What is wrong in the kidney?

Managing ARF Avoid preventable causes of ARF Correct pre-renal factors Maintain urine flow Correct post-renal factors Monitor progress Watch for and treat hyperkalemia Institute dialysis Treat the underlying disease

Chronic renal failure

Chronic renal failure – clinical features Small kidney size (except with polycystic kidneys) Renal bone disease Peripheral neuropathy Normocytic anaemia

The causes of CRF

Emergencies in CRF Hyperkalemia Pericarditis Pulmonary edema Hypertensive encephalopathy Convulsions Gastrointestinal bleeding The „uremic state”

Anemia and bone disease in CRF

Management of CRF Control hypertension Avoid and correct pre-renal factors Identify and relieve superimposed obstruction Detect and treat infection Treat hyperphosphatemia, avoid hypercalcaemia Avoid nephrotoxic drugs Dietary protein restriction Kidney replacement therapy (ESRD)

Management of CRF