Renal disorders

Kidney Function Detoxify blood Stimulate RBC production erythropoietin Regulate blood pressure and electrolyte balance renin

Renal disorders Acute renal failure Chronic renal failure

Acute Versus Chronic Acute Chronic sudden onset rapid reduction in urine output Usually reversible Chronic Progressive Not reversible 75% of function can be lost before its noticeable

75% of function can be lost before its noticeable So patients will be symptomless until late stages of renal failure..

Acute Renal Failure Pre-renal = 55% Renal parenchymal (intrinsic)= 40% Post-renal = 5-15%

Causes of ARF Pre-renal = vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure cardiac failure, liver dysfunction, or septic shock

Intrinsic Post-renal prostatic hypertrophy, cancer of the prostate or cervix, neurogenic bladder bilateral renal calculi,

Intrinsic renal failure Glolmerular causes Tubular causes –ATN by drugs Interstitial cause –acute intestitial nephritis caused by drugs Vascular causes –vasculitis

Glomerular causes An entity called glomerularnephritis It is a broad spectrum of diseases which might present in various ways Acute glomerularnephritis causing ARF commonly manifest as nephritic syndrome

Nephritic syndrome Charachterised by hematuria oliguria ,loss of renal function,edema and hypertension

Pathophysiology Inflammatoy damage to the glomerular capillary membrane ---- leakage of RBC into the glomerualr filtrate -------- Hematuria Inflammed kidnies wont function properly------- renal failure Renin- angiotensin activation ----Fluid retention -----oedema and hypertension

Post streptococcal GN After streptococcal skin infection or sore throat Immune reaction Can cause inflammation of glomeruli and acute renal failure

Symptoms of ARF Decrease urine output (70%) Edema, esp. lower extremity Heart failure Nausea, vomiting Pruritus Tachypenic Dyspnoea

Acute renal failure Can give rise to increased blood urea levels Accumulation of toxins Fluid overload Hyperkelemia …. Acidosis

Acute Renal Failure Management Identify the cause if possible Hypovolemia Toxic agents (drugs, myoglobin) Obstruction Treat reversible elements Hydrate Remove drug Relieve obstruction

Restrict fluids Monitor potassium and electrolyte levels

Hyperkalemia Symptoms Weakness Lethargy Muscle cramps Most are ASYMPTOMATIC –so should do electrolyte levels …

Chronic renal failure

Chronic Renal Failure 150–200 cases per million people = new cases each year Chronic renal failure and ESRD affect more than 2 out of 1,000 people in the U.S Mortality = 20%

Chronic Renal Failure Causes Diabetic Nephropathy Hypertension Glomerulonephritis HIV nephropathy Reflux nephropathy in children Polycystic kidney disease Kidney infections & obstructions

CRF Symptoms Malaise Weakness Fatigue Neuropathy CHF Anorexia Nausea Vomiting Seizure Constipation Peptic ulceration Diverticulosis Anemia Pruritus Jaundice Abnormal hemostasis

Acute Problems in CRF Relating to underlying disease Relating to ESRD Dialysis related problems

Problems Related to ESRD Metabolic – K/Ca Volume overload Anemia, platelet disorder, GI bleed HTN, pericarditis Peripheral neuropathy, dialysis dementia Abnormal immune function

Dialysis ½ of patients with CRF eventually require dialysis Diffuse harmful waste out of body Control BP Keep safe level of chemicals in body 2 types Hemodialysis Peritoneal dialysis

Hemodialysis 3-4 times a week Takes 2-4 hours Machine filters blood and returns it to body

Temporary Catheter

AV Fistula & Graft

Peritoneal Dialysis Abdominal lining filters blood

Dialysis Related Problems Lightheaded –give fluids Hypotension Dysrhythmias Disequilibration Syndrome At end of early sessions Confusion, tremor, seizure Due to decrease concentration of blood versus brain leading to cerebral edema

Thank you…..