GOOD

CHRONIC RENAL FAILURE (CRF)

Etiology Of Chronic Renal Failure

Diabetes mellitus
IDDM NIDDM

Hypertension Chronic glomerulonephritis Cystic diseases of the kidney Obstructive uropathy and other rare causes

Stages Of Chronic Renal Failure

Decreased kidney reserve Renal insufficiency (impairment) Chronic renal failure (CRF) End stage renal disease (ESRD)

Acute Vs. Chronic Renal Failure

Previous tests Family history Onset Creatinine rise Hb, Albumin Kidney size Ultrasound

ACUTE Normal Negative Abrupt Daily Normal? Normal? Lucent

CHRONIC Azotemia Positive? Indolent Monthly May be low Small? Dense

Large Kidneys In CRF

Diabetes mellitus
ADPKD

Amyloidosis
Multiple myeloma

Obstructive uropathy

The Uremic Syndrome

Pathogenesis: Retention of toxins (urea, polyamins,
guanidines, myoinositol, B2-microglobulin) Deficiencies (erythropoietin, vit D3, sex hormones) Excess (PTH, prolactin, GH) Extracellular (acidosis, Ca, Po4, K, Mg) Intracellular (Ca, Na, Na-K-ATPase)

The Uremic Syndrome

Cardiovascular system Pericarditis Arrhythmias Cardiomyopathy Hypertension Accelerated atherosclerosis

The Uremic Syndrome

Nervous system Polyneuritis, mononeuritis Motor weakness Insomnia Irritability Tremors Stupor, coma, seizures

The Uremic Syndrome

Immunologic system
Neoplasia

Infections
Burnout immune system

The Uremic Syndrome

Gastrointestinal system Anorexia Nausea, vomiting Gastritis Peptic ulcer disease GI bleeding Pancreatitis

The Uremic Syndrome

Hematologic system Anemia
Normochromic Hemolysis Erythropoietin GI

normocytic

bleeding dysfunction

Bleeding
Platelets Heparin

The Uremic Syndrome

Endocrine system
Impotence, infertility, menstrual irregularities

Hypogonadism
Growth retardation

Insulin resistance

Management Of CRF
Control the rate of progression of renal failure
Treatment Dietary

of HTN of proteinuria

protein and phosphate restriction

Reduction Treat

hyperlipidemia

Avoid further damage to the kidneys Manage the individual complications of uremia

Indications for Chronic HD

Uncontrolled fluid and electrolyte
abnormalities
Hyperkalemia Metabolic

acidosis Fluid overload (pulmonary edema)

Uncontrolled uremic symptoms and signs

Anorexia, Malaise Uremic

nausea, vomiting

pericarditis Uremic encephalopathy, motor and worsening sensory neuropathy

Renal Osteodystrophy
Ostitis fibrosa cystica
Osteomalacia Aplastic bone disease Mixed

Hemodialysis
Indications Vascular access Principles Anticoagulation Varieties Adequacy Complications

Outcome Of ESRD Therapy

Mortality and survival
Morbidity and hospitalization Quality of life Rehabilitation

Complications Of CRF
Fluid, electrolytes, and acid-base
Volume

overload or depletion Water overload or depletion Hyperkalemia Hypocalcemia Hyperphosphatemia Hypermagnesemia Metabolic acidosis

Complications Of CRF
Metabolism and organ function
Hypertension,

pericarditis Renal osteodystrophy Anemia and coagulopathy Hyperlipidemia Uremic neuropathy and enchephalopathy Sexual dysfunction Dermatological disorders Psychological disorders

Peritoneal Dialysis
Access Indications Principles Varieties Adequacy Complications

Transplantation
Indications and contraindications Selection of recipient Selection of donor Principles Varieties Immunosupression Complications

Fluid & Lytes Balance In CRF

Volume Sodium Potassium Calcium Phosphorus Magnesium

Drugs & Dosing in CRF

Bioavailability & pharmacokinitics Volume of distribution Drug half life Loading and maintenance dose Adjustment of dose Drug levels Drug-drug interactions

Causes Of Acute On Top Of Chronic Renal Failure

Dehydration Nephrotoxicity Uncontrolled HTN Obstruction Sepsis

Management Of ESRD
Conservative Dialysis
Hemodialysis

Peritoneal

dialysis

Transplantation
Life

donor Cadaveric Compined kidney and pancreatic transplantation

Immunosupression In Renal Transplantation

Induction Maintenance Treatment of rejection