1. Renal disorders

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

4. Renal disorders
Acute renal failure
Chronic renal failure

5. 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

6. 75% of function can be lost before its noticeable
So patients will be symptomless until late stages of renal failure..

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

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

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

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

12. 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

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

14. 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

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

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

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

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

19. Restrict fluids
Monitor potassium and electrolyte levels

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

21. Chronic renal failure

22. 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%

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

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

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

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

27. 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

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

29. Temporary Catheter

30. AV Fistula & Graft

31. Peritoneal Dialysis
Abdominal lining filters blood

32. 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

33. Thank you…..