A 62-year-old male presented with weakness, fatigue, shortness of breath, decreased urine output, and leg swelling. His medical history included hypertension, diabetes, and dyslipidemia. Lab tests showed elevated creatinine, BUN, and potassium levels and low albumin and hemoglobin. He was diagnosed with acute kidney injury likely due to complications of his medical conditions including hypertension and diabetes. The seminar discussed the anatomy and physiology of the kidneys, causes of acute and chronic kidney disease, clinical presentation of kidney failure, diagnosis, and management strategies.

2. RENAL
FAILURE
ROLL NO :- 1 -
10

3. OBJECTIVES OF THE SEMINAR
Anatomy and physiology of kidney
Biochemical aspects of kidney
The prevalence, risk factors, epidemiology of kidney of
kidney diseases
Etiology and etiological agents causing kidney damage
Pathology of renal failure
Pharmacotherapy & management of renal failure

5. Clinical Case

6. CLINICAL CASE
Sajid Aalam
Roll No : 01

7. CLINICAL CASE
Chief Complaint: A 62-year-old male
presented to the emergency department with
complaints of increasing weakness, fatigue,
and shortness of breath for the past week.
He reported a decreased urine output and
swelling of his legs

8. On examination: The patient appeared pale
and visibly fatigued. Blood pressure was
170/100 mmHg, and heart rate was 90 beats
per minute. The abdomen was distended, and
there was bilateral pitting edema in the lower
extremities. Heart sounds were regular with no
murmurs.

9. Past History: The patient had a past medical
history significant for hypertension, type 2
diabetes mellitus, and dyslipidemia. He also
had a history of heavy alcohol consumption,
smoking, and a sedentary lifestyle

10. Lab Findings:
Blood tests show:
1. Serum Creatinine = 9.5 mg/dL
2. Blood Urea Nitrogen = 90 mg/dL
3. Potassium = 6.5 mmol/L
4. Serum Albumin = 2.5 g/dL
5. Hemoglobin = 9 g/dL
Urine output = 50 ml/24 hours.

11. Anatomy

12. ANATOMY OF KIDNEY
Sameer Adhikari
Roll No : 5

13. Features & Location
Bean shaped
Posterior abdominal wall
11cm long , 6 cm broad and 3 cm thick
T12-L3
Right Kidney is lower than Left Kidney
Occupies Epigastric, hypochondrium,
lumbar and umbilical regions

14. External Features
Poles
 Upper
 Lower
Surfaces
 Anterior
 Posterior
Borders
 Lateral
 Medial
Hilum

15. Covering Of Kidney
 Paranephric fat
 Renal fascia
 Perinephric fat (adipose
capsule)
 True capsule of kidney

16. Kidney – Coronal Section
Outer Cortex
Inner Medulla
• Renal pyramid
• Renal papillae
• Renal column
• Minor calyx
• Major calyx

17. Renal Sinus
• Renal vein
• Renal artery
• Renal pelvis
Found the missing part

18. Left kidney:
i. Suprarenal area
ii. Splenic area
iii. Gastric area
iv. Pancreatic area
v. Jejunal area
vi. Colic area
Anterior Relation Of Kidney
Right kidney:
i.Suprarenal area
ii. Duodenal
iii. Hepatic area
iv. Colic area
v. Jejunal area

19. NEPHRON- Functional Unit
Glomerulus
Bowman’s Capsule
Proximal Convulated Tubules
Loop of Henle
Distal Convulated Tubules
Collecting Ducts

27. Arterial Supply
Renal artery- fromAA
Divides into anterior and
posterior trunks

28. Anterior trunk -
 Apical
 Upper and anterior (anterosupeior)
 Middle and anterior (anteroinferior)
 Inferior
Posterior Trunk
 Behind the renal pelvis
 Continue as posterior segmental artery

29. Vascular Segments
Apical
Caudal
Anterior Superior
Anterior Inferior
Posterior

31. Venous drainage

32. Lymphatic drainage
Lateral aortic lymph nodes
Nerve supply:
Renal plexus- coeliac plexus
Sympathetic fibers- T10- L1
 Parasympathetic- Vagus Nerve

