Ch i l f ilCh i l f ilChronic renal failureChronic renal failure
By
Dr. Balsam Mahdi Nasir
SMS3094
Genito-urinary system
DefinitionsDefinitionsDefinitionsDefinitions
UremiaUremia:
 It is a clinical syndrome associated with
fluid, electrolyt...
CHRONIC RENAL FAILURECHRONIC RENAL FAILURECHRONIC RENAL FAILURECHRONIC RENAL FAILURE
 It represents the end result of con...
Polycystic kidney diseasePolycystic kidney diseasePolycystic kidney diseasePolycystic kidney disease
EndEnd--stage kidneys due to diabetes usually retain a normal size or canstage kidneys due to diabetes usually retain a no...
EndEnd--stage kidneys due to essential hypertension (endstage kidneys due to essential hypertension (end--stagestage
nephr...
Stages of progressionStages of progressionStages of progressionStages of progression
Regardless of cause chronic renal fa...
Relation of renal function and renal massRelation of renal function and renal mass
Stages of progressionStages of progressionStages of progressionStages of progression
1 Diminished renal reserve1. Diminish...
Stages of progressionStages of progression
2 Renal insufficiency
Stages of progressionStages of progression
2. Renal insuf...
Stages of progressionStages of progression
3 Chronic renal failure
Stages of progressionStages of progression
3. Chronic r...
Stages of progressionStages of progression
4 End stage renal disease
Stages of progressionStages of progression
4.End-stag...
MorphologyMorphologyMorphologyMorphology
 Histologic findings of an end stage kidney Histologic findings of an end stage...
TwoTwo sclerosedsclerosed glomeruliglomeruli withwith
tubular atrophytubular atrophy
sclerosedsclerosed glomeruliglomeruli, chronic, chronic
inflammation, interstitial fibrosisinflammation, interstitial fibr...
Accumulation of NitrogenousAccumulation of Nitrogenous
WastesWastes
 It is an early sign of renal failure It is an early...
Water balance, sodium andWater balance, sodium and
potassium:potassium:
 Dehydration Dehydration.
 Fluid overload→ hear...
Acid base balance:Acid base balance:Acid base balance:Acid base balance:
 The kidneys normally regulate blood pH by The ...
Minerals & bone disorders:Minerals & bone disorders:Minerals & bone disorders:Minerals & bone disorders:
 Elevated serum ...
Skeletal disorders:Skeletal disorders:Skeletal disorders:Skeletal disorders:
 Renal osteodystrophy is a term used to Ren...
Hematologic disorders:Hematologic disorders:Hematologic disorders:Hematologic disorders:
 Anemia Anemia:
 In RF, erythr...
Hematologic disorders:Hematologic disorders:Hematologic disorders:Hematologic disorders:
Coagulopathies:Coagulopathies:
...
Cardiovascular disordersCardiovascular disordersCardiovascular disordersCardiovascular disorders
 Hypertension Hypertens...
GastroGastro intestinalintestinalGastroGastro--intestinalintestinal
 Anorexia Anorexia.
 Nausea.
 Vomiting
 Bleeding ...
Disorders of neural function:Disorders of neural function:Disorders of neural function:Disorders of neural function:
 Per...
Altered Immune FunctionAltered Immune FunctionAltered Immune FunctionAltered Immune Function
 Infection is a common compl...
Disorders of skin integrity:Disorders of skin integrity:Disorders of skin integrity:Disorders of skin integrity:
 The ski...
TreatmentTreatmentTreatmentTreatment
ConservativeConservative
 Dietary protein restriction
Bl d li ti Blood pressure n...
