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Renal Failure

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Renal Failure

  1. 1. Ben Savage
  2. 2.  Acute ◦ Causes ◦ Investigation ◦ Management ◦ Hyperkalaemia  Chronic ◦ Cause ◦ Staging ◦ Management
  3. 3.  Significant reduction in renal failure in hours or days.  Maybe no symptoms, oliguria is common (<400ml/24hrs)  Biochemically detected by increasing Urea & Creatinine.  Can occur in isolation but usually secondary to other pathology.  Pre Renal and acute tubular necrosis account for 80% of acute renal failure.
  4. 4.  Systemic cause that reduce perfusion of the kidney ◦ Hypovolemia ◦ Sepsis ◦ Post Surgery ◦ Shock ◦ Hepatic Failure ◦ Drugs – NSAIDs, ACEi ◦ Renal artery/vein occlusion
  5. 5.  Acute Tubular Necrosis  Glomerulonephritis  Nephrotoxic drugs ◦ NSAIDs, Gentamicin  Rabdomyolysis  Interstitial nephritis  Myeloma  Haemolytic Uremic Syndrome
  6. 6.  Stones  Fibrosis  Cancer ◦ Prostate, Cervix ◦ Bladder, Ureters  BPH
  7. 7.  Urine Dip  Bloods  ECG  Imaging relative to history
  8. 8.  Rapid diagnosis and appropriate treatment of underlying pathology crucial.  Crucial empirical management ◦ Oxygenation ◦ Ensure adequate circulation – fluids, blood ◦ Treatment of any hyperkalaemia ◦ Dialysis if indicated
  9. 9.  Indications for immediate dialysis ◦ Pulmonary oedema ◦ Potassium >6.5mM ◦ Acidosis pH<7.2 ◦ Pericarditis ◦ Encephalopathy
  10. 10.  Normal potassium levels 3.5 and 5.0 mmol  Treat aggressively if: ◦ Potassium >6 mmol ◦ ECG changes  ECG changes ◦ Peaked T-waves ◦ Widened QRS ◦ Small/ absent p-waves ◦ Sine wave appearance
  11. 11.  Calcium Gluconate (IV)  Insulin & Dextrose (IV)  Calcium Resonium (PO/PR )  Dialysis if indicated
  12. 12.  Causes ◦ Pre-renal ◦ Renal ◦ Post-renal  Pre Renal and acute tubular necrosis account for 80% of acute renal failure.  Rapid diagnosis and treatment of underlying pathology crucial.  Symptomatic management and empirical treatment vital.  Always be aware of hyperkalaemia
  13. 13.  Defined as kidney damage or a decreased kidney glomerular filtration rate (GFR) of less than 60 for 3 or more months  ESRD aged >65, increases mortality 6x  Usually asymptomatic in stage 1-3  CRF alter the dose of certain drugs and contraindicate others depending on the GFR
  14. 14.  Glomerular Nephritis (20%)  Interstitial nephritis & reflux nephropathy (20%)  Polycystic kidneys (10%)  Diabetes Mellitus  Renovascular disease/HTN (10%)  Obstructive/ unknown (20%)
  15. 15.  Stages: -measured using GFR 1. >90 }GFR alone not sufficient for 2. 60-89 }diagnosis of stage 1&2 3. 30-59 4. 15-29 5. <15 (ESRF)
  16. 16.  Salt & water homeostasis ◦ Fluid overload ◦ Fluid depletion  BP control ◦ HTN  Removal of uraemic toxins ◦ Uraemia  Calcium/phosphate balance ◦ Hyperphosphalipadeamia ◦ Hypocalcaemia ◦ Renal Bone disease ◦ 3ry hyperparathyroidism
  17. 17.  Erythropoietin production ◦ Anaemia  Potassium Balance ◦ Hyperkalaemia  Acid-Base balance ◦ Metabolic acidosis  Also affect immunity – increasing infections
  18. 18.  Is it truly chronic?  Treat any reversible causes or acute exacerbations  Treatment of consequences of chronic renal failure  Long term planning esp renal replacement therapy
  19. 19.  Review medication during progression of renal failure.  Symptoms can reflect failure of any the action of the kidneys.  Treat any reversible causes promptly  Plan long term therapy early
  20. 20. Any question

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