34. Physiology

35. PHYSIOLOGY OF KIDNEY
PRABEJ ALAM
Roll No : 06

36. NEPHRON

38. URINE FORMATION

39. Glomerular Filtration Rate (GFR)
 Rate of blood filtered
100-120 /ml /min /1.73 m2
Less in female
Less with ageing

40. FUNCTIONS OF KIDNEY
Excretory function
Homeostatic function
Endocrine function
Metabolic function

41. Excretory Function
By forming urine, the kidneys help excrete waste
substances that have no useful functions in the body
Some wastes excreted in urine
Ammonia and Urea
Bilirubin
Creatinine
Uric acid

42. Homeostatic Function
 Corrects any acid base
imbalance by :
 Removing excess
acid ( hydrogen ion)
or bases
(bicarbonates) in the
urine and
 Restoring the
bicarbonate
concentration in the
blood to normal

43. Regulation of blood pressure – RAAS System

44. Regulation of Osmolarity
and blood volume
 osmoreceptors signalling
pathway
Water deficit
Extracellular osmolarity
ADH secretion
(posterior pituitary)
Plasma ADH
H20 permeability in distal
tubule, collecting ducts
H2O reabsorption
H2O excreted
Osmoreceptors

45. Endocrine Function
Two hormones :
 Erythropoietin (EPO)
 Calcitriol (1,25[OH]2 Vitamin D3

46. Erythropoietin
 Acts on bone marrow to increase the production of RBC
 Stimuli such as bleeding or moving to high altitudes(where oxygen
is scarer) trigger the release of EPO
 Without a source of EPO, people with failing kidneys; dialysis
suffer from anaemia

47. Calcitriol
 It acts on :
 Cells of intestine to promote the absorption of calcium and phosphate
from food
 Bone to mobilize calcium from the bone to the blood

48. Metabolic Function
 Regulation of blood glucose level
 Gluconeogenesis - kidneys can use the amino acid glutamine in
gluconeogenesis, the synthesis of new glucose molecule
 They can then release glucose into the blood to help maintain a normal
blood glucose level

49. RENAL FUNCTION TEST
 Glomerular Function Test
 Tubular Function Test
 Analysis Of Blood / Serum
 Urine Examination

50. Glomerular Function Test
 Measures GFR
 GFR = Amount of blood filtered per minute by kidney
 It includes
 Creatinine Clearance =120-140 ml/min
 Urea Clearance = 75 ml/min

51. Tubular Function Test
 Measures functions of tubules to concentrate urine
 It includes
 Urine Concentration Test
Normal urine specific gravity = 1.020
 Osmolality Test
Normal osmolality = 500 – 1200 milliosmoles / kg

52. Analysis Of Blood / Serum
Estimates the clearance of substances from serum
Substance measured are
 Serum creatinine = 0.7 – 1.3 mg/dl ( male)
= 0.5 – 1.1 mg/dl ( female )
 Blood Urea = 10 – 40 mg/dl
 Serum Cystatin c = 0.8 – 1.2 mg/dl

53. Urine Examination

54. Acute Kidney
Injury

55. ACUTE KIDNEY INJURY
(AKI)
ASHISH BARAL
Roll No : 08

56.  Sudden impairment of kidney function
 Occurring over hours to days
 Resulting in the retention of nitrogenous and other
waste products
DEFINITION

57. EPIDEMIOLOGY
 5–7% of acute care hospital admissions
 30% of admissions in ICU
 Major medical issue of developing countries
 worldwide -13.3 million cases
- 1.7 million deaths/year
 etiologies - region specific
- species of snakes, spiders, bees
- malaria, leptospirosis

58. GLOBAL INCIDENCE
South
America
31%
Southeast
Asia 31%
South
Asia
7.5%

59. INCIDENCE IN NEPAL
Major health issue-rural areas
As per the WHO :
• 10% of population - suffering from renal problems
• 30,000 - final stage of kidney failure and
• 3,000 - suffer from kidney failure every year

