1. Chronic renal failure

2. Chronic renal failure
A progressive, irreversible deterioration in renal function resulting in the accumulation of urea and other nitrogenous wastes in the body. The disease process progresses until many nephrons are destroyed and replaced by scar tissues. Although there are many different causes of CRF, the end result is a systemic disease involving every body organ.

3. CAUSES Glomerulonephritis Drug induced nephropathy
Renal vascular disease
chronic pyelonephritis DM
SLE
Hypertension
obstructive post renal diseases e.g. calculi
Polycystic kidney disease
hyperthyroidism
Infections

4. PATHOPHYSIOLOGY
Chronic renal failure progresses until many nephrons are destroyed and replaced by scar tissue. Up to 80% of the GFR may be lost with few overt changes in body function. As renal function declines, the end products of protein metabolism accumulate in the blood. Uraemia develops and adversely affects every system in the body. The greater the waste build up, the more severe the symptoms.

5. diminished renal reserve, renal insufficiency
PATHOPHYSIOLOGY
Although there are no distinct stages in CRF, the disease progression may be divided into three well recognised stages namely:
diminished renal reserve,
renal insufficiency
end stage renal failure or uraemia.

6. Diminished or Reduced Renal Reserve
Is characterised by a 40-75% loss of nephron function.
usually a normal BUN and the absence of signs and symptoms because
the remaining nephrons are able to carry out the normal functions of the kidney.

7. About 75-90% loss of nephron function.
renal insufficiency
About 75-90% loss of nephron function.
the patient enters the phase in which renal compensation can no longer maintain homeostasis and symptoms become apparent.
Filtration is impaired and there is loss of tubular ability to vary the composition and volume of urine according to need to conserve or eliminate urinary solutes and water.
serum creatinine and the BUN rise, and anaemia develops.

8. esrd
Final stage of CRF, occurs when there is less than 10% nephron function remaining. All the normal functions of the kidney are severely impaired. There is elevated creatinine and BUN levels as well as electrolyte imbalances. Uraemia develops.

9. CLINICAL MANIFESTATIONS
Urinary system:
Polyuria
Nocturia
Fixed urine specific gravity of 1.010
Oliguria and later anuria
The urine may contain protein, casts, pus, and blood

10. CLINICAL MANIFESTATIONS
Metabolic disturbances
Azotemia: Elevated BUN and Cr levels
Oedema
Hyperkalemia
Hypophosphatemia
Hypocalcaemia
Acidosis
Hyperuricaemia

11. CLINICAL MANIFESTATIONS
Cardiovascular GI
Hypertension
Anorexia
CCF
Nausea and vomiting
Pericarditis
Hiccups
Cardiomyopathies
Uremic fetor
Pericardial effusion
GI bleeding
Pulmonary oedema
Stomatitis
Peptic ulcer

12. CLINICAL MANIFESTATIONS
Neurological
Seizures
Lethargy
Fatigue
Headache
Muscular irritability
Coma
Sleep disturbance
Irritability
Altered consciousness

13. CLINICAL FEATURES CONT’D
Pulmonary
Pruritus
Ecchymoses
Dyspnoea
Dry scaly skin
Uremic lung
Pulmonary oedema
Uremic skin color
Calcium deposits in the muscles
Depressed cough reflex
Integumentary
Pallor
Pigmented changes

14. CLINICAL MANIFESTATIONS
Endocrine
Haematological
Hyperparathyroidism
Anaemia
Thyroid abnormalities
Bleeding
Amenorrhoea
Infections
Infertility
Psychological
Sexual dysfunction
Denial
Hyperglycaemia
Anxiety
Depression
Psychosis

15. CLINICAL FEATURES CONT’D
Musculoskeletal
 Others
Osteodystrophy [renal rickets] characterised by osteomalacia and osteoporosis
Hypertensive retinopathy
Paraesthesias
Motor weakness
Carbohydrate intolerance
Bone pain
Hyperlipidaemia
Increased risk for spontaneous fractures
Nutritional deficiencies
Gouty arthritis

16. MANAGEMENT
Treatment of underlying cause to retard the progression of the disease. [e.g. hypertension, pyelonephritis]
Dietary management:
decreased protein intake, limited to only essential amino acids.
Increased carbohydrate intake to provide adequate calorie intake and prevent protein catabolism.
Low fat diet.
Decreased sodium intake if there is oedema or hypertension.
Low potassium and low sodium diet.
High vitamin diets.

17. Management of Hyperkalaemia Fluid restriction Medications:
Diuretics
antihypertensive medications, e.g. ACE inhibitors;
Dialysis
Kidney transplant