Chronic renal failure
Chronic renal failure
Chronic renal failure
Chronic renal failure
Chronic renal failure
Chronic renal failure
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Chronic renal failure

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Chronic renal failure

  1. 1. Ch i l f ilCh i l f ilChronic renal failureChronic renal failure By Dr. Balsam Mahdi Nasir SMS3094 Genito-urinary system
  2. 2. DefinitionsDefinitionsDefinitionsDefinitions UremiaUremia:  It is a clinical syndrome associated with fluid, electrolyte and metabolic abnormalities which develop withp chronic renal failure or later stages of chronic kidney disease secondary tochronic kidney disease secondary to azotemia. Li ll i i h bl d Literally means “urine in the blood”
  3. 3. CHRONIC RENAL FAILURECHRONIC RENAL FAILURECHRONIC RENAL FAILURECHRONIC RENAL FAILURE  It represents the end result of conditions It represents the end result of conditions that greatly reduce renal function by d t i l h d d idestroying renal nephrons and producing a marked decrease in (GFR) including diabetes,  hypertension hypertension,  glomerulonephritis,  and polycystic kidney disease. progressive and irreversible destruction of kidney structures
  4. 4. Polycystic kidney diseasePolycystic kidney diseasePolycystic kidney diseasePolycystic kidney disease
  5. 5. EndEnd--stage kidneys due to diabetes usually retain a normal size or canstage kidneys due to diabetes usually retain a normal size or cang y yg y y be slightly smaller, and the surface is finely granular.be slightly smaller, and the surface is finely granular.
  6. 6. EndEnd--stage kidneys due to essential hypertension (endstage kidneys due to essential hypertension (end--stagestage nephrosclerosisnephrosclerosis) are smaller than normal, firm, with a) are smaller than normal, firm, with app )) granular surface.granular surface.
  7. 7. Stages of progressionStages of progressionStages of progressionStages of progression Regardless of cause chronic renal failureRegardless of cause, chronic renal failure results in loss of renal cells with i d t i ti fprogressive deterioration of  Glomerular filtration.  Tubular reabsorptive capacity. E d i f ti f th kid Endocrine functions of the kidneys. The rate of nephron destruction differs from case to case, ranging from several months to many years.months to many years.
  8. 8. Relation of renal function and renal massRelation of renal function and renal mass
  9. 9. Stages of progressionStages of progressionStages of progressionStages of progression 1 Diminished renal reserve1. Diminished renal reserve:  GFR is about 50% of normal.  Serum BUN and creatinine values are normal, and the patients arenormal, and the patients are asymptomatic. H th tibl t However, they are more susceptible to developing azotemia with an additional renal insult.
  10. 10. Stages of progressionStages of progression 2 Renal insufficiency Stages of progressionStages of progression 2. Renal insufficiency:  GFR is 20% to 50% of normal.  Azotemia appears, usually associated with anemia and hypertension.with anemia and hypertension.  Polyuria and nocturia can occur as a lt f d d t ti bilitresult of decreased concentrating ability.  Sudden stress (e.g., with nephrotoxins)( ) may precipitate uremia.
  11. 11. Stages of progressionStages of progression 3 Chronic renal failure Stages of progressionStages of progression 3. Chronic renal failure:  GFR is less than 20% to 25% of normal.  The kidneys cannot regulate volume and solute composition, and patients developsolute composition, and patients develop edema, metabolic acidosis, and hyperkalemiahyperkalemia.  Overt uremia may ensue, with neurologic, gastrointestinal, and cardiovascular complications.p
  12. 12. Stages of progressionStages of progression 4 End stage renal disease Stages of progressionStages of progression 4.End-stage renal disease:  GFR is less than 5% of normal; this is the terminal stage of uremia.
  13. 13. MorphologyMorphologyMorphologyMorphology  Histologic findings of an end stage kidney Histologic findings of an end stage kidney disease include:  Reduction in renal capillaries.  Scarring in the glomeruli.Scarring in the glomeruli.  Atrophy and fibrosis are evident in the t b ltubules.  The mass of the kidneys usually is reduced.
  14. 14. TwoTwo sclerosedsclerosed glomeruliglomeruli withwith tubular atrophytubular atrophy
  15. 15. sclerosedsclerosed glomeruliglomeruli, chronic, chronic inflammation, interstitial fibrosisinflammation, interstitial fibrosis
  16. 16. Accumulation of NitrogenousAccumulation of Nitrogenous WastesWastes  It is an early sign of renal failure It is an early sign of renal failure.  Urea is one of the first nitrogenous wastes to be accumulatedaccumulated.  Uremia can lead to: 1. Pericarditis. 2. Gastrointestinal manifestations. 3. Skin disorders. 4 Neurologic manifestations4. Neurologic manifestations. 5. Sexual dysfunction.