60. CAUSES OF AKI
Pre renal
Intrinsic renal
Post renal

61. Sudden and severe reduction in blood flow
to the kidney
• Blood loss
• Dehydration
• Heart failure
• Sepsis
• Vascular occlusion
Pre renal
Direct injury to the kidney
• Acute tubular necrosis
• Acute interstitial nephritis
• Glomerular nephritis
Intrinsic renal
Sudden obstruction to flow of urine
• Kidney stones
• Bladder injury/tumor
• Enlarged prostate
• Urethral stricture
Post renal

63. RISK FACTORS
MODIFIABLE NON-MODIFIABLE
Hypercholesterolemia Age (above 65)
Hypertension Kidney disease
Hypoalbuminemia Congestive heart failure
Dehydration Diabetes mellitus
Sepsis AIDS
Rhabdomyolysis Renal artery stenosis
Nephrotoxic drugs use Peripheral vascular disease

64. Pathogenesis
Clinical Features

65. PATHOGENESIS &
CLINICAL FEATURES OF AKI
Keshav Acharya
Roll No : 03

66. PATHOGENESIS
Pre Renal
Renal
Post Renal

67. Pre renal

68. Renal
 Rapidly Progressive Glomerulonephritis (RPGN)
 Acute Tubular Necrosis(ATN)
 Acute Interstitial Nephritis e.g. Infections, drugs , toxins,
sarcoidosis, amyloidosis

69. Post Renal

70. CLINICAL PRESENTATION
Clinical presentation With Specific complications
 Hypovolemia
 Hypervolemia / Fluid overload
 Hyperkalemia
 Hypokalemia
 Uremia
Clinical Presentation In General

71. Clinical Presentation In General
Rash
Fever
Eosinophilia
Anuria
Hematuria
Foamy urine

72. Clinical Presentation With Hypovolemia
Symptoms:
 Dizziness
 Fatigue
 Confusion
 Decreased urine output
Physical examination findings:
 Hypotension tachycardia
 Poor skin turgor
 Dry mucous membrane

73. Clinical Presentation With Hypervolemia
 Symptoms:
 Dyspnea
 Abdominal distension
 Swelling in the extremities
 Physical examination findings:
 Edema
 Crackles
 Ascites
 Pleural effusion
 Elevated JVP
 S3 heart sound

74. Clinical Presentation With Hyperkalemia
Symptoms
 Severe muscle weakness
 Paralysis
 Cardiac conduction abnormalities
• RBBB
• LBBB
• Advanced atrioventricular block
• Arrythmias

75. Clinical Presentation With Hypokalemia
Symptoms
 Muscle cramps
 Ileus
Physical examination findings
 Usually normal
 May have muscle weakness with rhabdomyolysis, if severe
 ECG changes

76. Clinical Presentation With Uremia
Symptoms
 GI:
 Anorexia
 Nausea/vomiting
 Dysgeusia
 Neurologic:
 Confusion
 Drowsiness
 Encephalopathy
 Seizure
 Coma
Physical examination findings
 Asterixis
 Myoclonus
 Pericarditis
 pericardial effusion
Myoclonus

77. DIAGNOSIS,
MANAGEMENT &
COMPLICATIONS

78. DIAGNOSIS, MANAGEMENT
& COMPLICATIONS of AKI
Binayak Baral
Roll No : 09

79. DIAGNOSTIC EVALUATION
Urine Test
Blood Test
Imaging Techniques
Kidney Biopsy

80. Urine Tests
Urine output = <200 ml/6 hours
Hematuria
Proteinuria
↓ specific gravity.
Hyponatremia (below 20 mEq/L) in urine

81. BUN = Elevated
Serum creatinine increases (>0.3mg/dl in 48hrs)
Hyperkalemia
↓ bicarbonate level
↓ hematocrit and Hemoglobin
Low blood pH
Electrolyte level imbalance
Complete blood count for infections
Blood Tests

