TABLE NO.2 GENERAL CLINICAL CHARACTERISTICS
• High mortality was found associated with late
referral of patients , They were referred to
• Strict control of patients CRF in the Local
• Monitoring by CDC doctors and Specialists in
internal medicine to patients suffering from
HIV positive+ CKD.
• At the end of this session , all participants
should be able to:
• Define Chronic Renal Failure.
• Mention the main causes of Chronic Renal
• Know the signs and symptoms of renal failure.
• Know the treatment options of CRF
• Know new definition of CKD
• The kidneys are a pair of brownish-red structures
located retroperitoneally (behind and outside of
peritoneal cavity) on the posterior wall of the
abdomen from the 12th thoracic vertebra to the 3rd
lumbar vertebra in the adult.
• They are measure :
-12 cm long
- 6 cm wide
- 3 cm thick
Blood Pressure Regulation
4 mechanisms are involved
– Volume control
– Aldosterone effect
– Renal prostaglandin
• Erythropoietin is produced and
released by the kidneys in
response to decreased oxygen
tension in the renal blood
supply that is created by the
loss of red blood cells.
• Erythropoietin stimulates the
production of RBCs in the bone
• Erythropoietin deficiency leads
to anemia in renal failure.
Diagnostic Tools for Assessing Renal
• Blood Tests
– BUN elevated (norm 10-20)
– Creatinine elevated (norm 85 - 132)
– K elevated
– Ca decreased
– Specific gravity
– Creatinine clearance (GFR)
-Finding of small
b/l (<10 cm) by US
supports dx of CKD/
Glomerular Filtration Rate
• 24 hour urine for creatinine clearance
• Can estimate creatinine clearance by:
(140 – age) x weight (kg)}
72 x serum creatinine
Actually already since 2004, the
international community began
using the term of CKD for
replacing the term of CRF
NKF Classification System*
Chronic Kidney Desease (CKD).
* Kidney International (2004) 67, 2089–2100;
How To Avoid Kidney DiseaseFailure
THE FOLLOWING COULD CAUSE KIDNEY DISEASE:
• Delaying going to a toilet
Keeping your urine in
your bladder for too long
is a bad idea.
• A full bladder can cause
bladder damage. The
urine that stays in the
Eating too much salt
You should eat no more than 5.8 grams
of salt daily
Eating too much meat.
Too much protein in your diet is harmful
for your kidneys. Protein digestion
Not drinking water. Our kidneys should be
hydrated properly to perform their functions well. If
we don't drink enough, the toxins can start
accumulating in the blood, as there isn't enough
fluid to drain them through the kidneys.
Lack of Medical Checks .
Treat all your health problems
properly and have your health
Stop Smoking and Stop drinking
alcohol. You can reduce the strain
on your kidneys by cutting all
alcoholic drinks out of your lifestyle.
These drinks require that your
kidneys work very hard and not
drinking them can help prevent
Avoid potential medications that can
hurt the kidneys
• High doses or chronic
uses of antiinflammatory
• Antibiotics e.g.
Conservative management in ERSD
• Conservative treatment or palliative care is an
option for patients with CKD in ESRD , but
besides the CRF have other conditions or
failure organs , that preclude their recovery,
• Heart disease
• Liver Disease
• Advanced age
Nephrology 18 (2013) 393–400
• Some people decide to have ‘conservative’
treatment (also called, palliative or supportive
care) rather than have dialysis or a transplant.
• The aim of conservative treatment is to
manage the symptoms of kidney failure
without using dialysis or transplantation.
• Conservative treatment includes medical,
emotional, social, spiritual and practical care
for both the person with kidney failure and
• Multiple risk-factor intervention strategy is
the best to adopt in patients with CKD
• Control of BP is of paramount importance in
slowing down the progression of CKD
• Control of BP is more important in slowing
the progression of CKD than control of blood
sugar in patients with type II diabetes and
• In patients with CKD, AII blockers give benefit
beyond BP control
• The country needs of a
Program of CKD .
*Despite a lot of
advancement in the fields
of Medicine ,still there is
Permanent cure for Kidney
The Governments can not
support Dialysis Therapy
Prevention Program of
CKD and a program of