4. • INTRODUCTION TO KIDNEY DISEASES
Diseases of the kidneys are among the most important causes of death and disability
throughout the world.In 2009, more than 26 million adults in the United States were
estimated to have chronic kidney disease,more millions of people have acute renal
failure or less severe forms of kidney dysfunction.
Severe kidney diseases can be divided into two main categories
Acute renal failure, in which the kidneys abruptly stop working entirely or almost
entirely but may eventually recover nearly normal function.
Chronic renal failure, in which there is progressive loss of function of more and
more nephrons that gradually decreases overall kidney function
5. • RENAL FAILURE
The term renal failure denotes inability of the kidneys to perform excretory function
leading to retention of nitrogenous waste products from the blood.
Acute and chronic renal failure are the two kinds of kidney failure.
End-stage renal disease (ESRD)
When a patient needs renal replacement therapy, the condition is called end-stage
renal disease (ESRD).
6. • CHRONIC RENEL FAILURE
Chronic kidney disease is a slow and gradually progressive disease that causes kidney
dysfunction. However, if one kidney stops functioning correctly, the other can carry out
normal functions.
Signs and Symptoms
Hypertension, or high blood pressure, Anemia
Edema, Fatigue (tiredness), Decreased urine output
Blood in urine, Dark urine, in some cases
Decreased mental alertness when the condition is severe
Loss of appetite
Persistent itchy skin when the disease is severe
More frequent urination, especially at night, in some cases
7. • STAGES
Stage 1: The GFR rate is higher than 90 milliliters per minute (ml/min) per 1.73
m2. This is normal kidney function,
Stage 2: The GFR rate is between 60-89 ml/min per 1.73 m2. There is mild loss of
kidney function and proteinuria.
Stage 3: The GFR rate is between 30-59 ml/min per 1.73 m2. This is a mild to severe
loss of kidney function,
Stage 4: GRF rate is between 15-29 ml/min per 1.73 m2, regardless of whether there is
evidence of kidney disease.
Stage 5: GFR rate is 15 ml/min per 1.73 m2. Renal failure has occurred. A person will
require dialysis treatment or a kidney transplant to survive.
9. CAUSES OF CKD
Diabetes mellitus type 2 (30% to 50%)
Diabetes mellitus type 1 (3.9%)
Hypertension (27.2%)
Primary glomerulonephritis (8.2%)
Chronic Tubulointerstitial nephritis (3.6%)
Hereditary or cystic diseases (3.1%)
Secondary glomerulonephritis or vasculitis (2.1%)
Plasma cell dyscrasias or neoplasm (2.1%)
Sickle Cell Nephropathy (SCN) which accounts for less than 1% of ESRD patients in
the United States.
10. • TYPES OF CKD
Pre-renal Disease
Intrinsic Renal Vascular Disease
Intrinsic Glomerular Disease (Nephritic or Nephrotic)
Intrinsic Tubular and Interstitial Disease
Post-renal (Obstructive Nephropathy)
11. • ACUTE KIDNEY FAILURE
Acute kidney failure is when your kidneys stop working suddenly. Doctors
sometimes call it acute renal failure.
Phases of Acute renal Failure
Onset phase: Kidney injury occurs.
Oliguric (anuric) phase: Urine output decreases from renal tubule damage.
Diuretic phase: The kidneys try to heal and urine output increases, but tubule
scarring and damage occur.
Recovery phase: Tubular edema resolves and renal function improves
12. SYMPTOMS AND CAUSES OF ACUTE RENEL
FAILURE
Symptoms
Peeing less than normal, Swelling in your legs, ankles, and feet, Feeling drowsy or very tired,
Shortness of breath, Itching, Joint pain, swelling, Loss of appetite, Confusion, Throwing up or
feeling like you’re going to, Chest pain or pressure, Muscle twitching, Seizures or coma ,
Stomach and back pain, Fever, Rash, Nosebleed.
