Download MBBS CRF Lecture PPT

INTRODUCTION.

? Kidney failure also known as renal failure is

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the partial or complete impairment of kidney

function. It result in an inability to excrete

metabolic waste products and water, and it

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contributes to disturbances of all body system.

? The term uremic syndrome and renal failure

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are used synonymously. The term uremic

syndrome describes a set of manifestations

that result from loss of renal function.

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ACUTE KIDNEY INJURY.

? Acute kidney injury is a syndrome

characterized by-

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

blood(Azotemia).

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

homeostasis.

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CHRONIC RENAL FAILURE.

? CKD is defined as abnormalities of kidney structure

or function , present for > 3 month.

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

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ETIOLOGY.

? Glomerular disease obstruction
? Diabetes Stone
? Autoimmune disease

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? Systemic infection
? Drug
? Vascular disease Cystic disease
? polycystic kidney disease.

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? Atherosclerosis
? Hypertension
? Ischemia
Leading cause of CKD.

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? Diabeticnephropathy
? Glomerulonephritis
? Hypertension
? Autosomaldominantpolycystickidneydisease
? Cysticnephropathy.

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Genetically determined abnormalities in

kidney
Immune complex deposition and

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inflammation in certain type of

glomerulonephritis.
Toxin exposure
Hyperfilteration and Hypertrophy of remaining

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nephrons.
NEPHRON-Functional unit of kidney.

? each nephron contains-

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? 1. Glomerulus- tuft of

glomerular capillaries through which large

amount of fluid filtered from the blood.

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? 2. Long tubule-
? Filtered fluid is

converted into urine on its way to pelvis of the

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kidney.

?
Function of kidney.

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

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electrolyte concentration.

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

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hormones.

? 7.Gluconeogenesis.
STAGES OF CKD.

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

GFR.

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? Stage2--
? mild reduction( GFR 60-89ml/min)
? GFR of 60 may represent 50% loss in function.
? Stage3-

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? Moderate reduction(GFR 30-59)
? Stage4-
? severe reduction( GFR 15-29)
? Stage5-
? kidney failure(GFR < 15 ml/min), End stage kidney diseae.

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UREMIA

? Those consequent to the accumulation of

toxins that normally undergo renal excretion ,

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including product of protein metabolism.

? Those consequent to the loss of other kidney

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function , such as fluid and electrolyte

homeostasis and hormone regulation.

? Progressive systemic inflammation and its

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vascular and nutritional consequences.


Pathophysiology.

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Compensatory

Adaptive

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hypertrophy of

hyperfiltration

Loss of excretory

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nephrons.

and hypertrophy

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function

Decrease

Sclerosis of

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ph,k+,nitrogenous

remaining

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waste excretion.

nephrons and total

function loss.

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? Hundreds of toxins that accumulate in renal

failure have been implicated in the uremic

syndrome.

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? These include water soluble, hydrophobic,

protein bound charged and uncharged

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compounds.

? Nitrogenous excretory product includes

guanidino compounds, urates, hippurates,

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

? Elevated BUN and creatinin.

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? GFR
? Hyperkalemia
? Hyponatremia
? Acidosis
? Hypocalcemia

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? Hyperphosphatemia
? Elevated uric acid
? Hypoproteinemia
? Normocytic normochromic anemia
? Hematuria and proteinuria(Glomerulonephritis.)

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Classification of KFT.

? 1.To screen for kidney disease.

? Complete urine analysis

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? Plasma urea and creatinine
? Plasma electrolyte

? 2.To asses renal function

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

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?
? specific gravity

? Reabsorption and secretion

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? Concentration and dilution tests

? Renal acidification.
Blood Biochemistery.

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? Two biochemical parameters are commonly

used to assess renal function.

? 1.blood urea nitrogen.

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? 2.serum creatinine.
? Insensitive marker of glomerular function.


? 1.Pre- renal azotemia-

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? shock, CHF, salt and water

depletion.

? 2.Renal azotemia--

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? impairment of renal function.
? 3.Post- renal azotemia-
? obstruction of urinary tract.
? 4. Increaed rate of production of urea-
? High protein diet.

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? Increased protein catabolism.
?
Serum creatinine.

? Creatinine is a nitrogenous waste product

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formed in muscle from creatine phosphate.

? Serum creatinine is a more specific and more

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sensitive indicator of renal function as

compared to BUN.

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? 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

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

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

? normal urinary protein excretion--

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

Tamm Horsfall glycoprotein and alpha-1-microglobulin.

? Albuminurea - always pathological.

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

blood passing through capallaries.

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? Urea, glucose, creatinine, electrolyte are freely

filtered.

? Urinary concentration of proteins depend on

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the permeability of glomerular membrane and

the reabsorptive capacity of PCT.

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? 90 % of the filtered protein are reabsorbed by

healthy kidney.
PROTEINUREA.

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

albumin pass through damaged glomeruli more

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readly than the heavier globulins--NEPHROTIC

SYNDROME.

? Tubular reabsorption- Retinal binding

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

increased.

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? Oveflow proteinurea- SMW protein are increase

in bloods, they overflow into urine.

? Bens-jones protein--Multiple myeloma.

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PROTEINUREA.

? Nephron loss proteinurea--
? occurs when

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functional nephrons are reduced GFR is

increased and remaining nephrons are

overworking.

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? Urogenic proteinurea--
? Due to inflammation

of lower urinary tract, when proteins are

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secreted into tracts.
Microalbuminurea/minimal

albuminurea/paucialbuminurea.

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? Small amount of Albumin is excreted 30-

300/day.

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? 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.

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? Increased sp.gravity----dehydration, DM.
? Decreased sp.gravity----renal failure.
? Fixed sp.gravity--1.010-ISOSTHENURIA--CRF.
? OSMOLALITY--
? Plasma osmolality 285-300

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mosm/kg.

? Osmolality is measured by osmometer and based

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on the depression of Freezing point.
PRESENTING MANISFESTATION.

? symptom and sign--
? Decreased or no urine output.

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? Flank pain
? Edema
? Hypertension
? Discolored urine-Hematuria, pus in urine.
? Anemia.

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? Weakness, Anorexia, Nausea and vomiting.
Clinical manifestation.

? Failure of kidneys to remove excess fluid may cause?
? Edema of leg, ankle, feet, face or hand.

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? Shortness of breath due to extra fluid on the lung.
? METABOLIC CHANGES--
? An increase in serum creatinine or

BUN.

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? 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

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? fluid movement into

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

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

space--ventilation perfusion mismatch- shortness of
breath--pulmonary crackles.

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Water and Electrolyte disorder.

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

HAPERKALEMIA----Palpitation--Arrthymias.

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

Fatigue,pallor.

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Complication of uremia.

Urea and other

toxin.

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Platelet

Uremic

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dysfunction

pericarditis

Increase

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........chest pain,

tendency to

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.......Ecchymosis,

pericardial

bleed..

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GI bleeding

friction rub.