The document provides an overview of kidney diseases including chronic and acute renal failure, their signs and symptoms, stages, causes, types, diagnosis, and treatment options. It discusses chronic kidney disease in detail and covers end stage renal failure, dialysis, renal transplantation in Pakistan. Several specialized kidney centers in Pakistan are also mentioned that provide treatment for renal diseases including transplantation.

1. PREPARED BY : IRSA IKHLAQ
DEPARTMENT OF ZOOLOGY, SIALKOT

2. TOPIC :
KIDNEY DISEASES

3. • PRESENTATION OUTLINE
 Introduction to Kidney Diseases
 Renal Failure
 Chronic Renal Failure
 Signs & Symptoms ,Stages & Causes
 Types
 Acute Renal Failure
 Phases, Symptoms & Causes, Types
 Diagnosis, Complications & Prevention
 Kidney Failure Treatment & Home
Remedies
 End Stage Renal Failure
 Symptoms, Diagnosis & Risk factors &
Effects & Dialysis
 Renel Transplantation in Pakistan
 Renal Transplantation & Vascular Access
for Hemodialysis
 Specialized Kidney and Urology Centers
in Pakistan
 References

4. • INTRODUCTION TO KIDNEY DISEASES
 Diseases of the kidneys are among the most important causes of death and disability
throughout the world.In 2009, more than 26 million adults in the United States were
estimated to have chronic kidney disease,more millions of people have acute renal
failure or less severe forms of kidney dysfunction.
 Severe kidney diseases can be divided into two main categories
 Acute renal failure, in which the kidneys abruptly stop working entirely or almost
entirely but may eventually recover nearly normal function.
 Chronic renal failure, in which there is progressive loss of function of more and
more nephrons that gradually decreases overall kidney function

5. • RENAL FAILURE
 The term renal failure denotes inability of the kidneys to perform excretory function
leading to retention of nitrogenous waste products from the blood.
 Acute and chronic renal failure are the two kinds of kidney failure.
 End-stage renal disease (ESRD)
 When a patient needs renal replacement therapy, the condition is called end-stage
renal disease (ESRD).

6. • CHRONIC RENEL FAILURE
 Chronic kidney disease is a slow and gradually progressive disease that causes kidney
dysfunction. However, if one kidney stops functioning correctly, the other can carry out
normal functions.
 Signs and Symptoms
 Hypertension, or high blood pressure, Anemia
 Edema, Fatigue (tiredness), Decreased urine output
 Blood in urine, Dark urine, in some cases
 Decreased mental alertness when the condition is severe
 Loss of appetite
 Persistent itchy skin when the disease is severe
 More frequent urination, especially at night, in some cases

7. • STAGES
 Stage 1: The GFR rate is higher than 90 milliliters per minute (ml/min) per 1.73
m2. This is normal kidney function,
 Stage 2: The GFR rate is between 60-89 ml/min per 1.73 m2. There is mild loss of
kidney function and proteinuria.
 Stage 3: The GFR rate is between 30-59 ml/min per 1.73 m2. This is a mild to severe
loss of kidney function,
 Stage 4: GRF rate is between 15-29 ml/min per 1.73 m2, regardless of whether there is
evidence of kidney disease.
 Stage 5: GFR rate is 15 ml/min per 1.73 m2. Renal failure has occurred. A person will
require dialysis treatment or a kidney transplant to survive.

8. • STAGES OF CHRONIC KIDNEY FAILURE

9. CAUSES OF CKD
 Diabetes mellitus type 2 (30% to 50%)
 Diabetes mellitus type 1 (3.9%)
 Hypertension (27.2%)
 Primary glomerulonephritis (8.2%)
 Chronic Tubulointerstitial nephritis (3.6%)
 Hereditary or cystic diseases (3.1%)
 Secondary glomerulonephritis or vasculitis (2.1%)
 Plasma cell dyscrasias or neoplasm (2.1%)
 Sickle Cell Nephropathy (SCN) which accounts for less than 1% of ESRD patients in
the United States.

10. • TYPES OF CKD
 Pre-renal Disease
 Intrinsic Renal Vascular Disease
 Intrinsic Glomerular Disease (Nephritic or Nephrotic)
 Intrinsic Tubular and Interstitial Disease
 Post-renal (Obstructive Nephropathy)

11. • ACUTE KIDNEY FAILURE
 Acute kidney failure is when your kidneys stop working suddenly. Doctors
sometimes call it acute renal failure.
 Phases of Acute renal Failure
 Onset phase: Kidney injury occurs.
 Oliguric (anuric) phase: Urine output decreases from renal tubule damage.
 Diuretic phase: The kidneys try to heal and urine output increases, but tubule
scarring and damage occur.
 Recovery phase: Tubular edema resolves and renal function improves

