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Chronic renal failure


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Define Chronic Renal Failure.
Mention the main causes of Chronic Renal Failure.
Know the signs and symptoms of renal failure.
Know the treatment options of CRF
Know new definition of CKD

Published in: Health & Medicine
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Chronic renal failure

  1. 1. Introduction: Study carried out in 2014 showing increase in patients for years in Oshakati Hospital. 268/2014 200/2013 100/2012
  2. 2. CRF
  4. 4. Suggestions • High mortality was found associated with late referral of patients , They were referred to nephrology belatedly. • Strict control of patients CRF in the Local Areas. • Monitoring by CDC doctors and Specialists in internal medicine to patients suffering from HIV positive+ CKD.
  5. 5. Objective • At the end of this session , all participants should be able to: • Define Chronic Renal Failure. • Mention the main causes of Chronic Renal Failure. • Know the signs and symptoms of renal failure. • Know the treatment options of CRF • Know new definition of CKD
  6. 6. • 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
  7. 7. View of a sagittal section can be seen
  8. 8. The Kidneys Function
  9. 9. Blood Pressure Regulation 4 mechanisms are involved – Volume control – Aldosterone effect – Renin-angiotensin-aldosterone – Renal prostaglandin
  10. 10. Erythropoietin • 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 marrow. • Erythropoietin deficiency leads to anemia in renal failure.
  11. 11. Fluids regulation Output (0,9+1,5+0,1= 2,5)
  12. 12. Diagnostic Tools for Assessing Renal Failure • Blood Tests – BUN elevated (norm 10-20) – Creatinine elevated (norm 85 - 132) – K elevated – PO4elevated – Ca decreased • Urinalysis – Specific gravity – Protein – Creatinine clearance (GFR)
  13. 13. Diagnostic Tools • Biopsy • X-Rays • Ultrasound: -Finding of small echogenic kidneys b/l (<10 cm) by US supports dx of CKD/
  14. 14. Glomerular Filtration Rate GFR • 24 hour urine for creatinine clearance • Can estimate creatinine clearance by: (140 – age) x weight (kg)} 72 x serum creatinine
  15. 15. 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;
  16. 16. Prevalence of CKD . General Populacion . Oshakati. Namibia. 36,000/2015 Stage Descrpition GRF Population 36,000 % Prevalence 1 Kidney Damage wiht normal ↑ GRF CKD > 90 ml/min 1,188 3,3 2 Kidney Damage wiht Mild GFR CKD 60 – 89 ml/min 1,080 3 3 Moderate ↓ GRF CKD 30 – 59ml/min 1,548 4,3 4 Severe ↓ GRF CKD 15 – 29 ml/min 72 0,2 5 Kidney Failure CKD < 15 ml/min 36 0,1
  17. 17. Causes of Chronic Kidney Disease • Hypertension • Diabetes • Glomerulonephritis • Cystic disorders • Developmental - Congenital • Infectious (HIV)sea • Neoplasms • Obstructive disorders • Autoimmune diseases – Lupus • Hepatorenal failure • Scleroderma • Amyloidosis • Drug toxicity
  18. 18. What happens when the kidneys don’t function Properly??
  19. 19. Manifestations of CRF Skin • Pale, grayish-bronze color • Dry scaly • Severe itching • Bruise easily • Uremic frost Central Nervous Systems • Include irritability, difficulty concentrating, insomnia. • Confused sates
  20. 20. Manifestations of CRF Fluid - Electrolyte - pH • Volume expansion and fluid overload • Metabolic Acidosis • Electrolyte Imbalances –Hyperkalemia GI Tract • Uremic fetor • Anorexia, nausea, vomiting • GI bleeding
  21. 21. Manifestations of CRF Hematologic • Anemia • Platelet dysfunction Musculoskeletal • Muscle cramps • Soft tissue calcifications • Weakness • Related to calcium phosphorous imbalances
  22. 22. Manifestations of CRF Endocrine - Metabolic • Erythropoietin production decreased • Hypothyroidism • Insulin resistance • Growth hormone decreased • Gonadal dysfunction • Parathyroid hormone and Vitamin D3 • Hyperlipidemia Heart - Lungs • Hypertension • Congestive heart failure • Pericarditis • Pulmonary edema • Pleural effusions
  23. 23. FAST FOOD
  24. 24. 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 bladder multiplies bacteria quickly.
  25. 25. 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 produces ammonia 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.
  26. 26. Lack of Medical Checks . Treat all your health problems properly and have your health checked regularly. 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 kidney problems.
  27. 27. Avoid potential medications that can hurt the kidneys • High doses or chronic uses of antiinflammatory medications like Ibuprofen (Advil, Motrin), Naproxen (Eleve), Aspirin, indomathacin, • Antibiotics e.g. gentamicin, Amikacin, Estreptomicin
  28. 28. Adolescent Health Education Programs
  30. 30. Hemodialysis (Standard Therapy 4 hours duration/3 times /wk) The treatment room
  33. 33. 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, such as: • Heart disease • Liver Disease • Malignancies • Advanced age Nephrology 18 (2013) 393–400
  34. 34. Conservative Management • 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 their family.
  35. 35. Conclusion • 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 proteinuria • In patients with CKD, AII blockers give benefit beyond BP control
  36. 36. Suggestions • The country needs of a National Prevention Program of CKD .  Prevent* Detect Treat *Despite a lot of advancement in the fields of Medicine ,still there is not Permanent cure for Kidney The Governments can not support Dialysis Therapy without National Prevention Program of CKD and a program of Kidney Transplantation.
  37. 37. I am happy that now you know more about me!!!