Renal failure in hildren


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Renal failure in hildren

  1. 1. Renal Failure By Prakash S Siddapur Asso Professor BLDEAs Shri B M Patil Institute of Nursing Sciences, Bijapur
  2. 2. Anatomy of the Kidney
  3. 3. Physiology • What do the kidneys do? oThe kidneys are the filtering devices of blood. oThe kidneys remove waste products from metabolism such as urea, uric acid, and Creatinine by producing and secreting urine. Urine may also contain sulfate and phenol waste and excess sodium, potassium, and chloride ions. oThe kidneys help maintain homeostasis by regulating the concentration and volume of body fluids.
  4. 4. How do the kidneys work? • Blood flows into the kidneys through the renal artery and enters the glomerulus in Bowman's capsule. • In the glomerulus, the blood flow is split into fifty capillaries that have very thin walls. • The solutes in the blood are easily filtered through these walls due to the pressure gradient that exists between the blood in the capillaries and the fluid in the Bowman's capsule • The pressure gradient is controlled by the contraction or dilation of the arterioles.
  5. 5. • After passing through the afferent arteriole, the filtered blood enters the vasa recta. • Blood exits the kidneys through the renal vein. • On the other hand, the particles and fluid removed from the blood, the filtrate, and moves from the Bowman's capsule to the proximal tubule, loops of Henle, distal tubule, and collecting tubule. • Urine is formed in the collecting duct and then exits through the ureter and bladder.
  6. 6. • From the proximal tube to the collecting tubule, the filtered blood and filtrate pass very close together. The peritubular capillaries (containing the filtered blood) are actually surrounded by the tubules. • The nutrients that the body needs are reabsorbed into the blood at this point. Along with the nutrients that are reabsorbed into the blood, the balance of water and other molecules such as sodium and chloride is established by the reabsorption from the loop of Henle.
  7. 7. Renal Failure / ESRD • Renal failure is a serious medical condition affecting the kidneys. When a person suffers from renal failure, their kidneys are not functioning properly or no longer work at all. Renal failure can be a progressive disease or a temporary one depending on the cause and available treatment options. • In renal failure the kidneys undergo cellular death and are unable to filter wastes, produce urine and maintain fluid balances. This dysfunction causes a build up of toxins in the body which can affect the blood, brain and heart, as well as other complications. Renal failure is very serious and even deadly if left untreated.
  8. 8. There are two types of renal failure: acute and chronic. • Acute renal failure occurs suddenly and is usually initiated by underlying causes, for example dehydration, infection, serious injury to the kidney or the chronic use of over the counter pain medications like Tylenol (acetaminophen) or Advil (ibuprofen). Acute renal failure is often reversible with no lasting damage. • Chronic renal failure is more serious than acute renal failure because symptoms may not appear until the kidneys are extremely damaged. Chronic renal failure can be caused by other long term diseases, such as diabetes and high blood pressure. Chronic renal failure can worsen over time, especially when the problem has gone undiagnosed and treatment is delayed.
  9. 9. What are the symptoms of kidney failure? • In the beginning, kidney failure may be asymptomatic. As kidney function decreases, the symptoms are related to the inability to regulate water and electrolyte balances, to clear waste products from the body, and to promote red blood cell production. Lethargy, weakness, shortness of breath, and generalized swelling may occur. • Metabolic acidosis, or increased acidity of the body due to the inability to manufacture bicarbonate, will alter enzyme and oxygen metabolism, causing organ failure.
  10. 10. • Inability to excrete potassium and rising potassium levels in the serum (hyperkalemia) is associated with fatal heart rhythm disturbances (arrhythmias) including ventricular tachycardia and ventricular fibrillation. • Rising urea levels in the blood (uremia) can affect the function of a variety of organs ranging from the brain (encephalopathy) with alteration of thinking, to inflammation of the heart lining (pericarditis), to decreased muscle function because of low calcium levels (hypocalcaemia). • Generalized weakness may be due to anemia, a decreased red blood cell count, because lower levels of erythropoietin produced by failing kidneys do not adequately stimulate the bone marrow.