12. SYMPTOMS AND CAUSES OF ACUTE RENEL
FAILURE
 Symptoms
 Peeing less than normal, Swelling in your legs, ankles, and feet, Feeling drowsy or very tired,
Shortness of breath, Itching, Joint pain, swelling, Loss of appetite, Confusion, Throwing up or
feeling like you’re going to, Chest pain or pressure, Muscle twitching, Seizures or coma ,
Stomach and back pain, Fever, Rash, Nosebleed.
 Causes
 An infection, Liver failure, Medications, Blood pressure medications, Heart failure,
serious burns or dehydration, Blood or fluid loss, you have a condition that’s blocking
urine from leaving your kidneys.
 Medications that can directly damage kidneys, including NSAIDs like ibuprofen and
naproxen, chemotherapy, and antibiotics Glomerulonephritis.

13. • ACUTE RENEL FAILURE

14. TYPES OF ACUTE RENEL FAILURE
 Pre‐renal
 Intrinsic:
 Post‐renal
 Acute Kidney Failure Diagnosis
 Blood tests:
 Urine tests:
 Urine output measurement
 Kidney biopsy (renal biopsy)
 Imaging tests

15. • ACUTE KIDNEY FAILURE COMPLICATIONS
 Fluid buildup, Chest pain
 Acidic blood (metabolic acidosis), Muscle weakness
 Permanent kidney damage, Death
 Kidney Failure Treatment and Home Remedies:
 Diet, Medications
 Dialysis
 End-stage renal failure:
 End stage of renal failure also known as end-stage renal disease (ESRD), is the final,
permanent stage of chronic kidney disease, where kidney function has declined to the
point that the kidneys can no longer function on their own

16. • SYMPTOMS
 Fatigue, drowsiness, decrease in urination or inability to urinate, dry skin, itchy skin,
headache, weight loss, nausea, bone pain, skin and nail changes and easy bruising.
 Diagnosis of ESRD: Doctors can diagnose the disease with blood tests, urine tests,
kidney ultrasound, kidney biopsy, and CT scan. According to the National Center for
Chronic Disease Prevention and Health Promotion, about 30 million people, or 15% of
adults, in the U.S. are estimated to have chronic kidney disease
 Effects:
 Anemia in Chronic Kidney Disease (CKD)
 Uremia

17. TREATMENTS
 Shock Wave Lithotripsy
 URS
 PNCL
 Dialysis:
 The mechanism of hemodialysis
 The mechanism of peritoneal dialysis
 Basic principle involve in dialysis

18. • HEMODIALYSIS & PERITONEAL DIALYSIS

19. • RENALTRANSPLANTATION IN PAKISTAN
 In 1979 in Rawalpindi at Armed Forces Institute of Urology (AFIU)
 ‘The Transplantation of Human Tissues and Organs Ordinance 2007’
 Now, there are approximately 18-19 centres in the country in public and private
sectors where renal transplantation is being performed. The largest public sector
centre for renal transplantation is Sindh Institute of Urology and Transplantation
(SIUT) founded by Prof. S. A. H Rizvi in Karachi, where more than 6200 renal
transplants have been performed after November 1986 inclusive of four cadaveric
kidney transplants harvested locally from Pakistan.

20. • RENAL TRANSPLANTAND VASCULAR ACCESS FOR
HEMODIALYSIS IN PAKISTAN
 A total of 6,202 renal transplants have been done in S.I.U.T since 1986.
 In Pakistan, renal transplantation is done by urologists in collaboration
with nephrology units that are attached with Urology units. Therefore, it
is important to train our urologists in renal transplant programmes as a
part of fellowship or masters, so that they can deal with surgical
complications of renal transplantation, if needed.
 we can see in the future is an increase in transplant activity in Pakistan
with the use of Laparoscopic donor nephrectomy in live related
programmes and deceased organ donation programmes yet to take off.

21. SPECIALIZED KIDNEY AND UROLOGY CENTRES
IN PAKISTAN
 Sindh Institute of Urology and Transplantation (SIUT),.
 S.I.U.T Sukkur, a satellite center of S.I.U.T, Karachi, was established in 2009.
 Balochistan Institute of Nehro-Urology, Quetta with 13 – 14 Urologists was established in the year 2015
 Institute of Kidney Diseases (IKDC), Peshawar was established in 2007 under the leadership of Prof. Nasir
Orakzai
 Armed Forces Institute of Urology (A.F.I.U), Rawalpindi: Provides Urology, nephrology & transplantation
facilities.
 Pakistan Kidney and Liver Institute (P.K.L.I), Lahore was established by Government of Punjab
 Institute of Kidney Diseases, Multan
 Rawalpindi Institute of Urology and Transplantation (R.I.U.T): yet to be started in the near future.
 Tayab Urudgan Hospital (Urology+Nephrology), Muzaffar Garh
 Benazir Institute of Urology and transplantation, Nawabshah, Sindh.

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