Renal failure is a medical condition at which the kidneys are functioning at less than 15% of the normal. Two main classifications Acute renal failure or Acute kidney injury (AKI) Chronic renal failure or Chronic kidney disease (CKD)

1. RENAL FAILURE
PRESENTERS
DR. WANYAMA RONALD STEPHEN

2. Definition;
Renal failure is a medical condition at which
the kidneys are functioning at less than 15% of
the normal.
Two main classifications
1. Acute renal failure or Acute kidney injury
(AKI)
2. Chronic renal failure or Chronic kidney
disease (CKD)

3. ACUTE RENAL FAILURE (ARF OR AKI)
•AKI aka Acute renal failure (ARF) is an abrupt
deterioration in parenchymal renal function
resulting in the inability to excrete metabolic
wastes and maintain proper fluid & electrolyte
balance
•It is usually associated with oliguria. although
urine output may be normal or increased
•BUN & creatinine values are elevated
•Reversible over a period of days or weeks

4. • ARF may occur in 3 clinical settings:
• There are many causes of AKI and its frequently multi
factorial often classified into 3 subtypes
• As an adaptive response to severe volume depletion
and hypotension, with structurally and functionally
intact nephrons (Prerenal)
• In response to cytotoxic or ischemic insults to the
kidney, with structural and functional damage
(Intrinsic or Intrarenal)
• Obstruction to the passage of urine (Postrenal)
Pathophysiology

5. Clinical Presentation:
may also have none of these signs
– Oliguria (<400ml/m2 BSA)
– Oedema
– Pulmonary oedema
– Uremic encephalopathy
– Hypertension
– Arrhythmias
– Seizures, ALC, coma
– Signs of underlying cause

6. Investigations
OUrinalysis
OCBC
OBUN and creatinine
OElectrolytes
OAbdominal UUS etc.
Management
OSupportive
OSpecific

7. Chronic Renal Failure
• Also known as End-Stage Renal Failure (ESRF),
is a longstanding (more than 3 months)
progressive deterioration in renal function in
which the body’s ability to maintain metabolic
and fluid and electrolyte balance fails, resulting
in uremia (retention of urea and other
nitrogenous wastes in the blood).
• decreased kidney glomerular filtration rate
(GFR) of <60 mL/min/1.73 m2 for 3 or more
months

8. • As renal function declines, the end products of protein metabolism (which
are normally excreted in the urine), accumulate in the blood. Uremia
develops and adversely effects every system in the body.
• The greater the buildup of waste products, the more severe the symptoms.
• Approximately 1 million nephrons are present in each kidney, each
contributing to the total GFR. Regardless of the etiology of renal injury, with
progressive destruction of nephrons, the kidney has an innate ability to
maintain GFR by hyperfiltration and compensatory hypertrophy of the
remaining healthy nephrons.
• This nephron adaptability allows for continued normal clearance of plasma
solutes such that substances such as urea and creatinine start to show
significant increases in plasma levels only after total GFR has decreased to
50%, when the renal reserve has been exhausted. The plasma creatinine
value will double with a 50% reduction in GFR.
Pathophysiology

9. Stages of Chronic Renal Disease
Stage 1: Reduced
Renal Reserve
Characterized by a
40%-75% loss of
nephron funtion.
The patient is
usually
asymptomatic
because the
remaining
nephrons are able
to carry out normal
function of the
kidney
Stage 2: Renal
Insufficiency
 Occurs when 75%-
90% of nephron
function is lost. At
this point, the serum
creatinine and BUN
rise, the kidney loses
its ability to
concentrate urine and
anemia develops. The
patient may report
polyuria and nocturia
Stage 3: End-Stage Renal
Disease
 The final stage, occurs when
there is less than 10% of
nephron function remaining.
All normal regulatory,
excretory, and hormonal
functions of the kidneys are
severely impaired. ESRD is
evidenced by elevated
creatinine and BUN levels
as well as electrolyte
imbalances.
 Dialysis is usually indicated
at this point.

10. Hypertension
Diabetes
Renal artery stenosis
Glomerular diseases
Systemic inflammatory
diseases e.g SLE
Interstitial diseases
Congenital and inherited
e.g polycystic kidney
disease
HIV
Drug intoxication
Progression of AKI
Common causes
O Increased blood pressure
O Smoking
O Increased proteinuria
O Decreased HDL
O Alcohol intake
O Poorly managed DM
O Obesity
O Chronic use of NSAIDS
O Old age etc.
Risk factors

11. Increased blood urea and
creatinine
Hypertension
Proteinuria
Edema
Easy fatigability
Vomiting
Loss of appetite
Confusion
Clinical assessment

12. Staging of CKD according to
estimated GFR
O Urea and creatinine
O Urinalysis and quantification of
proteinuria
O CBC
O Electrolytes- for K+ and acidosis
O Calcium, phosphate & parathyroid
hormone- to asses renal
osteodystrophy
O Renal ultrasound
O Hepatitis and HIV serology
Investigations

13. Management of
stages 1-3 of CKD
Pts will not develop ESRD in
these stages
But those with proteinuria,
microalbuminemia & GFR
<50ml/min are at increased
cardiovascular risk.
Therefore Do;
Blood pressure control
Use ACEi & ARB in those
with proteinuria
Lipid management and
give lifestyle advice
Management of
progressive and stage 4+
CKD
OIdentify the underlying renal
disease where possible
OIdentify reversible factors
and correct them
OPrevent further renal
damage
OAddress any associated
cardiovascular risk diseases
OInstitute renal replacement
therapy- dialysis,

14. OAnemia- reduced production
of Erythropoietin
OHyperkalemia
OHyperphosphatemia
OHypocalcemia
OMetabolic acidosis
OLow vit D 1,25
OEdema
OUremia
Complications of CKD
Questions?
Thank you for listening.