82. Imaging Tests
Ultrasonography
KUB radiography
MRI
Pyelography
Computerized
Tomography(CT)
Pyelography

83. USG of kidney showing Hydronephrosis

84. Kidneys, Ureters, Bladder
(KUB) radiograph showing
calculus

85. Kidney Biopsy
 Kidney biopsy is done as a last resort of diagnosis of Acute renal
failure
Acute tubular necrosis

86. MANAGEMENT
Treatment for acute kidney failure varies according to
underlying cause
Goal of treatment is to :
 Correct or treat the cause of kidney failure
 Restore kidney function and
 Prevent fluid and waste from building up

87. Pharmacologic Therapy
Optimization of systemic and renal hemodynamics
 Antihypertensive
 Diuretics
Elimination of nephrotoxic agents(NSAIDs,
aminoglycosides)
 Diuretics
 Hyperkalemia
 Discontinuation of potassium-sparing diuretics, ACE
inhibitors, ARBs, NSAIDs
 Loop diuretics to promote urinary potassium loss

88. Metabolic acidosis
 Sodium bicarbonate (if pH <7.2 , serum bicarbonate >15 mmol/L)
Infections
 Antibiotics erythromycin, azithromycin, chloramphenicol
Dialysis to remove toxins from the blood

89. COMPLICATION
Fluid buildup in lungs
Muscle weakness, paralysis
Cardiac complications
Infections
Acidosis
Permanent kidney damage
AKI can lead to loss of kidney function and ,ultimately death

90. CHRONIC KIDNEY
DISEASES (CKD)

91. CHRONIC KIDNEY DISEASES
(CKD)
Bishal Banmala
Roll No : 07

92. DEFINITION
Subtle ↓ kidney function
Develops over a minimum 3 months
Renal function are compromised
↓ GFR, ↓ Renal output

93. EPIDEMIOLOGY
Public health problem worldwide
Incidence and prevalence increasing
Prevalent in older adults, males, americans
Us prevalence -15%
Europe prevalence 3% to 17%

94. GLOBAL INCIDENCE

95. RISK FACTORS
Advanced age
Family history
Systemic inflammation
Dyslipidemia

96. ETIOLOGY
Initiation
 Diabetes
 Hypertension
 Glomerulonephritis
Progression
 Hyperglycemia
 Proteinuria
 Obesity

97. Lumen of renal artery decreased,
less oxygen supply
Glomerulus sclerosis/Chronic kidney
disease
Mesangial Cells -Mesoangioblasts -
Extracellular Matrix
TGF-B1 release
Ischemia , immune cell activated

98. Glomerulus sclerosis gross Glomerulus sclerosis Histology

99. Non enzymatic glycation
occurs in efferent
arteriole
Stiffness and narrowing of
efferent arteriole
Glomerulus sclerosis

100. PATHOGENESIS
& STAGES

101. PATHOGENESIS & STAGES
of CKD
Prashant Basel
Roll No : 10

102. Initiating factor
Hypertension, diabetes, toxin exposure,
immune complex deposition, autoimmune
disease etc.
Decrease number & function of
nephrons
PATHOGENESIS
 Aging = nephron number

104. STAGES OF CKD

106. Stage 5 CKD: End Stage Renal Disease (ESRD)
Inability of kidney to function completely
Accumulates toxin, fluids, electrolyte
Disturb water, electrolyte homeostasis

107. CLINICAL FEATURES
&
DIAGNOSIS

108. CLINICAL FEATURES &
DIAGNOSIS OF CKD
Anurag Acharya
Roll No : 02

109. CLINICAL FEATURES
Azotemia Followed By Uremia
Electrolyte Imbalance
Hematopoietic System
Gastrointestinal Tract
Urinary System
CVS

110. Azotemia Followed By Uremia
 General symptoms
 Nausea
 Loss of appetite
 Burning urination
 CNS
 Encephalopathy
 Coma and even death
 CVS
 Pericarditis
 Bleeding – platelets don’t stick, and no clot is formed.
 Skin
 Uremic Frost

111. Electrolyte Imbalance
 Potassium imbalance
Hyperkalemia  Cardiac arrhythmia
 Calcium imbalance
less activated Vitamin D  Hypocalcemia  PTH hormones
act Renal osteodystrophy
 Sodium imbalance
sodium & water retained  HTN, Edema