Causes
An infection, Liver failure, Medications, Blood pressure medications, Heart failure,
serious burns or dehydration, Blood or fluid loss, you have a condition that’s blocking
urine from leaving your kidneys.
Medications that can directly damage kidneys, including NSAIDs like ibuprofen and
naproxen, chemotherapy, and antibiotics Glomerulonephritis.
15. • ACUTE KIDNEY FAILURE COMPLICATIONS
Fluid buildup, Chest pain
Acidic blood (metabolic acidosis), Muscle weakness
Permanent kidney damage, Death
Kidney Failure Treatment and Home Remedies:
Diet, Medications
Dialysis
End-stage renal failure:
End stage of renal failure also known as end-stage renal disease (ESRD), is the final,
permanent stage of chronic kidney disease, where kidney function has declined to the
point that the kidneys can no longer function on their own
16. • SYMPTOMS
Fatigue, drowsiness, decrease in urination or inability to urinate, dry skin, itchy skin,
headache, weight loss, nausea, bone pain, skin and nail changes and easy bruising.
Diagnosis of ESRD: Doctors can diagnose the disease with blood tests, urine tests,
kidney ultrasound, kidney biopsy, and CT scan. According to the National Center for
Chronic Disease Prevention and Health Promotion, about 30 million people, or 15% of
adults, in the U.S. are estimated to have chronic kidney disease
Effects:
Anemia in Chronic Kidney Disease (CKD)
Uremia
17. TREATMENTS
Shock Wave Lithotripsy
URS
PNCL
Dialysis:
The mechanism of hemodialysis
The mechanism of peritoneal dialysis
Basic principle involve in dialysis
19. • RENALTRANSPLANTATION IN PAKISTAN
In 1979 in Rawalpindi at Armed Forces Institute of Urology (AFIU)
‘The Transplantation of Human Tissues and Organs Ordinance 2007’
Now, there are approximately 18-19 centres in the country in public and private
sectors where renal transplantation is being performed. The largest public sector
centre for renal transplantation is Sindh Institute of Urology and Transplantation
(SIUT) founded by Prof. S. A. H Rizvi in Karachi, where more than 6200 renal
transplants have been performed after November 1986 inclusive of four cadaveric
kidney transplants harvested locally from Pakistan.
20. • RENAL TRANSPLANTAND VASCULAR ACCESS FOR
HEMODIALYSIS IN PAKISTAN
A total of 6,202 renal transplants have been done in S.I.U.T since 1986.
In Pakistan, renal transplantation is done by urologists in collaboration
with nephrology units that are attached with Urology units. Therefore, it
is important to train our urologists in renal transplant programmes as a
part of fellowship or masters, so that they can deal with surgical
complications of renal transplantation, if needed.
we can see in the future is an increase in transplant activity in Pakistan
with the use of Laparoscopic donor nephrectomy in live related
programmes and deceased organ donation programmes yet to take off.
21. SPECIALIZED KIDNEY AND UROLOGY CENTRES
IN PAKISTAN
Sindh Institute of Urology and Transplantation (SIUT),.
S.I.U.T Sukkur, a satellite center of S.I.U.T, Karachi, was established in 2009.
Balochistan Institute of Nehro-Urology, Quetta with 13 – 14 Urologists was established in the year 2015
Institute of Kidney Diseases (IKDC), Peshawar was established in 2007 under the leadership of Prof. Nasir
Orakzai
Armed Forces Institute of Urology (A.F.I.U), Rawalpindi: Provides Urology, nephrology & transplantation
facilities.
Pakistan Kidney and Liver Institute (P.K.L.I), Lahore was established by Government of Punjab
Institute of Kidney Diseases, Multan
Rawalpindi Institute of Urology and Transplantation (R.I.U.T): yet to be started in the near future.
Tayab Urudgan Hospital (Urology+Nephrology), Muzaffar Garh
Benazir Institute of Urology and transplantation, Nawabshah, Sindh.
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