1. Chronic renal failure and common accompanying diseases Hradec Králové, November 2007 © by Adrian Franke

2. Etiology can be found in every age  highly depending on educational, social and hence nutritional status is either acquired or inherited occurs with higher probabilities in certain diseases (e.g. diabetes mellitus, arteriosclerosis, arterial hypertonia, viral diseases) occurs with higher probabilities in older people

3. Definition we speak of a chronic kidney disease, if there is either: 1.proteinuria or microalbuminuria 2.or a kidney function of less than 60% of normal 3.or a pathological alteration of the kidneys 4.and if this situation if present for more than 3 months

4. Measurement of kidney function achieved by measurement of creatinin (metabolic waste product) concentration in the blood (physiological: 50 – 120 µmol/L) estimation of glomerular filtration rate (GFR) by usage of a formula  creatinin clearance (= rate of expulsion from the body) creatinin clearance = concentration of creatinin in the urine * volume of urine concentration of creatinin in the plasma * time creatinin

5. 5 stadia after KDOQI = renal disease outcomes quality initiative based on the ultra-filtration rate of the glomeruli in the kidney StadiumGFRwith proteinuriawithout proteinuria 1> 89renal disease with normal functionnormal finding 260 – 89 renal disease with mild renal insufficiency mild renal insufficiency, but no renal disease 330 – 59renal disease with moderate renal insufficiency 415 – 29renal disease with heavy renal insufficiency 5< 15chronic renal failure

6. http://www.unckidneycenter.org/kcpp/index.htm

7. Role of the kidney  removal of metabolic waste products water balance electrolyte balance acid-base balance removal of medications and toxic substances release of hormones: –renin (blood pressure) –erythropoietin (eryhtropoiesis) –Vitamin D3 (metabolism of the bones)

8. diseases occurring with renal insufficiency  diseases leading to renal insufficiency

9. Percentual distribution of diagnoses at the beginning of renal substitution therapy Year199619971999200020012002200320042005 diabetes mellitus II2429303132 333132 nephrosklerosis1416 151718202223 glomerulonephritis1615141514 1213 interstitial nephritis1311 1099888 unknown genesis119109 9998 cystic kidneys666665554 systemic diseases444434444 various443444444 diabetes mellitus I766544333 congenital diseases111111111

11. terminal renal insufficiency & treatment possibilities 1.hemodialysis 2.peritoneal dialysis 3.transplantation

12. 1. hemodialysis

13. 2. peritoneal dialysis  cannot be applied indefinitely due to sclerosis of the endothelium

14. 3. transplantation

15. prevention of renal insufficiency healthy nutrition in combination with exercise balanced blood pressure balanced diabetes (treatment with insulin) sufficient water intake (approx. 2L of water a day)  in all cases prevention is the better way to go for rather than acute treatment

16. economical aspects of renal insufficiency 60.000 people in Germany need to go to dialysis (94% hemodialysis, 6% peritoneal dialysis) treatment of a patient costs cca 50.000 – 60.000€ per year a transplantation surgery costs cca. 30.000€ and the costs for sustaining the transplant within the patient cca. 20.000 – 25.000€ a year  costs of transplant would already be amortized after one year waiting list: 12.000 – 15.000 patients  3.000 patients are receiving a draft organ

17. sneak peek into the future health prevention subject at school optimization of dialysis treatment –reusage of dialysators –more adequate solutions for peritoneal dialysis optimization of transplantation –living donation –optimization of legitimate principles –xenotransplantation –artificial organs produced by monoclonal stem cells

18. Sources http://de.wikipedia.org http://www.fresenius.de http://www.unckidneycenter.org/kcpp/inde x.htmhttp://www.unckidneycenter.org/kcpp/inde x.htm http://www.nephrologe.de/patient/erkranku ngen/nierenversagen/chr_nierenvers1.htmhttp://www.nephrologe.de/patient/erkranku ngen/nierenversagen/chr_nierenvers1.htm