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