  17. 17. Water balance, sodium andWater balance, sodium and potassium:potassium:  Dehydration Dehydration.  Fluid overload→ heart failure→ edema.  Salt wasting is a common problem in advanced renal failure because ofadvanced renal failure because of impaired tubular reabsorption of sodium. H k l i Hyperkalemia.
  18. 18. Acid base balance:Acid base balance:Acid base balance:Acid base balance:  The kidneys normally regulate blood pH by The kidneys normally regulate blood pH by eliminating hydrogen ions produced in metabolic processes and regeneratingmetabolic processes and regenerating bicarbonate.  This is achieved through hydrogen ion This is achieved through hydrogen ion secretion, sodium and bicarbonate reabsorption and the production of ammoniareabsorption, and the production of ammonia.  Renal failure→ metabolic acidosis  Bone buffering action→ bone resorption→ skeletal disorders.
  19. 19. Minerals & bone disorders:Minerals & bone disorders:Minerals & bone disorders:Minerals & bone disorders:  Elevated serum phosphate levels Elevated serum phosphate levels,  Decreased serum calcium levels,  Impaired renal activation of vitamin D.  Secondary hyperparathyroidism Secondary hyperparathyroidism.  Renal osteodystrophy.
  20. 20. Skeletal disorders:Skeletal disorders:Skeletal disorders:Skeletal disorders:  Renal osteodystrophy is a term used to Renal osteodystrophy is a term used to describe the skeletal complications of ESRD. S tSymptoms:  Bone tenderness.  Muscle weakness.  Proximal muscle weakness in the lower Proximal muscle weakness in the lower extremities is common, making it difficult to get out of a chair or climb stairsget out of a chair or climb stairs.  Fractures.
  21. 21. Hematologic disorders:Hematologic disorders:Hematologic disorders:Hematologic disorders:  Anemia Anemia:  In RF, erythropoietin production usually is insufficient to stimulate adequate red blood cell production by theadequate red blood cell production by the bone marrow→ anemia.
  22. 22. Hematologic disorders:Hematologic disorders:Hematologic disorders:Hematologic disorders: Coagulopathies:Coagulopathies:  Although platelets production often is normal in ESRD platelet function isnormal in ESRD, platelet function is impaired → bleeding disorders are manifested by:manifested by:  Epistaxis. M h i Menorrhagia.  Gastrointestinal bleeding.  Bruising of the skin and subcutaneous tissues.
  23. 23. Cardiovascular disordersCardiovascular disordersCardiovascular disordersCardiovascular disorders  Hypertension Hypertension.  Left ventricular hypertrophy.  Ischemic heart disease.  Congestive heart failure Congestive heart failure.  Pulmonary edema.  Cardiomyopathy.  Uremic pericarditis Uremic pericarditis.
  24. 24. GastroGastro intestinalintestinalGastroGastro--intestinalintestinal  Anorexia Anorexia.  Nausea.  Vomiting  Bleeding esophagitis Bleeding esophagitis.  Gastritis.  Colitis
  25. 25. Disorders of neural function:Disorders of neural function:Disorders of neural function:Disorders of neural function:  Peripheral neuropathy is caused by Peripheral neuropathy is caused by atrophy and demyelination of nerve fib ibl d b i t ifibers, possibly caused by uremic toxins.  Uremic encephalopathy.p p y
  26. 26. Altered Immune FunctionAltered Immune FunctionAltered Immune FunctionAltered Immune Function  Infection is a common complication and Infection is a common complication and cause of hospitalization and death of ti t ith h i l f ilpatients with chronic renal failure.  Due to high levels of urea and metabolicg wastes.
  27. 27. Disorders of skin integrity:Disorders of skin integrity:Disorders of skin integrity:Disorders of skin integrity:  The skin often is pale owing to anemia The skin often is pale owing to anemia and may have a sallow, yellow-brown hhue.  Pruritus.  Dermatitis.
  28. 28. TreatmentTreatmentTreatmentTreatment ConservativeConservative  Dietary protein restriction Bl d li ti Blood pressure normalization.  Correct the resulting anemia, hypocalcemia, and acidosis. Renal replacement therapy:p py  Dialysis.  Transplantation Transplantation.

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