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Renal failure

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Renal failure

  1. 1. RENAL INSUFFICIENY Prepared by: Minel Aşcıoğlu 220i-2a MPF-2 Azerbaijan Medical University
  2. 2. RENAL FAILURE •Renal failure is a condition in which the kidneys fail to remove metabolic end- products from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids. The cause may be renal disease, systemic disease, or urologic defects of nonrenal origin. Renal failure can occur as an acute or a chronic disorder.
  3. 3. ACUTE RENAL FAILURE • Acute renal failure represents a rapid decline in renal function sufficient to increase blood levels of nitrogenous wastes and impair fluid and electrolyte balance. The most common indicator of acute renal failure is azotemia, an accumulation of nitrogenous wastes (urea nitrogen, uric acid, and creatinine) in the blood. In acute renal failure the glomerular filtration rate (GFR) is decreased. As a result, excretion of nitrogenous wastes is reduced and fluid and electrolyte balance cannot be maintained
  4. 4. • Prerenal failure, the most common form of acute renal failure, is characterized by a decrease in renal blood flow. It is reversible if the cause of the decreased renal blood flow can be identified and corrected before kidney damage occurs. Causes of prerenal failure include depletion of vascular volume (hemorrhage), impaired perfusion caused by heart failure and cardiogenic shock, and decreased vascular filling because of increased vascular capacity (e.g., anaphylaxis or sepsis). The Causes Of Acute Renal Failure
  5. 5. • Intrarenal renal failure results from conditions that cause damage to structures within the kidney— glomerular, tubular, or interstitial. Injury to the tubules is most common and often is ischemic or toxic in origin. The major causes of intrarenal failure are ischemia associated with prerenal failure, toxic insult to the tubular structures of the nephron, and intratubular obstruction. Acute glomerulonephritis and acute pyelonephritis also are intrarenal causes of acute renal failure.
  6. 6. • Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter (i.e., calculi and strictures), bladder (i.e., tumors or neurogenic bladder), or urethra (i.e., prostatic hypertrophy).
  7. 7. •Initial phase: is a period, which courses from lesion of kidneys until oliguria development. It takes several hours (ischemia) up to about one week (after action nephrotoxine) •Oliguric stage: is characterized by urinary output of less than 400 ml per day, causing sudden retention of endogenous metabolites such as urea, potassium, sulfate, and creatinine that normally are excreted by the kidneys. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. If the period of oliguria is prolonged, hypertension frequently develops and with it manifestation of uremia. When untreated, the neurologic manifestations of uremia progress from neuromuscular irritability to somnolence, coma, and death . STAGES OF ARF
  8. 8. •Diuretic stage: The period during which repair of renal tissue takes place. Its usually a gradual increase in urine output and a fall in serum creatinine, indicating that the nephrons have recovered. Diuresis often occurs before renal function has fully returned to normal. BUN (blood urea nitrogen) and serum creatinine, potassium, and phosphate levels may remain elevated or continue to rise. In some cases, the diuresis may result from impaired nephron function and may cause excessive loss of water and electrolytes. • Stage of recovery: Full recovery with healing of tubular epithelial cells occurs in about half the cases. The process of healing may take up to one year with restoration of normal tubular function.
  9. 9. CHRONIC RENAL FAILURE • Chronic renal failure is a syndrome characterised by progressive and irreversible deterioration of renal function due to slow destruction of renal parenchyma, eventually terminating in death when sufficient number of nephrons have been damaged. Chronic renal failure can result from a number of conditions that cause loss of nephrons, including diabetes, hypertension, glomerulonephritis. • The symptoms of renal failure occur gradually and do not become evident until the disease is far advanced. Chronic renal failure results in progressive deterioration of glomerular filtration, tubular reabsorptive capacity, and endocrine functions of the kidneys.
  10. 10. •1. Initial stage: At this stage, damage to renal parenchyma is marginal and the kidneys remain functional. The GFR (glomerular filtration rate) is about 50% of normal, BUN (blood urea nitrogen) and creatinine values are normal and the patients are usually asymptomatic except at times of stress. •2. Stage of Polyuria: At this stage, about 75% of functional renal parenchyma has been destroyed. The GFR is about 25% of normal accompanied by elevation in BUN and serum creatinine. As nephrons are destroyed, the remaining nephrons compensate for those that are lost by filtering more solute particles from the blood. Because the solute particles are osmotically active, they cause additional water to be lost in the urine. One of the earliest symptoms of renal insufficiency is isosthenuria with urine that is almost isotonic with plasma.
  11. 11. • 3.Stage of Oliguria: At this stage, about 90% of functional renal tissue has been destroyed. The GFR is about 10% of normal. Tubular cells are essentially nonfunctional. As a result, the regulation of sodium and water is lost resulting in edema, metabolic acidosis, hypocalcaemia, and signs and symptoms of uremia.
  12. 12. • 4. Terminal Stage: The GFR at this stage is less than 5% of normal. Uremia, which means “urine in the blood,” is the term used to describe the clinical manifestations of ESRD. Uremia differs from azotemia, which merely indicates the accumulation of nitrogenous wastes in the blood and can occur without symptoms.
  13. 13. Treatment of Chronic Renal Failure: Dialysis •Hemodialysis – must go to a clinic about 3 times per week for about 4 hours •Peritoneal Dialysis – more frequent, but can be done at home. Generally better outcomes. Also: Transplantation
  14. 14. THANK YOU! Prepared by: Minel Aşcıoğlu 220i-2a MPF-2 Azerbaijan Medical University

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