112. Hematopoietic System
Impaired Erythropoiesis
 Due to less erythropoietin
 Lower production of RBC
 Finally, anemia

113. Gastrointestinal Tract
Mucosal ulcerations
GI bleeding
Stomatitis

114. Urinary System
Polyuria = Inability of kidney to concentrate urine
Oliguria
Anuria

115. CVS
 Low fluid filtered  Renin  HTN
HTN CKD

116. DIAGNOSIS OF CKD
History
 ≥ 3 months of Kidney injury
GFR
 Normal= 125ml/min
 Can be estimated by : (i) Creatinine test
(ii) Cystatin C test

118. Albuminuria

119. Polycystic Kidney Disease
Renal Ultrasonography

120. Renal Biopsy

121. 1. Complete Blood Count
RBC  Decreased  Anemia (normocytic,
normochromic)
2. Parathyroid level  Increased
3. Basic Metabolic Panel(BMP) test
K+ and Na+  Increased
4. Arterial Blood Gas(ABG) Analysis
H+  Increased (metabolic acidosis)
5. Lipid panel test
Triglyceride and LDL  Increased
Other Lab Investigations

122. MANAGEMENT

123. MANAGEMENT OF CKD
Laxman Acharya
Roll No : 04

124. THERAPEUTIC MANAGEMENT
Managing complications
 Disorders Of Calcium And Phosphate Metabolism
 Cardiovascular Abnormalities
 Hematological Abnormalities
 Neuromuscular Abnormalities
 Medication Dose Adjustment
 Renal Replacement Therapy

125. Disorders Of Calcium And Phosphate Metabolism
low phosphate diet
Use of phosphate binding agents
Use of calcitriol

126. Cardiovascular Abnormalities
Management of hypertension
 Salt restrictions
 Antihypertensive agents like ARBs ACE inhibitors

127. Hematological Abnormalities
 Anemia
 Recombinant human Erythropoietin Stimulating Agents
therapy

128. Neuromuscular Abnormalities
 Peripheral neuropathy is an indication to start Renal Replacement
therapy

129. Medication Dose Adjustment
 Loading dose not affected by CKD.
 Maintenance doses need to be adjusted

130. Renal Replacement Therapy
 why is it required ?
 What are the indications for
initiation of Renal
Replacement Therapy ?
 Treatment options for
patients with ESRD ?
after renal
replacement

131. DIALYSIS
Hemodialysis
Peritoneal dialysis

132. TRANSPLANTATION OF KIDNEY
 Treatment of choice with ESRD
 Types
 Living donor kidney transplant
 Deceased donor kidney transplant
 Transplant rejection ?

133. SUMMARY

134. SUMMARY
&
CLINICAL CASE DIAGNOSIS
Sajid Aalam
Roll No : 01

135. So did you all understand
renal failure ??
or

136. SUMMARY
Several etiological factors
Acute renal injury Chronic renal disease
Resolve
End stage renal disease
Death
Normal kidneys

137. THE CASE…
Chief Complaint : A 62-year-old male presented to the emergency
department with complaints of increasing weakness, fatigue, and shortness
of breath for the past week. He reported a decreased urine output and
swelling of his legs.
 On examination: the patient appeared pale and visibly fatigued. Blood
pressure was 170/100 mmHg, and heart rate was 90 beats per minute. The
abdomen was distended, and there was bilateral pitting edema in the
lower extremities. Heart sounds were regular with no murmurs.
Past History : The patient had a past medical history significant for
hypertension, type 2 diabetes mellitus, and dyslipidemia. He also reported
a history of heavy alcohol consumption, smoking, and a sedentary
lifestyle.

138. Blood tests show:
1. Serum Creatinine = 9.5 mg/dL
2. Blood Urea Nitrogen = 90 mg/dL
3. Potassium = 6.5 mmol/L
4. Serum Albumin = 2.5 g/dL
5. Hemoglobin = 9 g/dL
Urine output = 50 ml/24 hours
Laboratory Findings :

139. DIAGNOSIS ?

140. Q & A

141. Failed FNT is better than a failed kidney
but I know we can pass both
so
study enough & drink enough!
HAVE A GOOD DAY!
water