Renal Failure

Renal FailureTwo typesi) Acute Renal Failure (ARF)

ii) End Stage Renal Disease (ESRD)

Acute Renal Failure

Failure of renal excretory function owing to depression of the glomerular filtration rate.

Dys function of the kidney

1) Reduced erythropoietin production

2) Reduced vitamin D Hydroxylation

3) Impaired acid-base balance

4) Impaired salt water balance

5) Impaired blood pressure maintenance

Definition

Abrupt deterioration in paren chymal renal function which is usually but not invariably reversible over a period of days or weak.

Oliguria Uraemia

ARF will cause sudden life threatening bio chemical disturbances therefore it is an medical emergency.

Types:

i) Pre renal failure

ii) Renal renal or intra renal failure

iii) Post renal failure

Pre-renal failure Due to volume reduction

i) Hypotension

ii) Massive haemorrhage

iii) Cardiac failure

iv) Vascular diseases

v) Drugs ACE inhibitors

- NSAID Investigation

Urinary specific gravityUrinary osmolalityManagement

Correct Hypovolumia

Intra Renal Failure

Due to acute renal parenchymal diseases

Eg: Acute tubular necroses ATN

Vascalitis

Hypertension

Cholesterol Embolism

Haemolytic Uraemic syndrome

Thrombotic thrombocytopaenic purpura

Pre Eclampsia

Cresentic glomerular nephritis Malignant lysis

Burns

Severe diarrhoea

Pancreatitis

Myocardial infarction

Endotoxic shock

Snake bite

Haemoglobinuria

Hepato-renal syndrome

Contrast toxicity

Drugs - Aminogly cosides

NSAID

ACE inhibitors

Eclampsia

Investigations - Urine analysis

Blood urea

Serum electrolytes

Serum creatinine

FBC

ESR

C-Reactive protein

Blood sugar level

Septic profile

Liver profile

Imaging -

X-ray abdomen

USS abdomen

CT abdomen

MRI abdomen

Management Correct underlying causes

Treat abnormal function

Eg Hyperkalaemia

-Peritoneal dialysis

-Haemo filtration

-Antibiotics if needed

Post Renal Failure -Usually surgical causes

-Renal stone/Calculi

-Tumours

-Congenital abnormalities Ix Same as intra renal failure

Management - Correct underlying cause - Surgery-Supportive management End Stage Renal Disease

Longstanding and usually progressive impairment in renal function. It is a irreversible condition.

Causes

Poly cystic kidney disease

Tubular sclerosis

Congenital obstructive uropathy

Focal Glomerular nephritis

Amyloidosis

Haemolytic uraemic syndrome

Thrombotic thrombo cyto paenic purpura

Systemic sclerosis

Hypertension

Reflux nephropathy

Mutiple myeloma

Papillary necrosis

Calculus disease

Prostatic disease

Pelvic Tumors

Schisto somiasis

Clinical featuresMalaise

Loss of energy

Loss of appetite

Insomnia

Nocturia

Polyuria

Pruritus

Nausea

Vomiting

Diarrhoea

Paresthesia

Bone pain

Anaemia

Confusion

Coma

Fits

Pallor

Lethargy

PigmentationHT

Pericarditis

Heart failure

Osteo Malarsia

Muscle weakness

Amenorrhoea

Erectile importancePoly neuropathy

Investigation

1) Urine analysis

Haematuria

Protenuria

Glycosuria

Pus cell

Cast cell

2) 24 hrs urinary creatinine clearance

3) Urinary electrolytes

4) Urinary osmolality

5) Urinary electro phoresis6) Blood urea

7) Serum electrolytes

8) Serum creatinine

9) FBC

10) Urine culture and ABST

11) Blood culture and ABSTImaging X-ray

USS abdomen

CT Abdomen

Intravenous pyelogram

Renal biopsy

Management

Control blood pressure

Correct hyperkalaemia

Correct Acidosis

Diet Protein restriction

Salt restriction

Fluid restriction

Avoid drugs - NSAID

Amino glycosides

Correct anemia

Dialysis - Peritoneal dialysis

Haemo dialysis

Kidney transplantation

Indications for dialysia

1) Uraemia

2) Pericarditis

3) Severe bio chemical derangement

4) Uncontrolled hyperkalaemia

5) Pulmonary oedema severe

6) Severe acidosis Resistant acidosis

7) For removing drugs