azotemia and ultimately uremia.
? Sodium and water retention
? fluid movement into

extravascular space---edema in lower extremity--
swelling--generalized edema.

? Fluid accumulation----
? pulmonary edema and loss of

space--ventilation perfusion mismatch- shortness of
breath--pulmonary crackles.
Water and Electrolyte disorder.

? Kidney damage--inability to secrete potasium in the urine----

HAPERKALEMIA----Palpitation--Arrthymias.

? ANEMIA--
? Loss of Erythropoitin release--Anemia--

Fatigue,pallor.
Complication of uremia.

Urea and other

toxin.

Platelet

Uremic

dysfunction

pericarditis

Increase

........chest pain,

tendency to

.......Ecchymosis,

pericardial

bleed..

GI bleeding

friction rub.

This post was last modified on 30 November 2021