  11. 11. • As waste products build in the blood, loss of appetite, lethargy, and fatigue become apparent. This will progress to the point where mental function will decrease and coma may occur. • Because the kidneys cannot address the rising acid load in the body, breathing becomes more rapid as the lungs try to buffer the acidity by blowing off carbon dioxide. Blood pressure may rise because of the excess fluid, and this fluid can be deposited in the lungs, causing congestive heart failure.
  12. 12. How is kidney failure diagnosed? • Diagnosis of kidney failure is confirmed by blood tests measuring the buildup of waste products in the blood. • BUN, Creatinine, and GFR are routine blood tests used to measure the buildup of waste products in the blood. BUN and Creatinine become elevated, and the glomerular filtration rate (GFR) decreases. This is the rate with which blood is filtered through the kidneys and can be calculated based upon the Creatinine level, age, race, and gender.
  13. 13. • Urine tests may be done to measure the amount of protein, detect the presence of abnormal cells, or measure the concentration of electrolytes. • Abdominal ultrasound can assess the size of the kidneys and may identify whether any obstruction exists. • Biopsy of the kidney uses a thin needle that is placed through the skin into the kidney itself to get bits of tissue to examine under the microscope.
  14. 14. What is the treatment for kidney failure? Prevention is always the goal with kidney failure. Chronic diseases such as hypertension and diabetes are devastating because of the damage that they can do to kidneys and other organs. Lifelong diligence is important in keeping blood sugar and blood pressure within normal limits. Specific treatments are dependent upon the underlying diseases.
  15. 15. Diet • Since the kidneys cannot easily remove excess water, salt, or potassium, these may need to be consumed in limited quantities. Foods high in potassium include bananas, apricots, and salt substitutes. • Phosphorus is a forgotten chemical that is associated with calcium metabolism and may be elevated in the body in kidney failure. Too much phosphorus can leech calcium from the bones and cause osteoporosis and fractures. Foods with high phosphorus content include milk, cheese, nuts, and cola drinks
  16. 16. Medications • Phosphorus-lowering medications (calcium carbonate [Caltrate], calcitriol[Rocaltrol], sevelamer [Renagel]) • Red blood cell production stimulation (erythropoietin, darbepoetin [Aranesp]) • Red blood cell production (iron supplements) • Blood pressure medications • Vitamins
  17. 17. Dialysis • Hemodialysis Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess water and salt, to balance the other electrolytes in the body, and to remove waste products of metabolism. Blood is removed from the body and flows through tubing into the machine, where it passes next to a filter membrane. A specialized chemical solution (dialysate) flows on the other side of the membrane. The dialysate is formulated to draw impurities from the blood through the filter membrane. Blood and dialysate never touch in the artificial kidney machine.
  18. 18. • Peritoneal dialysis Peritoneal dialysis uses the lining of the abdominal cavity as the dialysis filter to rid the body of waste and to balance electrolyte levels. A catheter is placed in the abdominal cavity through the abdominal wall by a surgeon and is expected to remain there for the long-term. The dialysis solution is then dripped in through the catheter and left in the abdominal cavity for a few hours and then is drained out. In that time, waste products leech from the blood normally flowing through the lining of the abdomen (peritoneum).
  19. 19. Kidney transplantation • If kidney failure occurs and is non-reversible, kidney transplantation is an alternative option to dialysis. • Kidney transplants may provide better quality of life than dialysis. After one year, 95% of transplanted kidneys are still functioning and after five years the number is 80%. It seems that the longer a patient is on dialysis, the shorter the life of the transplanted kidney. • If the transplanted kidney fails, the alternative is another kidney transplant or a return to dialysis.
  20. 20. What is the prognosis for someone with kidney failure? The outlook for kidney failure depends upon the underlying condition that caused it. Kidney function may return to normal, especially if it is due to an acute obstruction and that obstruction is relieved. Other causes of decreased kidney function leading to kidney failure are due to underlying disease and occur slowly over time. Prevention is the best chance to maintain kidney function, and controlling high blood pressure and diabetes over a lifetime can decrease the potential for progressive kidney damage. Chronic kidney failure may be managed by a primary health care practitioner or a nephrologist to help monitor electrolyte and waste product levels in the bloodstream. Major abnormalities can be life- threatening, and treatment options may be limited to dialysis or transplant.