The document discusses a study conducted in 2014 on chronic renal failure (CRF) at Oshakati Hospital, emphasizing the rising patient numbers and associated high mortality due to late referrals. It details the kidney's functions, diagnostic tools, causes of chronic kidney disease (CKD), and potential treatment options, including conservative management and dialysis. The conclusion advocates for a national CKD prevention program to manage and treat the disease effectively.

2. Introduction:
Study carried out in 2014 showing increase in patients
for years in Oshakati Hospital.
268/2014
200/2013
100/2012

3. CRF

4. TABLE NO.2 GENERAL CLINICAL CHARACTERISTICS
Año 2014

5. 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.

7. 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

9. • 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

12. View of a sagittal section can be seen

14. The Kidneys Function

15. Blood Pressure Regulation
4 mechanisms are involved
– Volume control
– Aldosterone effect
– Renin-angiotensin-aldosterone
– Renal prostaglandin

16. 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.

17. Fluids regulation
Output
(0,9+1,5+0,1= 2,5)

18. 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)

19. Diagnostic Tools
• Biopsy
• X-Rays
• Ultrasound:
-Finding of small
echogenic kidneys
b/l (<10 cm) by US
supports dx of CKD/

20. Glomerular Filtration Rate
GFR
• 24 hour urine for creatinine clearance
• Can estimate creatinine clearance by:
(140 – age) x weight (kg)}
72 x serum creatinine

22. 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;

27. 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

28. 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

30. What happens when the kidneys
don’t function Properly??

31. 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

32. 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

33. Manifestations of CRF
Hematologic
• Anemia
• Platelet dysfunction
Musculoskeletal
• Muscle cramps
• Soft tissue
calcifications
• Weakness
• Related to calcium
phosphorous
imbalances

34. 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

35. FAST FOOD

36. 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.

38. 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.

39. 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.

40. 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

41. Adolescent Health Education Programs

42. CHRONIC RENAL
FAILURE (ESRD)

43. Hemodialysis
(Standard Therapy 4 hours duration/3 times /wk)
The treatment room

44. KIDNEY THERAPY
PERITONEAL DALISIS

45. KIDNEY TRANSPLANTATION

46. 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

47. 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.

48. 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

49. 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.

50. I am happy that
now you know
more about
me!!!