Topic: Chronic Renal Failure(CRF) or Chronic Kidney Disease(CKD)
Faculty: General Medicine
Course: BSc RDT - 2nd year
- Definition, Causes, Pathogenesis, Clinical Features, Diagnosis and Treatment of CRF/CKD
- Metabolic Bone Disease(Renal osteodystrophy) - short essay
- Other short answers
3. Chronic kidney disease or Chronic renal failure
Definition: gradual and irreversible decline in renal function due to
slow destruction of renal tissue
● Kidneys will be shrunken
● GFR less than 50% or <60 ml/min, for 3 months or more
4. Etiology
1, Diseases affecting glomerulus:
● Chronic glomerulonephritis
● diabetic nephropathy
2. Diseases affecting tubules and interstitium:
● Vascular: long-standing
hypertension
● Infectious: chronic pyelonephritis
● Toxic: long-term use of nephrotoxic
drugs(aspirin, paracetamol), lead
● Obstruction: tumours, kidney stones
5. Pathogenesis
1. Damage to glomerulus leads to changes in filtration, and
development of nephrotic syndrome(proteinuria, hypoalbuminemia
and oedema)
1. Damage to tubules leads to changes in reabsorption and secretion
of important substances, leading to excretion in large amounts of
dilute urine
6. Stages of CRF
5 stages, depending upon the GFR
1. Normal: GFR: 50-100%
2. Decreased renal reserve: GFR is <50%
3. Renal insufficiency: GFR: <25%
4. Renal failure: GFR: <10%
5. End-stage kidney disease: GFR: <5%
7. Clinical features
- Nocturia
- Polyuria
- Loss of appetite
- Nausea, vomiting
- Paresthesia
- Loss of libido
- Bone pain
- Pleural effusion
- Symptoms of anemia: fatigue
- Skin rash
- Seizure
- Coma
8.
9. Diagnosis of CKD
● CBC: anemia
● Urinalysis: hematuria, proteinuria
● Serum electrolytes: shows hyperkalemia
● RFT(renal function tests): increased serum urea, serum creatinine
● eGFR(estimated GFR): reduced to <50% or <60 ml/min
● USG Abdomen and Pelvis: shrunken kidneys
● Biopsy may be needed
10. Treatment
● Lifestyle modification and dietary restrictions:
● low salt diet (less than 2 g/day)
● renal diet (avoiding foods that are high in
phosphorus)
● restricting daily protein to 0.8 g per kg body weight
per day
● Potassium restriction in diet
● Stop smoking
● Reduce weight
● Avoid nephrotoxic medications
● Treatment of underlying cause
11. ● Maintenance of blood pressure:
● systolic BP <130 mmHg and diastolic BP <80
mmHg
● Antihypertensives like angiotensin-converting-
enzyme inhibitor (ACEI) or angiotensin 2 receptor
blocker (ARB)
● Diuretics
● Control blood sugar in diabetics: through diet/drug
therapy(antidiabetic drugs) - maintain HbA1C<7%
● Treatment of hypercholesterolemia: through diet/drugs such
12. ● Treatment of chronic metabolic acidosis: treated with
bicarbonate
● Hypocalcemia: treat with calcitriol and calcium
supplements
● Hyperphosphatemia: treated with phosphate binders
● Treatment of anemia: erythropoietin
● Treatment of uremia:
● Dialysis
● renal transplant
13. Short answers:
Erythropoietin(EPO):
It is a hormone produced by juxtatubular interstitial cells of renal
cortex, in response to hypoxia and anemia
Function: it increase rate of production of RBCs
In CKD, the body produces less EPO, leading to anemia
14. Treatment of anemia in CKD:
- Anemia of CKD is due to deficiency of erythropoietin(EPO)
- Treated with Recombinant Human Erythropoietin(rHuEPO)
- Given via intravenous route
- 50 U/kg of EPO-alpha over 1–5 min, three times/week
16. Phosphate binders:
They are used to treat hyperphosphatemia
E.g:
- Calcium carbonate and calcium acetate
- Polymer sevelamer carbonate
- Lanthanum carbonate
17. Vaccination in stage 4 CKD:
● Hepatitis B-recombinant
● Inactivated Hepatitis A vaccine
● Inactivated Influenza vaccine
● Pneumococcal polysaccharide vaccine
Live vaccines are AVOIDED
23. Uremic encephalopathy:
Uremic encephalopathy is a brain dysfunction caused by the
accumulation of toxins resulting from acute or chronic renal failure
Causes: CKD, AKI
Clinical features: Tiredness, drowsiness, seizure, coma
Treatment: renal replacement therapy - hemodialysis
24. Metabolic bone disease in CKD(Renal Osteodystrophy)
- Form of bone disease that develops in CKD
- It is a complication of end-stage kidney disease
- It includes:
- Hyperparathyroid bone disease
- Osteomalacia
- Osteoporosis
- Osteosclerosis
- Adynamic bone disease
25. Clinical features: bone pain, fractures
Investigations:
● serum PTH, ALP
● DEXA scan for bones
Treatment:
● Strict control of phosphate, calcium, vitamin D, and PTH
● Cinacalcet: to decrease PTH
● Low phosphorous diet - use of phosphate binders
● Maintain high calcium
26. Dialysis
- Procedure to remove waste products and excess fluid from blood,
using a machine
- 2 types: 1. Haemodialysis
2. Peritoneal dialysis
- Haemodialysis:
- Done using a dialysis machine and a special filter called a
dialyzer
- Tube is attached to needle in arm. Blood passes from this to a
machine and then back to the body through another tube
- Done 3 times a week at hospital, each session for about 4 hours
31. Peritoneal dialysis
- Dialysing fluid(dialysate)
- Uses peritoneal membrane as filter
- Needs to be done everyday
- Can be done by machine overnight while patient is sleeping
32. Kidney transplant
- Transfer of healthy kidney from one person into the body of a person
with a poorly functioning kidney
- Need only 1 kidney to survive
- Ideally donor should be a close relative
- Major surgery
33. References:
● Archith Boloor, Ramadas Nayak - Medicine Prep
Manual for Undergraduates
Questions:
salman.s.ansari92@gmail.com
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