DR. ASMATULLAH SAPAND
A H M A D S H A H A B D A L I
I N S T U T U T E O F H I G H E R
E D U C AT I O N
D E PA R T M E N T O F
I N T E R N A L M E D I C I N E
K H O S T - A F G H A N I S TA N
DEFINITION OF CRF:
Chronic renal Failure (CRF) now called
Chronic Kidney Disease (CKD) is the
irreversible deterioration of renal function
OR when the GFR is reduced to
<60ml/min/1.73m2 for at least 3 or more
months it is called CKD or CRF.
CKD results from the loss of the following
PATHOPHYSIOLOGY OF CKD:
It circles on the following 2 conditions:
2. Uremic syndrome
• Hyperfunction of the glomerules and
• Enlargement of the glomerules and
• Overload and hypertrophy of the
• Finally fibrosis and sclerosis of the
All due to
2. Uremic Syndrome
• Accumulation of the Urea and Creatinine.
• Accumulation of other Hundreds of toxins other than
Urea and Creatinine.
• Abnormal regulation of Acid-Base balance.
• Decreased degradation, excretion and abnormal
regulation of many hormones includind PTH, FGF-23,
prolactin, steroid hormones, insulin and glucagon.
• Progressive systemic inflammation.
Clinical Features of CKD and Uremia
• In the early stages CKD is asymptomatic.
• Symptoms and Signs of Uremia are manifested with
GFR of less than 5-10ml/min/1.73m2.
• At this point, the build-up of metabolic waste products
or uremic toxins can result in uremic syndrome.